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The electromechanical substrate for response to cardiac resynchronization therapy in patients with right bundle branch block.

Publication ,  Journal Article
Atwater, BD; Wagner, GS; Kisslo, J; Risum, N
Published in: Pacing Clin Electrophysiol
December 2017

BACKGROUND: Some patients with RBBB may respond to cardiac resynchronization therapy (CRT). However, little is known regarding the electromechanical substrate for CRT and whether this is the optimal pacing strategy. METHODS: This was a pilot prospective double crossover randomized controlled clinical study comparing ventricular back up pacing (VVI-40), RV fusion pacing (DDD-40, RV only), and biventricular (BIV) pacing (DDD-40 BIV) in nine patients with RBBB and depressed EF. The study compared the frequency of dyssynchrony on baseline echocardiogram in patients with RBBB (n = 4), RBBB + anterior MI (RBBB with left axis deviation + left ventricular (LV) anterior wall thinning, n = 3), and RBBB + LAFB (RBBB with left axis deviation without LV anterior wall thinning n = 2). Echocardiographic assessment of LV dyssynchrony, LV size, and LV function was repeated after 6 months in each pacing mode. RESULTS: Patients with RBBB + LAFB demonstrated baseline echocardiographic dyssynchrony between the LV anterior and inferior wall. Both DDD-40 RV-only pacing and DDD-40 BIV pacing resulted in improved LV function and clinical status compared to VVI-40 back up pacing. Patients with RBBB alone and RBBB with anterior MI had no baseline dyssynchrony and CRT using either RV only or BIV pacing resulted in LV dilation, worsened left ventricular ejection fraction and worsened clinical status compared to VVI-40 back up pacing. CONCLUSION: Patients with RBBB, left axis deviation, and no prior anterior MI may have LV dyssynchrony between the anterior and inferior walls that is correctable with CRT.

Duke Scholars

Published In

Pacing Clin Electrophysiol

DOI

EISSN

1540-8159

Publication Date

December 2017

Volume

40

Issue

12

Start / End Page

1358 / 1367

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Single-Blind Method
  • Prospective Studies
  • Pilot Projects
  • Male
  • Humans
  • Electrophysiological Phenomena
  • Cross-Over Studies
  • Cardiovascular System & Hematology
  • Cardiac Resynchronization Therapy
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Atwater, B. D., Wagner, G. S., Kisslo, J., & Risum, N. (2017). The electromechanical substrate for response to cardiac resynchronization therapy in patients with right bundle branch block. Pacing Clin Electrophysiol, 40(12), 1358–1367. https://doi.org/10.1111/pace.13231
Atwater, Brett D., Galen S. Wagner, Joseph Kisslo, and Niels Risum. “The electromechanical substrate for response to cardiac resynchronization therapy in patients with right bundle branch block.Pacing Clin Electrophysiol 40, no. 12 (December 2017): 1358–67. https://doi.org/10.1111/pace.13231.
Atwater BD, Wagner GS, Kisslo J, Risum N. The electromechanical substrate for response to cardiac resynchronization therapy in patients with right bundle branch block. Pacing Clin Electrophysiol. 2017 Dec;40(12):1358–67.
Atwater, Brett D., et al. “The electromechanical substrate for response to cardiac resynchronization therapy in patients with right bundle branch block.Pacing Clin Electrophysiol, vol. 40, no. 12, Dec. 2017, pp. 1358–67. Pubmed, doi:10.1111/pace.13231.
Atwater BD, Wagner GS, Kisslo J, Risum N. The electromechanical substrate for response to cardiac resynchronization therapy in patients with right bundle branch block. Pacing Clin Electrophysiol. 2017 Dec;40(12):1358–1367.

Published In

Pacing Clin Electrophysiol

DOI

EISSN

1540-8159

Publication Date

December 2017

Volume

40

Issue

12

Start / End Page

1358 / 1367

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Single-Blind Method
  • Prospective Studies
  • Pilot Projects
  • Male
  • Humans
  • Electrophysiological Phenomena
  • Cross-Over Studies
  • Cardiovascular System & Hematology
  • Cardiac Resynchronization Therapy