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Journal of Geriatric Cardiology 2014年第4期11卷 357-362页

作者： Rong-Zeng DU Jun QIAN Jun WU Yi LIANG Guang-Hua CHEN Tao SUN Ye ZHOU Yang ZHAO Jin-Chuan YAN Department of Cardiology Affiliated Hospital of Jiangsu University Zhenjiang 212001 Jiangsu Province China

A 54-year-old female patient with congenital heart disease had a persistent complete left bundle branch block three months after closure by an Amplatzer ventricular septal defect occluder. Nine months later, the patient suffered from chest distress, palpitation, and sweating at daily activities, and her 6-min walk distance decreased significantly （155 m）. Her echocardiography showed increased left ventricular end-diastolic diameter with left ventricular ejection fraction of 37%. Her symptoms reduced significantly one week after received cardiac resynchronization therapy. She had no symptoms at daily activities, and her echo showed left ventricular ejection fraction of 46%and 53%. Moreover, left ventricular end-diastolic diameter decreased 6 and 10 months after cardiac resynchronization therapy, and 6-min walk dis-tance remarkably increased. This case demonstrated that persistent complete left bundle branch block for nine months after transcatheter closure with ventricular septal defect Amplatzer occluder could lead to left ventricular enlargement and a significant decrease in left ventricular systolic function. Cardiac resynchronization therapy decreased left ventricular end-diastolic diameter and increased left ventricular ejection fraction, thereby improving the patient’s heart functions.

关键词： Ventricular septal defect Amplatzer occluder left bundle branch block Heart failure Cardiac resynchronization therapy

Delayed spontaneous reversibility of left bundle branch block in non-ischemic cardiomyopathy: a case report

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Journal of Geriatric Cardiology 2020年第3期17卷 164-168页

作者： Marcus VH Carvalho Priscila C Kroll Vinicius N Carvalho Department of Cardiothoracic Medicine JundiaíMedical SchoolJundiaíSPBrazil Transplant Hospital E J Zerbini Sao PauloSPBrazil Municipal Hospital Mario Gatti CampinasSao PauloSPBrazil

left bundle branch block(LBBB)causes a delay in left ventricular contraction with an unsynchronized ventricular *** is an independent determinant of morbi-mortality mainly when associated with cardiomyopathy and left ventricular dysfunction.[1] LBBB due to non-ischemic cardiomyopathy is considered *** irreversibility occurs because LBBB and cardiomyopathy act in a synergic manner in order to maintain both ***,there are a few reports in the literature showing that some patients have had an improvement in cardiac function with normalization of QRS and have experienced a reverse remodelling with pharmacological therapy only.[2–4]

关键词： Desynchronization Heart failure left bundle branch block Reverse remodelling

Intermittent left bundle branch block and Myocardial Ischemia in Patient Without Coronary Artery Stenosis:A Case Report

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South China Journal of Cardiology 2009年第1期10卷 36-39页

作者：池菊芳郭航远刘龙斌 Department of Cardiology Shaoxing People's HospitalThe First Affiliated Hospital of Shaoxing University

left bundle branch block （ LBBB ）, traditionally viewed as an electrophysiologic abnormality, is increasingly recognized for its effects on hemodynamics and patient＇s prognosis^[1]. Exercise nuclear studies frequently show reversible perfusion defects in the absence of obstructive coronary artery disease^[2] and some patients with intermittent LBBB develop angina coincident with the onset of LBBB^[3]. We report a case of intermittent LBBB with abnormal stress technetium 99m TC single-photon emission computed tomography （SPECT） study and normal coronary artery angiography.

关键词： left bundle branch block myocardial ischemia coronary artery disease

Cardioprotective effects of trimetazidine on patients with dilated cardiomyopathy and left bundle branch block

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South China Journal of Cardiology 2014年第2期15卷 130-135页

作者：张汉梁远红林纯莹费洪文刘烈陈东骊陈泗林 Guangdong Dianbai people’s Hospital Department of Internal Medicine Guangdong General Hospital Guangdong Academy of Medical Sciences Department of Cardiology Guangdong Provincial Cardiovascular Institute

Background The effects of trimetazidine on patients with dilated cardiomyopathy（DCM） and left bundle branch block（LBBB） are not clear. Methods Sixty consecutive patients with DCM, LBBB and heart dysfunction（35% ≤ LVEF ≤ 45%） were randomly allocated to heart failure therapy plus trimetazidine group（20 mg three times a day; 30 patients） or heart failure therapy alone group（30 patients）. During follow-up of 6months, QRS morphology, plasma NT-proBNP, 6-minute walk test（6MWT） and echocardiographic indexes were measured. Results At the 6th month, a significant functional improvement was noted in patients receiving trimetazidine added to heart failure treatment. In patients from the trimetazidine group, an increase of left ventricular ejection fraction（LVEF） was noted（from 38 ± 5.5% to 47 ± 7.1%, P = 0.020）. The increase of LVEF in the trimetazidine group was associated with a more significant reduction of the left ventricular endsystolic diameter（LVESD） compared with the control group at 6-month follow-up. The NT-pro BNP levels decreased significantly in the trimetazidine group（3.11 ± 0.47 at baseline and 2.77 ± 0.45 at 6-month followup, P 〈 0.01） and the 6MWT increased significantly in the trimetazidine group（325 ± 44 m at baseline and419 ± 56 m at 6-month follow-up, P 〈 0.01）. The differences in NT-pro BNP levels（2.77 ± 0.45 vs 2.96 ±0.46, P = 0.036） and 6MWT（419 ± 56 m vs 366 ± 54 m, P = 0.032） between the two groups were significant at 6-month follow-up. Conclusions Trimetazidine can improve LV function caused by DCM and LBBB. The positive effects of trimetazidine on LV function are especially evident in patients with optimization of drug therapy for heart failure, which strongly suggests an additive effect of these therapy modalities.

关键词： trimetazidine left bundle branch block dilated cardiomyopathy heart function

Clinical efficacy and predictor of cardiac resynchronization therapy on left bundle branch block-associated heart dysfunction

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South China Journal of Cardiology 2013年第4期14卷 230-236页

作者：梁远红陈泗林林纯莹费洪文刘烈陈东骊詹贤章吴书林 Department of Cardiology Guangdong Provincial Cardiovascular InstituteGuangdong General HospitalGuangdong Academy of Medical Sciences

Background left bundle branch block （LBBB） results in an altered pattern of left ventricular （LV） activation and subsequent contraction. Cardiac synchrony and cardiac function are deteriorated by LBBB. However, the effect of LBBB history on progressive heart dysfunction and clinical efficacy of cardiac resynchronization therapy （CRT） in such patients are not clear. In this study we explore the clinical efficacy and predictor of cardiac resynchronization therapy in LBBB heart dysfunction. Methods Twenty-seven LBBB patients with severe heart failure were treated with CRT. Twenty-six LBBB patients without CRT served as control. During 6 months follow-up, ECG, plasma NT-proBNP and echocardiogram indexes were measured. Results Compared with baseline, NYHA functional class of 23 patients （85.2%） was improved in CRT group. Compared with baseline and control, QRS duration （QRSd） was significantly more narrow （P = 0.023, P = 0.019）, NT-proBNP was significantly lower （P = 0.011,P = 0.009）, ventricular septal to left ventricular posterior wall delay time and left ventricular dyssynchrony index （Ts-SD） were significantly worse （P 〈 0.05）; left ventricular ejection fraction, left ventricular end-systolic volume, mitral regurgitation area were significantly improved in CRT group （P 〈 0.05）. when the LBBB history was I〉 2 years and QRSd I〉 155 ms, the sensitivity and specificity of CRT super-response were 53.4% and 85.6% respectively. Conclusions CRT can improve the synchronization and hemodynamic of LBBB patients with heart dysfunction, the LBBB history I〉 2 years and QRSd I〉 155 ms are one of the CRT super-response predictors.

关键词： cardiac resynchronization therapy left bundle branch block hyperresponse predictors

Defective recovery of QT dispersion following transcatheter aortic valve implantation： frequency, predictors and prognosis

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Journal of Geriatric Cardiology 2015年第5期12卷 482-488页

作者： Rutger-Jan Nuis Gokhan Turgut Robert M van der Boon Nicolas M van Mieghem Sjoerd T Nauta Patrick W Serruys Ron T van Domburg Giulio Zuchelli Luc Jordaens Peter P de Jaegere Department of Cardiology Erasmus University Medical Center Rotterdam the Netherlands Department of Electrophysiology Erasmus Thoraxcenter Rotterdam the Netherlands Department of Biostatistics Erasmus Thoraxeenter Rotterdam the Netherlands Division of Cardiovascular Diseases Azienda Ospedaliero-Universitaria Pisana Pisa Italy

Background Corrected QT dispersion （cQTD） has been correlated with non-uniform ventricular repolarisation and increased mortality. In patients with aortic stenosis, cQTD has been shown improved after surgical valve replacement, but the effects of transcatheter aortic valve implantation （TAVI） are unknown. Therefore, we sought to explore the frequency, predictors and prognostic effects of defective cQTD recovery at 6 months after TAVI. Methods A total of 222 patients underwent TAVI with the Medtronic-CoreValve System between November 2005 and January 2012. Patients who were on class Ⅰ or Ⅲ antiarrhythmics or on chronic haemodialysis or who developed atrial fibrillation, a new bundle branch block or became pacemaker dependent after TAVI were excluded. As a result, pre-, post- and follow-up ECG （median： 6 months） analysis was available in 45 eligible patients. Defective cQTD recovery was defined as any progression beyond the baseline cQTD at 6 months. Results In the 45 patients, the mean cQTD was 47 ± 23 ms at baseline, 45 ±17 ms immediately after TAVI and 40 ± 16 ms at 6 months （15% reduction, P = 0.049）. Compared to baseline, cQTD at 6 months was improved in 60% of the patients whereas defective cQTD recovery was present in 40%. cQTD increase immediately after TAVI was an independent predictor of defective cQTD recovery at 6 months （per 10 ms increase; OR： 1.89, 95% CI： 1.15-3.12）. By univariable analysis, defective cQTD recovery was associated with late mortality （HR： 1.52, 95% CI： 1.05-2.17）. Conclusions Despite a gradual reduction ofcQTD after TAVI, 40% of the patients had defective recovery at 6 months which was associated with late mortality. More detailed ECG analysis after TAVI may help to avoid late death.

关键词： Aortic stenosis Conduction abnormalities left bundle branch block Predictors QT dispersion Transcatheter aortic valve implantation

Pacemaker post transcatheter aortic valve replacement:A multifactorial risk?

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World Journal of Cardiology 2024年第4期16卷 168-172页

作者： Stephane Noble Karim Bendjelid Department of Medicine Structural Heart UnitUniversity Hospital of GenevaGeneva 1211Switzerland Department of Acute Medicine Geneva University HospitalsGeneva 1211Switzerland

Pacemaker post-transcatheter aortic valve replacement is related to multifactorial *** et al brought to the body of evidence electrocardiogram and clinical ***,procedural characteristics have at least as much impact on the final need for a permanent pacemaker and potentially on the pacing *** this regard,long-term follow-up and understanding of the impact of long-term stimulation is of utmost importance.

关键词： Transcatheter aortic valve replacement Permanent pacemaker implantation Conduction abnormalities Right bundle branch block left bundle branch block

left bundle branch pacing set to outshine biventricular pacing for cardiac resynchronization therapy?

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World Journal of Cardiology 2024年第4期16卷 186-190页

作者： Akash Batta Juniali Hatwal Department of Cardiology Dayanand Medical College and HospitalLudhiana 141001India Department of Internal Medicine Advanced Cardiac CentrePost Graduate Institute of Medical Education&ResearchChandigarh 160012India

The deleterious effects of long-term right ventricular pacing necessitated the search for alternative pacing sites which could prevent or alleviate pacinginduced *** recently,biventricular pacing(BiVP)was the only modality which could mitigate or prevent pacing induced ***,BiVP could resynchronize the baseline electromechanical dssynchrony in heart failure and improve ***,the high non-response rate of around 20%-30%remains a major *** non-response has been largely attributable to the direct non-physiological stimulation of the left ventricular myocardium bypassing the conduction *** overcome this limitation,the concept of conduction system pacing(CSP)came *** initial success of the first CSP via His bundle pacing(HBP),certain drawbacks including lead instability and dislodgements,steep learning curve and rapid battery depletion on many occasions prevented its widespread use for cardiac resynchronization therapy(CRT).Subsequently,CSP via left bundle branch-area pacing(LBBP)was developed in 2018,which over the last few years has shown efficacy comparable to BiVP-CRT in small observational ***,its safety has also been well established and is largely free of the pitfalls of the *** the recent metanalysis by Yasmin et al,comprising of 6 studies with 389 participants,LBBPCRT was superior to BiVP-CRT in terms of QRS duration,left ventricular ejection fraction,cardiac chamber dimensions,lead thresholds,and functional status amongst heart failure patients with left bundle branch ***,there are important limitations of the study including the small overall numbers,inclusion of only a single small randomized controlled trial(RCT)and a small follow-up ***,the entire study population analyzed was from China which makes generalizability a *** the concerns,the meta-analysis adds to the growing body of evidence demonstrating the efficacy of *** this st

关键词： Biventricular pacing Cardiac resynchronization therapy Conduction system pacing left bundle branch-area pacing left bundle branch block Electromechanical dssynchrony

Clinical Characteristics and Prognosis of End-stage Hypertrophic Cardiomyopathy

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Chinese Medical Journal 2015年第11期128卷 1483-1489页

作者： Yan Xiao Kun-Qi Yang Yan-Kun Yang Ya-Xin Liu Tao Tian Lei Song Xiong-Jing Jiang Xian-Liang Zhou Department of Cardiology State Key Laboratory of Cardiovascular Disease Fuwai Hospital National Center for Cardiovascular Disease Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China

Background： End-stage hypertrophic cardiomyopathy （HCM） is complicated by substantial adverse events. However, few studies have focused on electrocardiographic features and their prognostic values in HCM. This study aimed to evaluate the clinical manifestations and prognostic value of electrocardiography in patients with end-stage HCM. Methods： End-stage HCM patients were enrolled from a total of 1844 consecutive HCM patients from April 2002 to November 2013 at Fuwai Hospital. Clinical data, including medical history, electrocardiography, and echocardiography, were analyzed. Cox hazards regression analysis was used to assess the risk factors for cardiovascular mortality. Results： End-stage HCM was identified in 99 （5.4%） patients, averaged at 52 ± 16 years old at entry. Atrial fibrillation was observed in 53 patients and mural thrombus in 19 patients. During 3.9 ±3.0 years of follow-up, embolic stroke, refractory heart failure, and death or transplantation were observed in 20, 39, and 51 patients, respectively. The incidence of annual mortality was 13.2%. Multivariate Cox hazards regression analysis identified New York Heart Association Class （NYHA） Ill/IV at entry （hazard ratio [HR]： 1.99; 95% confidence interval [C/I： 1.05-3.80; P = 0.036）, left bundle branch block （LBBB）（HR： 2.80; 95% CI： 1.47-5.31; P = 0.002）, and an abnormal Q wave （HR： 2.21; 95% CI： 1.16-4.23; P = 0.016） as independent predictors of cardiovascular death, in accordance with all-cause death and heart failure-related death. Conclusions： LBBB and an abnormal Q wave are risk factors of cardiovascular mortality in end-stage HCM and provide new evidence for early intervention. Susceptibility of end-stage HCM patients to mural thrombus and embolic events warrants further attention.

关键词： End-stage Hypertrophic Cardiomyopathy left bundle branch block Prognosis Q wave

Cardiac resynchronization therapy: Dire need for targeted left ventricular lead placement and optimal device programming

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World Journal of Cardiology 2014年第12期6卷 1270-1277页

作者： Sokratis Pastromas Antonis S Manolis Department of Cardiology Evagelismos Hospital and Athens University School of Medicine

Cardiac resynchronization therapy(CRT) effected via biventricular pacing has been established as prime therapy for heart failure patients of New York Heart Association functional class Ⅱ, Ⅲ and ambulatory Ⅳ, reduced left ventricular(LV) function, and a widened QRS complex. CRT has been shown to improve symptoms, LV function, hospitalization rates, and survival. In order to maximize the benefit from CRT and reduce the number of non-responders, consideration should be given to target the optimal site for LV lead implantation away from myocardial scar and close to the latest LV site activation; and also to appropriately program the device paying particular attention to optimal atrioventricular and interventricular intervals. We herein review current data related to both optimal LV lead placement and device programming and their effects on CRT clinical outcomes.

关键词： Heart failure Cardiac dyssynchrony left bundle branch block Cardiac resynchronization therapy Biventricular pacing