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Cardiac resynchronisation therapy
Session:
SESSÃO DE POSTERS 52 - INSUFICIÊNCIA CARDÍACA, RESSINCRONIZAÇÃO E IMAGEM
Speaker:
André Paulo Ferreira
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:
André Paulo Ferreira; Ana Raquel Santos; Sofia Jacinto; Hélder Santos; Guilherme Portugal; Ana Lousinha; Bruno Valente; Pedro Silva Cunha; Rui Cruz Ferreira; Mário Oliveira
Abstract
<p>Background: The benefits of cardiac resynchronisation therapy (CRT) are optimal for patients with wide QRS complexes and left bundle branch block (LBBB) morphology. It remains uncertain whether patients with non-LBBB QRS complex morphologies can have the same rates of response to CRT and functional status improvement.<br /> <br /> Purpose: To assess the impact and reverse remodelling effects of CRT implantation in patients with non-LBBB QRS complex morphology.<br /> <br /> Methods: A single-centre retrospective study of patients with heart failure who underwent CRT implantation between 2016 and 2023. Responders were defined as those exhibiting an absolute >5% improvement in LVEF at 6 months of follow-up. CRT response was compared between patients with LBBB and non-LBBB QRS complex morphologies, with the latter including right bundle branch block (RBBB), atypical RBBB, and interventricular conduction delay.<br /> <br /> Results: A total of 190 patients were included in this study. Patient's mean age was 69.5±10.1 years, and 70.8% were male. At the baseline, the New York Heart Association functional class (NYHA) was 2 in 30.5%, and 3 in 65.6% of patients, 25.6% had ischemic heart disease and 74.4% dilated cardiomyopathy. Of the total, 64.7% had LBBB and 35.3% non-LBBB QRS morphology. Analyzing the non-LBBB group, the mean baseline QRS width was 148±23ms and the mean left ventricle ejection fraction (LVEF) was 26.5±5.7%. At 6 months of follow-up after CRT implantation, patients showed a similar response rate in both non-LBBB and LBBB groups, with a mean increase in LVEF of 11.6±5.5% vs 12.1±3.4% (p = 0.655), and improvement of ≥1 classes in NYHA classification 65.7% vs 74.3% (p = 0.248), respectively. The majority of patients in both groups were CRT responders 67.9% vs 72.5% (p = 0.602). However, we should note that patients with atypical RBBB had significantly higher rates of response than those with typical RBBB 70.4% vs 34.7% (p < 0.001). Patients with interventricular conduction delay had similar rates of response compared to those with atypical RBBB 63.8% vs 70.4% (p = 0.104). Mortality rates at 1 year were similar between both groups 4.4% vs 3.9% (p = 0.477).<br /> <br /> Conclusion: The majority of patients with HFrEF and wide >150ms of non-LBBB morphology show a favourable CRT response, and therefore CRT implantation should be taken into consideration in these patients. Some specific non-LBBB morphologies appear to respond better than others, and this hypothesis should be further investigated in experimental studies.</p>
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