Abe Temidayo A, Markson Favour, Friedman Daniel J, Jackson Larry R
Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Division of Cardiology, Department of Medicine, Jefferson Health-Einstein Hospital, Philadelphia, Pennsylvania, USA.
Pacing Clin Electrophysiol. 2025 Sep;48(9):973-980. doi: 10.1111/pace.70020. Epub 2025 Aug 8.
Left bundle branch block (LBBB) and right ventricular pacing (RVP) are associated with abnormal myocardial mechanics and cardiomyopathy. Consequently, chronic LBBB may increase the risk of heart failure and mortality in patients undergoing RVP.
Using the TriNetX Analytics Network database, we identified patients who underwent pacemaker implantation between January 1, 2014 and January 1, 2024. Exclusion criteria included a history of heart failure, previous cardiac devices, cardiac resynchronization therapy (CRT) during the index hospitalization, or a left ventricular ejection fraction (LVEF) of less than 50%. The primary outcome incident systolic heart failure and all-cause mortality occurring from the index hospitalization through November 2024.
Among 70,526 patients undergoing RVP implantation, 3916 (5.6%) had chronic LBBB prior to the procedure, with a median age of 75 ± 15 years. Over a median follow-up of 2.5 years, 5356 (7.6%) developed incident systolic heart failure, and 9714 (13.7%) experienced all-cause mortality. After propensity score matching, chronic LBBB was associated with a higher risk of systolic heart failure (HR: 1.39; 95% CI: 1.20-1.62) but not all-cause mortality (HR: 0.93; 95% CI: 0.83-1.06). Patients with chronic LBBB who developed systolic heart failure were more likely to present with moderately depressed LVEF and require CRT upgrades during follow-up compared to those without chronic LBBB.
Chronic LBBB was associated with a higher risk of systolic heart failure, worse left ventricular function, and greater likelihood of CRT upgrade among patients undergoing RVP.
左束支传导阻滞（LBBB）和右心室起搏（RVP）与心肌力学异常和心肌病相关。因此，慢性LBBB可能会增加接受RVP患者发生心力衰竭和死亡的风险。
利用TriNetX分析网络数据库，我们确定了在2014年1月1日至2024年1月1日期间接受起搏器植入的患者。排除标准包括心力衰竭病史、既往心脏装置、索引住院期间的心脏再同步治疗（CRT）或左心室射血分数（LVEF）低于50%。主要结局为从索引住院到2024年11月发生的收缩期心力衰竭和全因死亡率。
在70526例接受RVP植入的患者中，3916例（5.6%）在手术前患有慢性LBBB，中位年龄为75±15岁。中位随访2.5年，5356例（7.6%）发生了收缩期心力衰竭，9714例（13.7%）经历了全因死亡。倾向评分匹配后，慢性LBBB与收缩期心力衰竭风险较高相关（HR：1.39；95%CI：1.20-1.62），但与全因死亡率无关（HR：0.93；95%CI：0.83-1.06）。与无慢性LBBB的患者相比，发生收缩期心力衰竭的慢性LBBB患者更有可能出现中度降低的LVEF，并且在随访期间需要升级CRT。
慢性LBBB与接受RVP患者的收缩期心力衰竭风险较高、左心室功能较差以及CRT升级的可能性较大相关。
