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Title: | Left bundle branch block criteria in the 2021 ESC guidelines on CRT: a step back in identifying CRT candidates? | Authors: | Beela, Ahmed S. Rijks, Jesse H. J. Manetti, Claudia A. Vernooy, Kevin van Stipdonk, A. M. W. Prinzen, Frits W. Delhaas, Tammo HERBOTS, Lieven Lumens, Joost |
Issue Date: | 2024 | Publisher: | OXFORD UNIV PRESS | Source: | European heart journal. Cardiovascular imaging (Print), | Status: | Early view | Abstract: | In the latest version of the European Society of Cardiology (ESC) guidelines on cardiac pacing and cardiac resynchronization therapy (CRT), a new and stricter definition of left bundle branch block (LBBB) was introduced (ESC-2021). 1 In the current work, we investigate the impact of applying the ESC-2021 vs. the ESC-2013 definitions of LBBB on the relation between LBBB at baseline and (i) LV reverse remodelling after CRT and (ii) baseline mechanical dyssynchrony, both assessed by echocardiography. 2 We retrospectively investigated 244 CRT patients in sinus rhythm from two European centres, Jessa Hospital in Hasselt, Belgium (n = 164) and Maastricht University Medical Center+ (MUMC+) in Maastricht, The Netherlands (n = 80). Pre-implant ECGs were analysed according to the ESC-2013 and ESC-2021 LBBB definitions (Table 1). Mechanical dyssynchrony was evaluated using echocardiography, both qualitatively based on the presence of either apical rocking or septal flash (ApRock/SF), 3 and quantitatively using the strain-derived systolic stretch index (SSI). 4 LV reverse remodelling was measured as the relative change of LV end-systolic volume (LVESV) at 12 ± 6 months follow-up. The study was approved by the Ethics Review Committee of both Jessa Hospital and the MUMC+. Of the study population, 70% were males and 51% had ischaemic cardiomyopathy. Mean age was 69 ± 10 years and baseline QRS duration 154 ± 24 ms. ApRock/SF was present in 57% of the study population. Applying the ESC-2021 definition, 18% of the patients (n = 45) had LBBB compared with 64% (n = 157) when applying the ESC-2013 definition. Stratifying the population per the ESC-2021 guideline classes of recommendation, 14% (n = 35) had class I recommendation (LBBB + QRS ≥ 150 ms), 44% (n = 107) had class IIa (LBBB + QRS 130-149 ms or non-LBBB + QRS ≥ 150 ms), 29% (n = 70) had class IIb (Non-LBBB + QRS 130-149 ms), and 13% (n = 32) were not recommended because of having baseline QRS between 120 and 129 ms. On the other hand, applying the ESC-2013 guidelines, 64% (n = 157) had class I (LBBB + QRS ≥ 120 ms), 13% (n = 32) had class IIa (non-LBBB + QRS ≥ 150 ms), and 23% (n = 55) had class IIb (Non-LBBB + QRS 120-149 ms), Figure 1, top panel. Assessment of ApRock/SF was successfully conducted in 100% of the study population, whereas SSI was obtained in 88% of cases, limited by suboptimal image quality for strain analysis. The prevalence of ApRock/ SF in patients with LBBB was similar between the ESC-2021 and ESC-2013 definitions (80% vs. 73%, respectively). However, among patients without LBBB, the prevalence differed: 52% vs. 30% according to the ESC-2021 vs. the ESC-2013 definitions, respectively. Overall, the agreement between LBBB and ApRock/SF was weak applying the ESC-2021 (kappa agreement coefficient = 0.15, P = 0.001) and moderate applying the ESC-2013 (0.41, P < 0.001). Similarly, there was no significant difference in SSI values between patients with and without LBBB according to the ESC-2021 definition (3.0%, interquartile range (IQR): [2.0-5.0] vs. 3.0%, IQR: [1.0-6.0], P = 0.9). On the other hand, applying the ESC-2013 definition, patients with LBBB had significantly higher values of SSI compared with patients without LBBB (4.0%, IQR: [2.0-7.0] vs. 2.0%, IQR: [1.0-4.0], P = 0.001), Figure 1, middle panel. At CRT follow-up, there was no significant difference in LV reverse remodelling between patients with and without LBBB according to the ESC-2021 definition (44%, IQR: [31-62] vs. 38%, IQR: [20-57], P = 0.08), neither among the four ESC-2021 guideline classes. However, when applying the ESC-2013 definition, LV reverse remodelling was significantly more pronounced in patients with LBBB than in patients without LBBB (43%, IQR: [30-63] vs. 31%, IQR: [10-49], P < 0.01). In addition, patients with an ESC-2013 class I indication showed significantly more pronounced decrease in LVESV at CRT | Notes: | Beela, AS (corresponding author), Maastricht Univ Med Ctr MUMC, Cardiovasc Res Inst Maastricht CARIM, Dept Biomed Engn, NL-6200 MD Maastricht, Netherlands.; Beela, AS (corresponding author), Suez Canal Univ, Fac Med, Dept Cardiovasc Dis, Ismailia 41522, Egypt. a.salembeela@maastrichtuniversity.nl |
Document URI: | http://hdl.handle.net/1942/43572 | ISSN: | 2047-2404 | e-ISSN: | 2047-2412 | DOI: | 10.1093/ehjci/jeae164 | ISI #: | 001273247200001 | Rights: | The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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