Prognosis of CRT-treated and CRT-untreated unselected population with LBBB in Stockholm County. in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology / Europace. 2023 Jul 4;25(7):euad192. doi: 10.1093/europace/euad192.

2023
AOU Città della Salute di Torino

Tipo pubblicazione

Journal Article

Autori/Collaboratori (8)Vedi tutti...

Gatti P
Division of Cardiology, Department of Medicine, Karolinska Institutet, Norrbacka S1:02, Eugeniavägen 27-31, 171 76 Stockholm, Sweden.
Lind S
Department of Cardiology, Karolinska Universitetssjukhuset, Stockholm, Sweden.
Kristjánsdóttir I
Division of Cardiology, Department of Medicine, Karolinska Institutet, Norrbacka S1:02, Eugeniavägen 27-31, 171 76 Stockholm, Sweden.

et alii...

Abstract

AIMS: Left bundle branch block (LBBB) might be the first finding of cardiovascular diseases but also the prerequisite for cardiac resynchronization therapy (CRT) in heart failure (HF) with reduced ejection fraction (HFrEF). The prognosis for patients with LBBB and the implications of CRT in an unselected real-world setting are the focus of our study. METHODS AND RESULTS: A central electrocardiogram (ECG) database and national registers have been screened to identify patients with LBBB. Predictors of HF and the use of CRT were identified with Cox models. The hazard ratios (HRs) of death, cardiovascular death (CVD), and HF hospitalization (HFH) were estimated according to CRT use. Of 5359 patients with LBBB and QRS > 150?ms, median age 76 years, 36% were female. At the time of index ECG, 41% had a previous history of HF and 27% developed HF. Among 1053 patients with a class I indication for CRT, only 60% received CRT with a median delay of 137 days, and it was associated with a lower risk of death [HR: 0.45, 95% confidence interval (CI): 0.36-0.57], CVD (HR: 0.47, 95% CI: 0.35-0.63), and HFH (HR: 0.56, 95% CI: 0.48-0.66). The age of over 75 years and the diagnosis of dementia and chronic obstructive pulmonary disease were predictors of CRT non-use, while having a pacing/defibrillator device independently predicted CRT use. CONCLUSION: In an unselected LBBB population, CRT is underused but of great value for HF patients. Therefore, it is crucial to find ways of better implementing and understanding CRT utilization and characteristics that influence the management of our patients.

Accesso banca dati bibliografica

PMID : 37403689

DOI : 10.1093/europace/euad192

Keywords

Humans; Female; Aged; Male; Cardiac Resynchronization Therapy/methods; Bundle-Branch Block; Heart Failure/therapy; Defibrillators, Implantable; Treatment Outcome; Stroke Volume; Arrhythmias, Cardiac/therapy; Prognosis; Electrocardiography; CRT; Heart failure; LBBB;