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Cardiac resynchronization therapy, LBBB, ECG
Background: Cardiac resynchronization therapy (CRT) is effective in reducing the risk of death and hospitalization and clinical events in systolic heart failure patients with a wide QRS. Previous retrospective studies suggest only patients with QRS prolongation due to a left bundle-branch block (LBBB) benefit from CRT.
Objective: The main purpose of this study was to assess the effect of different durations of QRS on the outcome of CRT / CRTD implantation in patients with heart failure and its subgroups.
Methods: A retrospective cohort study was conducted on 151 heart failure patients receiving CRT / CRTD treatment at Xi'an Jiaotong University's First Affiliated Hospital, from January 2016 to December 2018. The inclusion criteria were QRS duration of approximately 130, left bundle branch block (LBBB) and non-left bundle branch block (NLBBB), LVEF£35%, ischemic and non-ischemic heart disease, N.Y.H.A II-IV. The diagnostic criteria for non-ischemic heart disease include X-ray and echocardiographic tests. The findings of coronary angiography, X-ray, and echocardiography are focused on ischemic heart disease. The observation indexes were ECG's QRS duration before and 12 months after operation. Echocardiography used the Simpson biplane technology to measure the percentage of left ventricular ejection fraction. M-mode was used to measure the changes in left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDd), and left atrial size (LA). Comparison has been made of the response of IHD, NIHD, LBBB, and NLBBB groups to CRT.
Results: The QRS morphology was LBBB in 79 cases (52.31%) and NLBBB in 72 cases (47.68%). Cardiac resynchronization therapy appears to be beneficial in patients with QRSd ≥ 150 ms, compared to 130 ms ≤ QRSd ≤ 149 ms patients. The CRT response of NIHD patients was better than that of IHD patients. Both LBBB and NLBBB patients responded in 130 ms ≤ QRSd ≤ 149 ms and QRSd ≥ 150 ms. However, LVEF and LVESV of LBBB patients improved more significantly.
Conclusion: The relative benefit of CRT or CRTD therapy increased with the prolongation of the QRS duration.
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