Specificity of the wide QRS complex tachycardia algorithms in recipients of cardiac resynchronization therapy

2012 ◽  
Vol 45 (3) ◽  
pp. 319-326 ◽  
Author(s):  
Marek Jastrzebski ◽  
Piotr Kukla ◽  
Danuta Czarnecka ◽  
Kalina Kawecka-Jaszcz
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Cardiac Resynchronization ◽  
Qrs Complex ◽  
Resynchronization Therapy

Abstract P64: Right Ventricular Outflow Septal Pacing as Cardiac Resynchronization Therapy in Patients with Right Bundle-Branch Block: Results in 62 Patients

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Phillip E Schrumpf ◽  
Michael Giudici ◽  
Deborah Paul ◽  
Roselyn Krupa ◽  
Cynthia Meirbachtol
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Right Ventricular ◽  
Right Bundle Branch Block ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Qrs Complex ◽  
Resynchronization Therapy ◽  
Ventricular Performance ◽  
Bundle Branch Block ◽  
Qrs Duration

Background: Cardiac resynchronization therapy has been shown to improve left ventricular performance in patients with left ventricular dysfunction and a left-sided interventricular conduction delay. This is performed by placing a pacing lead on the lateral left ventricular wall to stimulate the area normally stimulated by the left bundle branch. In patients with right bundle branch block (RBBB), pacing the right bundle branch could also result in resynchronization. Previous studies have shown that right ventricular outflow septal (RVOS) pacing does, in fact, utilize the native conduction system. Methods: 62 consecutive patients, 46 male/16 female, aged 75 +/− 10.5 yr, with RBBB and indications for pacing, underwent RVOS lead placement using commercially available pacing systems. The patients subsequently underwent bedside A-V optimization to achieve the narrowest QRS duration and most “normal” QRS complex. Echocardiography was performed to evaluate changes in wall motion comparing baseline with optimal pacing. Results: Baseline mean QRS duration 146 +/− 20.9 ms Optimized mean QRS duration 111 +/− 20.5 ms Average decrease in QRS duration -35 +/− 21.5 ms p < 0.001 Echocardiography demonstrated improvement in septal contraction abnormalities. Conclusions: 1) RVOS pacing in RBBB patients can significantly narrow the QRS complex on ECG. 2) Septal contraction abnormalities due to RBBB can be improved with RVOS pacing and optimal A-V timing. 3) Further studies are warranted to evaluate this therapy in a heart failure population.

scholarly journals Efficacy of Cardiac Resynchronization Therapy in Patients with a Narrow QRS Complex

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Toshiko Nakai ◽  
Yukitoshi Ikeya ◽  
Hiroaki Mano ◽  
Rikitake Kogawa ◽  
Ryuta Watanabe ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Response Rate ◽  
Nyha Class ◽  
Heart Association ◽  
Cardiac Resynchronization ◽  
Qrs Complex ◽  
Resynchronization Therapy ◽  
Narrow Qrs ◽  
Narrow Qrs Complex ◽  
Crt Response

Aims. In the guidelines for cardiac resynchronization therapy (CRT), there is a gap between the Japanese Circulation Society (JCS) criteria, which specify a QRS duration of ≥120 ms, and other countries, with a QRS ≥ 130 ms. The efficacy of CRT remains controversial in patients with a narrow QRS <130 ms. The aims of this study are to evaluate the response to CRT in patients with a narrow QRS and to identify predictors of mortality. Methods. We retrospectively studied 212 patients who received CRT. They were divided into narrow QRS (<130 ms) and wide QRS (≥130 ms) groups. We compared CRT response rates and investigated whether age, gender, baseline New York Heart Association (NYHA) class, ischemic etiology, atrial fibrillation, and ventricular arrhythmias are associated with response and also predictive of mortality. Results. The CRT response rate was not significantly different between the wide QRS group and the narrow QRS group (74.6% versus 77.2%, p  = 0.6876), and the response rate in the narrow QRS group was as good as that reported worldwide. NYHA class IV was shown to be a predictor of mortality (HR 9.38, 95% CI 5.35–16.3, p  < 0.0001). Conclusions. The present study demonstrated that patients with a narrow QRS complex responded well to CRT. Even with QRS <130 ms, CRT should be tried if no other effective treatment is available.

A comparison of long-term outcomes between narrow and broad QRS complex patients treated with cardiac resynchronization therapy

2016 ◽  
Vol 71 (3) ◽  
pp. 323-330
Author(s):  
Lok Bin Yap ◽  
Son Thai Bin Nguyen ◽  
Faisal Qadir ◽  
Soot Keng ◽  
Zulkeflee Muhammad ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Cardiac Resynchronization ◽  
Qrs Complex ◽  
Resynchronization Therapy ◽  
Long Term Outcomes ◽  
Complex Patients

scholarly journals The Role of Echocardiography in the Optimization of Cardiac Resynchronization Therapy: Current Evidence and Future Perspectives

2017 ◽  
Vol 11 (1) ◽  
pp. 133-145 ◽  
Author(s):  
Michael Spartalis ◽  
Eleni Tzatzaki ◽  
Eleftherios Spartalis ◽  
Christos Damaskos ◽  
Antonios Athanasiou ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Patient Selection ◽  
Left Bundle Branch Block ◽  
Cardiac Resynchronization ◽  
Qrs Complex ◽  
Resynchronization Therapy ◽  
Bundle Branch Block ◽  
Ischaemic Cardiomyopathy ◽  
Lead Placement

Background: Cardiac resynchronization therapy (CRT) has become a mainstay in the management of heart failure. Up to one-third of patients who received resynchronization devices do not experience the full benefits of CRT. The clinical factors influencing the likelihood to respond to the therapy are wide QRS complex, left bundle branch block, female gender, non-ischaemic cardiomyopathy (highest responders), male gender, ischaemic cardiomyopathy (moderate responders) and narrow QRS complex, non-left bundle branch block (lowest, non-responders). Objective: This review provides a conceptual description of the role of echocardiography in the optimization of CRT. Method: A literature survey was performed using PubMed database search to gather information regarding CRT and echocardiography. Results: A total of 70 studies met selection criteria for inclusion in the review. Echocardiography helps in the initial selection of the patients with dyssynchrony, which will benefit the most from optimal biventricular pacing and provides a guide to left ventricular (LV) lead placement during implantation. Different echocardiographic parameters have shown promise and can offer the possibility of patient selection, response prediction, lead placement optimization strategies and optimization of device configurations. Conclusion: LV ejection fraction along with specific electrocardiographic criteria remains the cornerstone of CRT patient selection. Echocardiography is a non-invasive, cost-effective, highly reproducible method with certain limitations and accuracy that is affected by measurement errors. Echocardiography can assist with the identification of the appropriate electromechanical substrate of CRT response and LV lead placement. The targeted approach can improve the haemodynamic response, as also the patient-specific parameters estimation.

Results of the randomized studies on cardiac resynchronization therapy and the reevaluation of the cardiac ventricular activation in left bundle branch block

2013 ◽  
Vol 154 (18) ◽  
pp. 688-693 ◽  
Author(s):  
István Préda
Keyword(s):  
New York ◽  
Cardiac Resynchronization Therapy ◽  
Left Bundle Branch Block ◽  
Heart Association ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Qrs Complex ◽  
Resynchronization Therapy ◽  
Bundle Branch Block ◽  
New York Heart Association

If New York Heart Association Class II–IV heart failure is present, and ejection fraction ≤35%, electrocardiographic QRS width ≥ 120 ms in the presence of left bundle branch block, cardiac resynchronization therapy is indicated. Reevaluation of the data of cardiac resynchronization trials and electrophysiologic findings in left bundle branch block provided evidence that “true” left bundle branch block requires a QRS width of ≥130 ms (in woman) and ≥140 ms (in man). In “true” left bundle branch block, after the 40th ms of the QRS notched/slurred R waves are characteristic in minimum two of I, aVL, V1, V2, V5 and V6 leads, in addition to a ≥40 ms increase of the QRS complex, as compared to the original QRS complex. In contrast, slowly and continuously widened “left bundle branch block like” QRS patterns are mostly occur in left ventricular hypertrophy or in a metabolic/infiltrative disease. Orv. Hetil., 2013, 154, 688–693.

Pre-implantation interlead EKG heterogeneity is superior to QRS complex duration in predicting mechanical super-response and survival in patients receiving cardiac resynchronization therapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.L Bortolotto ◽  
R.L Verrier ◽  
B.D Nearing ◽  
A.A Marum ◽  
B Araujo Silva ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Area Under The Curve ◽  
Central Moment ◽  
Cardiac Resynchronization ◽  
Qrs Complex ◽  
Resynchronization Therapy ◽  
Predictors Of Response ◽  
All Cause Mortality ◽  
Before And After

Abstract Background Reliable quantitative predictors of response to cardiac resynchronization therapy (CRT) are needed. We compared the utility of pre-implantation R-wave and T-wave heterogeneity (RWH, TWH) to standard QRS complex duration for determination of mechanical super-response and mortality risk. Methods Of patients who received CRT devices between 2006 and 2018 at our institution, we retrospectively analyzed resting 12-lead ECG recordings from all 155 who met class I and IIA ACC/AHA/HRS guideline-based indications and had echocardiograms before and after implantation. Super-responders (n=35) (patients with ≥20% increase in LVEF and/or ≥20% decrease in LVESD) were compared to non super-responders (n=120), who did not. RWH and TWH, i.e., interlead splay, were measured by second central moment analysis. QRS complex duration was computed from the longest interval in a representative non-premature beat. Results Pre-implantation RWHV1–3 (p=0.01) and TWH in all lead sets tested (p=0.004 to 0.04) were significantly lower in super-responders than in non super-responders with corresponding significance for area under the curve (AUC) (p=0.002 to 0.03). Preimplantation QRS complex duration did not differ between super-responders and non super-responders (166±3 vs. 167±2 ms, p=0.8); the AUC for QRS complex duration (0.48, p=0.74) was not significant. RWHV1–3LILII at &gt;420 μV predicted 3-year all-cause mortality (p=0.037) with a hazard ratio of 7.440 (95% CI: 1.015–54.527, p=0.048) but QRS complex duration &gt;150 ms did not predict mortality (p=0.27). Conclusion Pre-implantation interlead EKG heterogeneity is superior to QRS complex duration in predicting mechanical super-response to CRT and survival. Bortolotto ESC graph Funding Acknowledgement Type of funding source: None

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