Zeyu Jiang1, Yuanhao Qiu1, Zhiyong Qian1, Yao Wang1, Yongwei Zhao1, Xiaofeng Hou1, Yanchun Liang2, Liangrong Zheng3, Geng Xu4, Yangang Su5, Xiang Gu6, Jiangang Zou7. 1. Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China. 2. Department of Cardiology, Cardiovascular Institute of People's Liberation Army, General Hospital of Northern Theater Command, Shenyang, Liaoning, China. 3. Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China. 4. Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China. 5. Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China. 6. Department of Cardiology, Subei People's Hospital of Jiangsu Province, Yangzhou University, Yangzhou, Jiangsu, China. 7. Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China. Electronic address: jgzou@njmu.edu.cn.
Abstract
BACKGROUND: Cardiac resynchronization therapy (CRT) is a standard treatment for selected patients with chronic heart failure (HF). However, up to 30%-50% of patients still do not respond to CRT. OBJECTIVE: Our aim was to identify the predictive value of an S wave in lead V6 in CRT response in patients with complete left bundle branch block (CLBBB). METHODS: The CLBBB definition included the Strauss left bundle branch block criteria and the absence of q waves in leads I, V5, and V6. According to the electrocardiogram at baseline, CLBBB patients were divided into 3 groups: T-CLBBB group (CLBBB without an S wave in lead V5 or V6), V5S group (CLBBB with an S wave in lead V5 and no S wave in lead V6), and V5&V6S group (CLBBB with S waves in leads V5 and V6). CRT response was defined as left ventricular end-systolic volume reduction ≥ 15% at 6-month follow-up. The combined end point included HF rehospitalization or all-cause death. RESULTS: Of 181 patients with left bundle branch block-like pattern, 112 patients with CLBBB were included into 3 groups: 54 in the T-CLBBB group, 32 in the V5S group, and 26 in the V5&V6S group. The CRT response rate was 85.2% (46), 65.6% (21), and 38.5% (10), respectively (P < .001). Kaplan-Meier curves demonstrated that patients in the V5&V6S group had a higher incidence of HF rehospitalization or all-cause death than those in the other 2 groups (P < .001). In a multivariate logistic regression model analysis, an S wave in lead V6 was significantly associated with CRT nonresponse (hazard ratio 0.33; 95% confidence interval 0.11-0.96; P = .042). CONCLUSION: An S wave in lead V6 can predict poor response to CRT and long-term outcome.
BACKGROUND: Cardiac resynchronization therapy (CRT) is a standard treatment for selected patients with chronic heart failure (HF). However, up to 30%-50% of patients still do not respond to CRT. OBJECTIVE: Our aim was to identify the predictive value of an S wave in lead V6 in CRT response in patients with complete left bundle branch block (CLBBB). METHODS: The CLBBB definition included the Strauss left bundle branch block criteria and the absence of q waves in leads I, V5, and V6. According to the electrocardiogram at baseline, CLBBBpatients were divided into 3 groups: T-CLBBB group (CLBBB without an S wave in lead V5 or V6), V5S group (CLBBB with an S wave in lead V5 and no S wave in lead V6), and V5&V6S group (CLBBB with S waves in leads V5 and V6). CRT response was defined as left ventricular end-systolic volume reduction ≥ 15% at 6-month follow-up. The combined end point included HF rehospitalization or all-cause death. RESULTS: Of 181 patients with left bundle branch block-like pattern, 112 patients with CLBBB were included into 3 groups: 54 in the T-CLBBB group, 32 in the V5S group, and 26 in the V5&V6S group. The CRT response rate was 85.2% (46), 65.6% (21), and 38.5% (10), respectively (P < .001). Kaplan-Meier curves demonstrated that patients in the V5&V6S group had a higher incidence of HF rehospitalization or all-cause death than those in the other 2 groups (P < .001). In a multivariate logistic regression model analysis, an S wave in lead V6 was significantly associated with CRT nonresponse (hazard ratio 0.33; 95% confidence interval 0.11-0.96; P = .042). CONCLUSION: An S wave in lead V6 can predict poor response to CRT and long-term outcome.
Authors: Kazi T Haq; Nichole M Rogovoy; Jason A Thomas; Christopher Hamilton; Katherine J Lutz; Ashley Wirth; Aron B Bender; David M German; Ryle Przybylowicz; Peter van Dam; Thomas A Dewland; Khidir Dalouk; Eric Stecker; Babak Nazer; Peter M Jessel; Karen S MacMurdy; Ignatius Gerardo E Zarraga; Bassel Beitinjaneh; Charles A Henrikson; Merritt Raitt; Cristina Fuss; Maros Ferencik; Larisa G Tereshchenko Journal: Heart Rhythm O2 Date: 2021-06-29