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Cardiac resynchronization therapy for non-LBBB patients and QRS mid-range: Worth it?
Session:
SESSÃO DE POSTERS 52 - INSUFICIÊNCIA CARDÍACA, RESSINCRONIZAÇÃO E IMAGEM
Speaker:
Marta Catarina Bernardo
Congress:
CPC 2025
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Cartazes
FP Number:
---
Authors:
Marta Catarina Bernardo; Isabel Martins Moreira; Luís Sousa Azevedo; Isabel Nóbrega Fernandes; José P. Guimarães; Sílvia Leão; Renato Margato; José Paulo Fontes; Pedro Mateus; Sofia Silva Carvalho; José Ilídio Moreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> The clinical benefit of cardiac resynchronization therapy (CRT) in patients with non-left bundle branch block (non-LBBB) morphology and QRS mid-range remains uncertain and controversial.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Aim: </strong>To assess the impact of QRS morphology and duration in echocardiographic response to CRT and clinical outcomes in our population. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> Single center retrospective analysis of pts admitted to CRT implantation between 2017-2024. Inclusion criteria: QRS duration ≥130 ms, left ventricular ejection fraction (LVEF) ≤35% and echocardiogram performed 6-12months post-implantation. Patients were classified into LBBB and non-LBBB groups and further stratified by QRS duration (130-149 ms and ≥150 ms). Echocardiographic response was defined as an improvement in LVEF≥10%/reduction in left ventricular end systolic volume ≥ 15% at 6-12 months post-implantation. The primary endpoint was a composite of all-cause death and heart failure hospitalizations (HFH). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>We included 128 pts (70±10 years, 66% males, LVEF 28±6%, 34% ischemic cardiomyopathy), 77% in the LBBB group. The non-LBBB group had a higher proportion of males (97% vs. 56%, p<0.005), atrial fibrillation (50% vs 30%, p=0,039) and less use of beta-blocker (87% vs 67%, p=0,012). Non-LBBB patients had a shorter baseline QRS duration (158±20 ms vs. 165±17 ms, p=0,04) and larger left atrial volumes (51 mL [IQR 42–64] vs. 41 mL [IQR 36–49], p=0,002). No differences in the rate of ICD implantations between groups (73% vs 64%, p=0,36).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">During the first year, there was a trend to higher echocardiographic response in the LBBB group (83% vs 65%, p=0,057) (Fig.1) with comparable rates of NYHA improvement (63% vs 58%, p=0,62). During a median follow-up of 34 [IQR 16–53] months, there were no statistically significant differences in the primary endpoint between groups (40% vs 27%, p=0,18), with similar rates of HFH (p=0,34) and all-cause death (p=0,13). However, the non-LBBB group experienced more ventricular arrhythmias (23,3% vs 8,2%, p=0,014). When we stratified the groups according to the QRS duration (LBBB+QRS≥150 ms, LBBB+QRS 130-149ms, Non-LBBB≥150 ms, Non-LBBB+QRS 130-149ms), it was noticeable that, despite the absence of significant differences in the rates of echocardiographic response (p=0,20), there was a clear significant difference in the rates of the primary endpoint, with worse outcomes in the non-LBBB+ QRS 130-149 ms group (p<0,005), mainly driven by all-cause death (Fig.2).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>In our cohort, pts with non-LBBB benefit for CRT, with notable echocardiographic and clinical improvements. Those with QRS≥150 ms have clinical outcomes comparable to LBBB group, with worse prognosis of the ones with mid-range QRS. This underscores the importance of careful patient selection, particularly within the non-LBBB subgroup.</span></span></p>
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