Therefore, it may be helpful to build a specific and practical predictive model that incorporates variables from a real-word clinical database of CRT recipients without intrinsic LBBB. However, meta-analysis suggested that HFrEF patients without LBBB morphology do not have improvement of mortality or HF hospitalization rates after CRT ( 19). The REVERSE (REsynchronization reVErses Remodeling in Systolic Left vEntricular Dysfunction) trial showed that some patients with HFrEF and RBBB derived significant improvement from CRT ( 18). Some post-hoc analyses of landmark RCTs have shown a wide range of CRT response for HFrEF patients without intrinsic LBBB ( 1, 2, 16– 18). These patients usually refers to right bundle-branch block (RBBB), intraventricular conduction delay (IVCD), and predominantly ventricular paced rhythm with non-physiologic depolarization pattern ( 14, 15). Conversely, some patients without intrinsic LBBB may have HF improvement ( 12, 13). However, nearly 20% to 50% of CRT recipients do not have a good outcome after CRT ( 10, 11). The current American College of Cardiology/American Heart Association/Heart Rhythm Society (ACC/AHA/HRS) and European Society of Cardiology guidelines provide the strongest recommendations for the use of CRT in patients with typical LBBB pattern and wide QRS, who benefit most from CRT ( 7– 9). Randomized clinical trials (RCTs) have shown CRT to be beneficial in improving heart failure (HF) symptoms, left ventricular ejection fraction (LVEF), quality of life, and survival ( 1– 6).Īside from QRS duration, intrinsic LBBB is generally considered an important determinant of CRT response. The model had an area under the receiver operating characteristic curve of 0.71 (95% CI, 0.63–0.78).Ĭonclusions: Among patients without intrinsic LBBB undergoing CRT, upgrade from pacemaker and AVN ablation were favorable factors in achieving CRT response and better long-term outcomes.Ĭardiac resynchronization therapy (CRT) is an effective therapy for patients with heart failure with reduced ejection fraction (HFrEF), left bundle-branch block (LBBB), and/or a wide QRS complex. Eight clinical variables were automatically selected to build a nomogram model and predict CRT response. Patients undergoing AVN ablation had a lower mortality rate than those without ablation. Patients with right bundle-branch block had a low response rate (39.2%). Patients with CRT upgrade from pacemaker or atrioventricular node (AVN) ablation had a greater odds of CRT response than those patients who had new implant, or who did not undergo AVN ablation. Six months after CRT, 47.8% of patients demonstrated improvement of left ventricular ejection fraction by more than 5%. Results: 761 patients without intrinsic LBBB were identified. Results were used to develop the nomogram model. Logistic regression and Cox proportional hazards regression analysis were performed for the odds of response to CRT and risk of death, respectively. Methods: We searched electronic health records for patients without intrinsic LBBB who underwent CRT at Mayo Clinic. Objective: We sought to develop a nomogram model to predict response to CRT in patients without intrinsic LBBB. 5Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United Statesīackground: Response rates for cardiac resynchronization therapy (CRT) in patients without intrinsic left bundle-branch block (LBBB) morphology are poor.4Department of Cardiology and Atrial Fibrillation Center, The First Affiliated Hospital of Zhejiang University, Hangzhou, China.3Department of Cardiology, Sir Run Run Shaw Hospital, The First Affiliated Hospital of Zhejiang University, Hangzhou, China.2Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.1Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.Deshmukh 5 Yue-Hui Yin 1 Yong-Mei Cha 5 * Pei-Lin Xiao 1 Cheng Cai 2 Pei Zhang 3 Jie Han 4 Siva K.
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