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Journal of the American Heart... Sep 2021
Topics: Arrhythmias, Cardiac; Bundle-Branch Block; Electrocardiography; Humans; ST Elevation Myocardial Infarction
PubMed: 34514811
DOI: 10.1161/JAHA.121.023275 -
JACC. Clinical Electrophysiology Jan 2022
Topics: Bundle of His; Bundle-Branch Block; Humans
PubMed: 35057981
DOI: 10.1016/j.jacep.2021.08.007 -
BMC Family Practice May 2019Right bundle branch block is one of the most common electrocardiographic abnormalities. Most cases of right bundle branch block are detected in asymptomatic patients in...
BACKGROUND
Right bundle branch block is one of the most common electrocardiographic abnormalities. Most cases of right bundle branch block are detected in asymptomatic patients in primary care, so a correct interpretation of electrocardiograms (ECGs) at this level is necessary. The objective of this research is to determine the degree of concordance in the diagnosis of incomplete and complete right bundle branch block between four primary care researchers and a cardiologist.
METHODS
The research design is a retrospective cohort study of patients over 18 years of ages of patients over 18 years of ages who underwent an ECG for any reason and were diagnosed with right bundle branch block by their physician. The physicians participating, 4 primary care researchers and a cardiologist were specialized in interpreting electrocardiographic records. The diagnosis of incomplete and complete right bundle branch block was recorded and other secondary variables were analysed. In case of diagnostic discordance between the researchers, the ECGs were reviewed by an expert cardiologist, who interpreted them, established the diagnosis and analysed the possible causes for the discrepancy.
RESULTS
We studied 160 patients diagnosed with right bundle branch block by their general practise. The patients had a mean age of 64.8 years and 54% of them were men. The concordance in the diagnosis of incomplete right bundle branch block showed a Fleiss' kappa index (k) of 0.71 among the five researchers and of 0.85 among only the primary care researchers. The k for complete right bundle branch block was 0.93 among the five researchers and 0.96 among only the primary care researchers.
CONCLUSION
The interobserver agreement in the diagnosis of right bundle branch block performed by physicians specialized in ECG interpretation (primary care physicians and a cardiologist) was very good. The variability was greater for the diagnosis of incomplete right bundle branch block.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bundle-Branch Block; Cardiologists; Electrocardiography; Female; Humans; Male; Middle Aged; Observer Variation; Physicians, Primary Care; Retrospective Studies; Young Adult
PubMed: 31060516
DOI: 10.1186/s12875-019-0946-3 -
Trends in Cardiovascular Medicine Feb 2020Cardiac resynchronization therapy (CRT) has been a major step in the treatment of heart failure patients and intraventricular conduction delay. As a considerable number... (Review)
Review
Cardiac resynchronization therapy (CRT) has been a major step in the treatment of heart failure patients and intraventricular conduction delay. As a considerable number of patients do not respond adequately to CRT, echocardiographic dyssynchrony selection criteria have been proposed to improve CRT response, but these parameters eventually failed to provide superior selection of CRT candidates. In the last decade, an echo-dyssynchrony parameter called "septal flash" was been reported by several investigators and opinion leaders in the field of CRT. This parameter has a strong pathophysiological rationale and was shown to be a robust and predominant predictor of CRT response in recent observational and retrospective studies. We here provide a comprehensive and balanced overview of septal flash and address several important aspects, questions and potential future implications of septal flash in cardiomyopathy and CRT.
Topics: Action Potentials; Animals; Bundle-Branch Block; Cardiac Resynchronization Therapy; Cardiac Resynchronization Therapy Devices; Clinical Decision-Making; Heart Failure; Heart Rate; Heart Septum; Humans; Recovery of Function; Treatment Outcome; Ventricular Dysfunction, Left; Ventricular Function, Left; Ventricular Remodeling
PubMed: 31000325
DOI: 10.1016/j.tcm.2019.03.008 -
Pacing and Clinical Electrophysiology :... Sep 2021His bundle pacing (HBP) is a physiological pacing strategy to preserve the electrical synchrony of ventricular conduction and left ventricular (LV) function. Left bundle... (Comparative Study)
Comparative Study
BACKGROUND
His bundle pacing (HBP) is a physiological pacing strategy to preserve the electrical synchrony of ventricular conduction and left ventricular (LV) function. Left bundle branch pacing (LBBP) has emerged as an alternative physiological pacing technique.
OBJECTIVE
To evaluate cardiac electrical and mechanical synchrony comparing LBBP and HBP in patients with permanent atrial fibrillation (AF).
METHODS
Consecutive patients with symptomatic bradycardia and AF were enrolled from January to June of 2019. The cardiac electrical and mechanical synchrony in different pacing mode were evaluated at baseline and after implantation.
RESULTS
Both HBP and LBBP were performed in 20 patients. LBBP significantly widened the QRS duration compared with the intrinsic conduction (113.2 ± 14.5 vs. 96.5 ± 16.2 ms; p = .01), while HBP did not (104.5 ± 22.3 vs. 96.5 ± 16.2 ms; p = .12). Both LBBP and HBP patients had similar LV myocardial strain measurements for the mechanical synchrony evaluation without significant change compared with baseline. There was no significant difference in right ventricular synchrony measurement between LBBP and HBP. Compared to HBP, LBBP had less interventricular synchrony (IMVD, 14.7 ± 9.2 vs. 3.1 ± 12.7 ms, p < .01; Ts-LV-RV, 37.9 ± 10.7 vs. 18.5 ± 10.8 ms, p < .001).
CONCLUSIONS
Although LBBP's a physiological pacing mode can achieve a similar cardiac electrical and mechanical synchronization when compared to HBP, LBBP results in modest delay in RV activation, and the clinical implication remains to be studied.
Topics: Aged; Atrial Fibrillation; Bradycardia; Bundle of His; Bundle-Branch Block; Cardiac Pacing, Artificial; Female; Humans; Male
PubMed: 34337768
DOI: 10.1111/pace.14331 -
Europace : European Pacing,... Jun 2023To define a stepwise application of left bundle branch pacing (LBBP) criteria that will simplify implantation and guarantee electrical resynchronization. Left bundle... (Clinical Trial)
Clinical Trial
AIMS
To define a stepwise application of left bundle branch pacing (LBBP) criteria that will simplify implantation and guarantee electrical resynchronization. Left bundle branch pacing has emerged as an alternative to biventricular pacing. However, a systematic stepwise criterion to ensure electrical resynchronization is lacking.
METHODS AND RESULTS
A cohort of 24 patients from the LEVEL-AT trial (NCT04054895) who received LBBP and had electrocardiographic imaging (ECGI) at 45 days post-implant were included. The usefulness of ECG- and electrogram-based criteria to predict accurate electrical resynchronization with LBBP were analyzed. A two-step approach was developed. The gold standard used to confirm resynchronization was the change in ventricular activation pattern and shortening in left ventricular activation time, assessed by ECGI. Twenty-two (91.6%) patients showed electrical resynchronization on ECGI. All patients fulfilled pre-screwing requisites: lead in septal position in left-oblique projection and W paced morphology in V1. In the first step, presence of either right bundle branch conduction delay pattern (qR or rSR in V1) or left bundle branch capture Plus (QRS ≤120 ms) resulted in 95% sensitivity and 100% specificity to predict LBBP resynchronization, with an accuracy of 95.8%. In the second step, the presence of selective capture (100% specificity, only 41% sensitivity) or a spike-R <80 ms in non-selective capture (100% specificity, sensitivity 46%) ensured 100% accuracy to predict resynchronization with LBBP.
CONCLUSION
Stepwise application of ECG and electrogram criteria may provide an accurate assessment of electrical resynchronization with LBBP (Graphical abstract).
Topics: Humans; Bundle of His; Bundle-Branch Block; Cardiac Pacing, Artificial; Cardiac Resynchronization Therapy; Electrocardiography; Heart Conduction System; Treatment Outcome
PubMed: 37294671
DOI: 10.1093/europace/euad128 -
The Journal of International Medical... Feb 2020A 61-year-old woman was referred to our institution for evaluation of severe nonischemic dilated cardiomyopathy and left bundle branch block (LBBB). After permanent His...
A 61-year-old woman was referred to our institution for evaluation of severe nonischemic dilated cardiomyopathy and left bundle branch block (LBBB). After permanent His bundle pacing, the LBBB was immediately corrected; however, the right bundle branch was injured during the procedure. Subsequent recovery of the right bundle branch block and normalization of heart function were observed during follow-up. This case indicates that LBBB might result in the development of nonischemic cardiomyopathy and emphasizes the necessity of a temporary pacemaker during His bundle pacing for patients with LBBB.
Topics: Bundle of His; Bundle-Branch Block; Cardiac Pacing, Artificial; Cardiomyopathies; Electrocardiography; Female; Humans; Middle Aged
PubMed: 31679398
DOI: 10.1177/0300060519884188 -
Annals of Noninvasive Electrocardiology... Jul 2020Complete left bundle branch block (cLBBB) is associated with increased cardiovascular mortality and heart failure. On the contrary, the clinical relevance of incomplete...
BACKGROUND
Complete left bundle branch block (cLBBB) is associated with increased cardiovascular mortality and heart failure. On the contrary, the clinical relevance of incomplete left bundle branch block (iLBBB) is less known. This study investigated the profile and outcome of iLBBB patients and assessed the risk of progression to cLBBB.
METHODS
Patients diagnosed with iLBBB between July 2013 and April 2018 were retrospectively included. Subsequently, echo- and electrocardiographic examinations at time of iLBBB diagnosis and during follow-up, as well as progression to non-strict cLBBB and strict cLBBB, were evaluated.
RESULTS
The study enrolled 321 patients (33% female, age 74 ± 11 years). During the follow-up of 21 (8;34) months, 33% of iLBBB patients evolved to non-strict cLBBB and 27% to strict cLBBB. iLBBB patients who evolved to non-strict or strict cLBBB were older, had more frequently reduced left ventricular ejection fraction, and had more often QRS notching/slurring in the lateral leads and inferior leads, compared to patients without progression to cLBBB. In multivariate analysis, only QRS notching/slurring in the lateral leads was independently associated with progression to non-strict cLBBB (odds ratio 4.64, p < .001) and strict cLBBB (odds ratio 9.6, p < .001). iLBBB patients with QRS notching/slurring had a progression rate to non-strict cLBBB of 52% and 49% to strict cLBBB.
CONCLUSION
Among patients with iLBBB, up to one third of the patients progress to cLBBB within a period of 2 years. The presence of QRS notching/slurring in the lateral leads during iLBBB was the strongest predictor for progression toward cLBBB.
Topics: Aged; Belgium; Bundle-Branch Block; Disease Progression; Electrocardiography; Female; Follow-Up Studies; Heart Ventricles; Humans; Male; Risk Assessment
PubMed: 31823461
DOI: 10.1111/anec.12732 -
Annals of Noninvasive Electrocardiology... Jan 2022Right bundle-branch block (RBBB) and left bundle-branch block (LBBB) play a role in the pathogenesis and progression of coronary artery disease (CAD). However, the...
BACKGROUND
Right bundle-branch block (RBBB) and left bundle-branch block (LBBB) play a role in the pathogenesis and progression of coronary artery disease (CAD). However, the clinical features and the severity of coronary artery disease associated with different subtypes of bundle-branch block, according to time of new appearance, is not well characterized in patients with no known CAD.
METHODS
We retrospectively analyzed data pertaining to consecutive patients with RBBB or LBBB who underwent coronary angiography. The severity of coronary lesions was evaluated using the SYNTAX score. The differential effect of new-onset RBBB, old RBBB, new-onset LBBB, and old LBBB on the severity of CAD and its association with clinical characteristics was quantified. Multivariate logistic regression analysis was performed to evaluate the effect of RBBB and LBBB on the degree of coronary atherosclerosis in patients without known CAD.
RESULTS
Out of the 243 patients, 72 patients had old LBBB, 37 had new-onset LBBB, 93 patients had old RBBB, and 41 patients had new-onset RBBB. On univariate analysis, age, systolic blood pressure, diastolic blood pressure, creatinine, serum glucose, and glycosylated hemoglobin level were associated with high SYNTAX score (p < .05 for all). Patients in the new-onset RBBB, old RBBB, new-onset LBBB, and old LBBB groups showed significant differences in baseline characteristics and coronary atherosclerosis (p < .05 for all). However, there were no significant between-group differences with respect to the degree of coronary atherosclerosis as assessed by SYNTAX score.
CONCLUSIONS
New-onset RBBB, old RBBB, new-onset LBBB, and old LBBB were not associated with the severity of coronary lesions as assessed by SYNTAX score in patients without known CAD.
Topics: Arrhythmias, Cardiac; Bundle-Branch Block; Coronary Artery Disease; Electrocardiography; Humans; Retrospective Studies
PubMed: 34258804
DOI: 10.1111/anec.12883 -
JACC. Clinical Electrophysiology Feb 2020
Topics: Arrhythmias, Cardiac; Bundle-Branch Block; Cardiac Resynchronization Therapy; Electrocardiography; Heart Failure; Humans
PubMed: 32081224
DOI: 10.1016/j.jacep.2019.10.021