Cardiac Resynchronization Defibrillator Therapy for Nonspecific Intraventricular Conduction Delay Versus Right Bundle Branch Block

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:73

Article

Kawata, Hiro^1,2  Bao, Haikun³  Curtis, Jeptha P.^3,4  Minges, Karl E.^3,4  Mitiku, Teferi¹  Birgersdotter-Green, Ulrika⁵  Feld, Gregory K.⁵  Hsu, Jonathan C.⁵ 

[1] Univ Calif Irvine, Dept Cardiol, Orange, CA 92668 USA

[2] Oregon Heart & Vasc Inst, Springfield, OR USA

[3] Yale New Haven Hosp, Ctr Outcomes Res & Evaluat, 20 York St, New Haven, CT 06504 USA

[4] Yale Sch Med, Dept Internal Med, Sect Cardiovasc Med, New Haven, CT USA

[5] Univ Calif San Diego, Dept Med, Div Cardiol, Cardiac Electrophysiol Sect, La Jolla, CA 92093 USA

关键词: cardiac resynchronization therapy defibrillator;    CRT-D;    National Cardiovascular Data Registry;    LBBB;    NCDR;    NICD;    non-left bundle branch block;    nonspecific interventricular conduction delay;    RBBB;    right bundle branch block;   

DOI  :  10.1016/j.jacc.2019.04.025

来源: Elsevier

【 摘 要 】

BACKGROUND The benefits of cardiac resynchronization therapy (CRT) in patients with non-left bundle branch block (LBBB) conduction abnormality have not been fully explored. OBJECTIVES This study sought to evaluate clinical outcomes among Medicare-aged patients with nonspecific intraventricular conduction delay (NICD) versus right bundle branch block (RBBB) in patients eligible for implantation with a CRT with defibrillator (CRT-D). METHODS Using the National Cardiovascular Data Registry implantable cardioverter-defibrillator (ICD) registry data between 2010 and 2013, the authors compared outcomes in CRT-eligible patients implanted with CRT-D versus ICD-only therapy among patients with NICD and RBBB. Also, among all CRT-D-implanted patients, the authors compared outcomes in those with NICD versus RBBB. Survival curves and multivariable adjusted hazard ratios (HRs) were used to assess outcomes including hospitalization and death. RESULTS In 11,505 non-LBBB CRT-eligible patients, after multivariable adjustment, among patients with RBBB, CRT-D was not associated with better outcomes, compared with ICD alone, regardless of QRS duration. Among patients with NICD and a QRS >= 150 ms, CRT-D was associated with decreased mortality at 3 years compared with ICD alone (HR: 0.602; 95% confidence interval [CI]: 0.416 to 0.871; p = 0.0071). Among 5,954 CRT-D-implanted patients, after multivariable adjustment NICD compared with RBBB was associated with lower mortality at 3 years in those with a QRS duration of >= 150 ms (HR: 0.757; 95% CI: 0.625 to 0.917; p = 0.0044). CONCLUSIONS Among non-LBBB CRT-D-eligible patients, CRT-D implantation was associated with better outcomes compared with ICD alone specifically in NICD patients with a QRS duration of >= 150 ms. Careful patient selection should be considered for CRT-D implantation in patients with non-LBBB conduction. (C) 2019 by the American College of Cardiology Foundation.

【 授权许可】

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