Why is the clinical response to cardiac resynchronization better in LBBB patients?

Result code in IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00216208%3A11150%2F20%3A10418208" target="_blank" >RIV/00216208:11150/20:10418208 - isvavai.cz</a>

Alternative codes found

RIV/00179906:_____/20:10418208

Result on the web

<a href="https://verso.is.cuni.cz/pub/verso.fpl?fname=obd_publikace_handle&handle=g7kmATpgrV" target="_blank" >https://verso.is.cuni.cz/pub/verso.fpl?fname=obd_publikace_handle&handle=g7kmATpgrV</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1002/ehf2.12893" target="_blank" >10.1002/ehf2.12893</a>

Result language

angličtina

Original language name

Why is the clinical response to cardiac resynchronization better in LBBB patients?

Original language description

Aims: The improved clinical response in patients with left bundle branch block (LBBB) over LBBB-free patients treated with cardiac resynchronization therapy with a defibrillator (CRT-D) is commonly attributed to an LBBB abnormality. We aimed to find an alternative explanation. Methods and results: We analysed an immediate effect of selecting the LBBB group of patients in a cohort of 63 non-ischaemic cardiomyopathy (non-ICM) and 83 ischaemic cardiomyopathy (ICM) patients treated with CRT-D; 75% of non-ICM and 51% of ICM patients had an LBBB abnormality on the electrocardiogram, with a significant difference (P = 0.0032 by chi(2)). As a result of this difference, the proportion of non-ICM patients increased from 43% in the primary cohort to 53% in LBBB selection and decreased to 28% in non-LBBB group. By nonparametric survival analysis, the hazard ratio in non-ICM patients in the LBBB selection decreased from 0.48 (P = 0.0488) to 0.36 (P = 0.0251) and increased in the non-LBBB group to 0.75 (P = 0.6496). Any comparison of LBBB and non-LBBB groups must compare sets with a significantly altered proportion of patients of different aetiologies. Most publications on LBBB patients are erroneous because they compare LBBB with non-LBBB groups, not taking into account that the groups have been substantially changed by the selection process. Conclusions: The declared outcome of the LBBB groups reflects inevitably the survival outcome of their non-ICM patients and not the intended outcome of patients with LBBB. CRT-D in patients with different aetiologies of cardiomyopathy calls for separate evaluation.

Czech name

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Czech description

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Type

J_imp - Article in a specialist periodical, which is included in the Web of Science database

CEP classification

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OECD FORD branch

30201 - Cardiac and Cardiovascular systems

Project

—

Continuities

I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Publication year

2020

Confidentiality

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Name of the periodical

ESC Heart Failure [online]

ISSN

2055-5822

e-ISSN

—

Volume of the periodical

7

Issue of the periodical within the volume

6

Country of publishing house

GB - UNITED KINGDOM

Number of pages

9

Pages from-to

3667-3675

UT code for WoS article

000570189400001

EID of the result in the Scopus database

2-s2.0-85091034964