Europace Advance Access originally published online on April 3, 2008
Europace 2008 10(5):566-571; doi:10.1093/europace/eun081
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CARDIAC RESYNCHRONISATION THERAPY
Significance of QRS morphology in determining the prevalence of mechanical dyssynchrony in heart failure patients eligible for cardiac resynchronization: particular focus on patients with right bundle branch block with and without coexistent left-sided conduction defects
1 Department of Pacemaker and Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, PO Box 15745-1341, Mellat Park, Vali-E-Asr Avenue, Tehran 1996911151, Iran; 2 Department of Pacemaker and Electrophysiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran; 3 Department of Echocardiography, Baghiyatallah Hospital, Baghiyatallah University of Medical Sciences, Tehran, Iran; 4 Department of Echocardiography, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
Aims: The aim of this study was to assess the significance of QRS morphology in determining the prevalence of mechanical dyssynchrony in heart failure (HF) patients considered eligible for cardiac resynchronization.
Methods and results: A total of 200 consecutive HF patients (158 males, mean age 56 ± 13.5 years) with standard indications for cardiac resynchronization therapy (CRT) were evaluated prospectively. The prevalence of an interventricular mechanical delay 
40 ms was lower in patients with pure right bundle branch block (RBBB) than that in those with RBBB plus left fascicular hemiblock (RBBB-LFH) and those with left bundle branch block (LBBB) (33 vs. 50 vs. 54%, P = 0.05). A maximal difference in peak myocardial systolic velocity among all 12 segments (Ts)>100 ms was found in 63% of the patients with LBBB, whereas it was present in 31% of the patients with pure RBBB and in 42% of those with RBBB-LFH (P < 0.001). A standard deviation of Ts (Ts-SD)>34 ms was present in 58% of the LBBB subjects, but in only 29% and 42% of the patients with pure RBBB and RBBB-LFH, respectively (P < 0.001). Intraventricular dyssynchrony, however, was not different in patients with pure RBBB and in those with RBBB-LFH in terms of maximal difference in Ts (P = 0.25) and Ts-SD (P = 0.17).
Conclusions: Although LBBB was more often associated with intraventricular dyssynchrony, ECG sign of additional left ventricular (LV) conduction delay is not a helpful tool for the identification of intra-LV mechanical dyssynchrony in HF patients with RBBB who would benefit from CRT.
Key Words: Congestive heart failure, Right bundle branch block, Left-sided conduction defect, Left bundle branch block, Electrocardiography, Colour tissue Doppler imaging
* Corresponding author. Tel: +98 21 2392 2931; fax: +98 21 2204 8174.E-mail address: majid.haghjoo{at}gmail.com or haghjoo{at}rhc.ac.ir
Manuscript submitted 13 December 2007. Accepted after revision 16 March 2008.
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