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Left axis deviation in patients with left bundle branch block is a marker of myocardial disease associated with poor response to cardiac resynchronization therapy

Storkås, Hanne Stavø ; Hansen, Thomas Fritz ; Tahri, Jasmine Borg ; Lauridsen, Trine Kiilerich ; Olsen, Flemming Javier ; Borgquist, Rasmus LU ; Vinther, Michael ; Lindhardt, Tommi Bo ; Bruun, Niels Eske and Søgaard, Peter , et al. (2019) In Journal of Electrocardiology
Abstract

Aims: Patients with left axis deviation (LAD) and left bundle branch block (LBBB) show less benefit from cardiac resynchronization therapy (CRT) compared to other LBBB-patients. This study investigates the reasons for this. Methods: Sixty-eight patients eligible for CRT were included. Patients were divided into groups according to QRS-axis; normal axis (NA), left axis deviation (LAD) and right axis deviation (RAD). Before CRT implantation CMR imaging was performed to evaluate scar tissue. Echocardiography was performed before and after implantation. The electrical substrate was assessed by measuring interlead electrical delays. Response was evaluated after 8 months by left ventricular (LV) remodelling and clinical response. Results:... (More)

Aims: Patients with left axis deviation (LAD) and left bundle branch block (LBBB) show less benefit from cardiac resynchronization therapy (CRT) compared to other LBBB-patients. This study investigates the reasons for this. Methods: Sixty-eight patients eligible for CRT were included. Patients were divided into groups according to QRS-axis; normal axis (NA), left axis deviation (LAD) and right axis deviation (RAD). Before CRT implantation CMR imaging was performed to evaluate scar tissue. Echocardiography was performed before and after implantation. The electrical substrate was assessed by measuring interlead electrical delays. Response was evaluated after 8 months by left ventricular (LV) remodelling and clinical response. Results: Forty-four (65%) patients were responders in terms of LV remodelling. The presence of LAD was found to be independently associated with a poor LV remodelling non-response OR 0.21 [95% CI 0.06–0.77] (p = 0.02). Patients with axis deviation had more myocardial scar tissue (1.3 ± 0.6 vs. 0.9 ± 0.6, P = 0.04), more severe LV hypertrophy (14 (64%) and 6 (60%) vs. 7 (29%), P = 0.05) and tended to have a shorter interlead electrical delay than patients with NA (79 ± 40 ms vs. 92 ± 48 ms, P = 0.07). A high scar tissue burden was more pronounced in non-responders (1.4 ± 0.6 vs. 1.0 ± 0.5, P = 0.01). Conclusions: LAD in the presence of LBBB is a predictor of poor outcome after CRT. Patients with LBBB and LAD have more scar tissue, hypertrophy and less activation delay.

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@article{34bc3a28-fec5-4f0e-b2c7-8de0b5d31cc9,
  abstract     = {<p>Aims: Patients with left axis deviation (LAD) and left bundle branch block (LBBB) show less benefit from cardiac resynchronization therapy (CRT) compared to other LBBB-patients. This study investigates the reasons for this. Methods: Sixty-eight patients eligible for CRT were included. Patients were divided into groups according to QRS-axis; normal axis (NA), left axis deviation (LAD) and right axis deviation (RAD). Before CRT implantation CMR imaging was performed to evaluate scar tissue. Echocardiography was performed before and after implantation. The electrical substrate was assessed by measuring interlead electrical delays. Response was evaluated after 8 months by left ventricular (LV) remodelling and clinical response. Results: Forty-four (65%) patients were responders in terms of LV remodelling. The presence of LAD was found to be independently associated with a poor LV remodelling non-response OR 0.21 [95% CI 0.06–0.77] (p = 0.02). Patients with axis deviation had more myocardial scar tissue (1.3 ± 0.6 vs. 0.9 ± 0.6, P = 0.04), more severe LV hypertrophy (14 (64%) and 6 (60%) vs. 7 (29%), P = 0.05) and tended to have a shorter interlead electrical delay than patients with NA (79 ± 40 ms vs. 92 ± 48 ms, P = 0.07). A high scar tissue burden was more pronounced in non-responders (1.4 ± 0.6 vs. 1.0 ± 0.5, P = 0.01). Conclusions: LAD in the presence of LBBB is a predictor of poor outcome after CRT. Patients with LBBB and LAD have more scar tissue, hypertrophy and less activation delay.</p>},
  author       = {Storkås, Hanne Stavø and Hansen, Thomas Fritz and Tahri, Jasmine Borg and Lauridsen, Trine Kiilerich and Olsen, Flemming Javier and Borgquist, Rasmus and Vinther, Michael and Lindhardt, Tommi Bo and Bruun, Niels Eske and Søgaard, Peter and Risum, Niels},
  issn         = {0022-0736},
  language     = {eng},
  month        = {04},
  publisher    = {Elsevier},
  series       = {Journal of Electrocardiology},
  title        = {Left axis deviation in patients with left bundle branch block is a marker of myocardial disease associated with poor response to cardiac resynchronization therapy},
  url          = {http://dx.doi.org/10.1016/j.jelectrocard.2019.04.007},
  doi          = {10.1016/j.jelectrocard.2019.04.007},
  year         = {2019},
}