Right Bundle Branch Block Predicts Appropriate Implantable Cardioverter Defibrillator Therapies in Patients with Non-Ischemic Dilated Cardiomyopathy and a Prophylactic Implantable Cardioverter Defibrillator

• Published in: Diagnostics (Basel) Vol. 14; no. 11; p. 1173
• Main Authors: Jiménez-Blanco Bravo, Marta, Alonso Salinas, Gonzalo Luis, Parra Esteban, Carolina, Toquero Ramos, Jorge, Amores Luque, Miguel, Zamorano Gómez, Jose Luis, García-Izquierdo, Eusebio, Álvarez-García, Jesús, Fernández Lozano, Ignacio, Castro Urda, Víctor
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.06.2024; MDPI
• Subjects: Cardiac arrhythmia; Cardiac patients; Cardiomyopathy; Care and treatment; Complications and side effects; Defibrillators; Drug therapy; Evaluation; Heart; Heart diseases; implantable cardioverter defibrillator; Implantable cardioverter-defibrillators; Implants, Artificial; Infections; Ischemia; Left ventricular function; Medical imaging; Mortality; non-ischemic dilated cardiomyopathy; Patient outcomes; Patients; primary prevention; Prosthesis; right bundle branch block; Software; Spain; Statistical analysis; sudden cardiac death; Transplants & implants; Ultrasonic imaging; Valsartan; Variables; Spain; primary prevention; non-ischemic dilated cardiomyopathy; implantable cardioverter defibrillator; sudden cardiac death; right bundle branch block
• ISSN: 2075-4418; 2075-4418
• DOI: 10.3390/diagnostics14111173

The benefit of prophylactic implantable cardioverter defibrillators (ICDs) in patients with severe systolic dysfunction of non-ischemic origin is still unclear, and the identification of patients at risk for sudden cardiac death remains a major challenge. We retrospectively reviewed all consecutive patients with non-ischemic dilated cardiomyopathy (NICM) who underwent prophylactic ICD implantation between 2008 and 2020 in two tertiary centers. Our main goal was to identify the predictors of appropriate ICD therapies (anti-tachycardia pacing [ATP] and/or shocks) in this cohort of patients. A total of 224 patients were included. After a median follow-up of 51 months, 61 patients (27.2%) required appropriate ICD therapies. Patients with appropriate ICD therapies were more frequently men (87% vs. 69%, = 0.006), of younger age (59 years, (53-65) vs. 64 years, (57-70); = 0.02), showed more right bundle branch blocks (RBBBs) (15% vs. 4%, = 0.007) and less left bundle branch blocks (LBBBs) (26% vs. 47%, = 0.005) in the ECG, and had higher left ventricular end-diastolic (100 mL/m , (90-117) vs. 86, (71-110); = 0.011) and systolic volumes (72 mL/m , (59-87) vs. 61, (47-81), = 0.05). In a multivariate competing-risks regression analysis, RBBB (HR 2.26, CI 95% 1.02-4.98, = 0.043) was identified as an independent predictor of appropriate ICD therapies. RBBBs may help to identify patients with NICM at high risk of ventricular arrhythmias and requiring ICD intervention.