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Impact of non-typical LBBB on CRT response
Session:
Posters (Sessão 3 - Écran 1) - Resincronização cardíaca
Speaker:
Miguel Azaredo Raposo
Congress:
CPC 2023
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Pósters Electrónicos
FP Number:
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Authors:
Miguel Azaredo Raposo; Joana Brito; Ana Abrantes; Beatriz Garcia; Beatriz Silva; Margarida Martins; Catarina Gregório; Diogo Ferreira; Pedro Silverio António; Sara Couto Pereira; Inês Ricardo; Fausto J.Pinto; João de Sousa; Pedro Marques
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><strong><span style="font-size:10.0pt">Introduction:</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><span style="font-size:10.0pt">Cardiac resynchronization therapy (CRT) benefits have been established in patients with heart failure and reduced left ventricular ejection fraction (HFrEF) who have a broad QRS and remain symptomatic despite optimized medical therapy. Responders typically are female, with LBBB and broader QRS. It remains uncertain to what extent do patients with non-LBBB QRS complex morphology respond to CRT and also if there are differences among various types of intraventricular conduction delays.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><strong><span style="font-size:10.0pt">Purpose: </span></strong><span style="font-size:10.0pt">To evaluate the impact of non-typical left bundle branch block (LBBB) on reverser remodeling and clinical events.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><strong><span style="font-size:10.0pt">Methods: </span></strong><span style="font-size:10.0pt">Single center, observational, retrospective study including patients (pts) who implanted CRT in the context of HFrEF, from 2015 to 2020. Evaluation of QRS morphology analysis was conducted. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><span style="font-size:10.0pt">CRT response was defined by a reduction of LVESV </span><span style="font-size:10.0pt">≥</span><span style="font-size:10.0pt">15% or an increase in LVEF </span><span style="font-size:10.0pt">≥</span><span style="font-size:10.0pt">10%. Predictors of CRT response were evaluated with Chi-square and Mann-Whitney analysis. Impact on reverse remodeling and clinical outcomes was performed with Kaplan-Meyer analysis.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><strong><span style="font-size:10.0pt">Results: </span></strong><span style="font-size:10.0pt">A total of 361 pts were included for analysis, of which 184 had non-typical LBBB. Pts had a mean age of 71</span><span style="font-size:10.0pt">±</span><span style="font-size:10.0pt">9years old, the majority of pts were female (61%), and almost half were ischemic (47.8%). </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><span style="font-size:10.0pt">EGC evaluation prior to CRT implantation, revealed an atypical LBBB in 83 (45.1%) pts, typical RBBB in 23 (12.5%) pts, atypical RBBB 9 (</span><span style="font-size:10.0pt">4.9%) pts and <span style="background-color:white"><span style="color:black">nonspecific intraventricular conduction delay</span></span></span><span style="font-size:10.0pt"> in 69 (37.5%) pts.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><span style="font-size:10.0pt">During a mean time of follow-up of 2.9 </span><span style="font-size:10.0pt">±</span><span style="font-size:10.0pt">2.4years, 33 pts (18%) had hospitalizations due to HF and 68 (37%) died. In this cohort, 78 pts (42.4%) were deemed as responders, who presented a better clinical outcome when compared to non-responders (p < 0.001, HR 2.629 [95% CI 1.635-4.225].</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><span style="font-size:10.0pt">There was no difference among the four types of intraventricular conduction analyzed in respect to degree of CRT response – figure 1. Regarding clinical events during follow-up, there was once again no significant difference among the different patterns of non-typical LBBB– figure 2.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><span style="font-size:10.0pt">In this subset population we found no independent predictors of CRT response, although non-responders were significantly older than responders (72</span><span style="font-size:10.0pt">±</span><span style="font-size:10.0pt">8 vs 69</span><span style="font-size:10.0pt">±</span><span style="font-size:10.0pt">10 years-old (p=0.016).</span></span></span></p> <p style="text-align:justify"> </p> <p><strong><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion</span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">: Although pts with non-typical LBBB morphology display a lower therapy response to CRT than reported for LBBB pts, the rate of response is not negligible and represents a protective factor for clinical outcomes. Different types of intraventricular conduction delay present no difference regarding long-term prognosis or reverse remodeling.</span></span></p>
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