THE IMPACT OF QRS MORPHOLOGY ON THE EVOLUTION OF GLOBAL, LEFT VENTRICULAR WASTED WORK IN CARDIAC RESYNCHRONIZATION THERAPY RECIPIENTS

Abstract Background The effectiveness of cardiac resynchronization therapy (CRT) in patients without left bundle branch block (non-LBBB) QRS morphology is limited, compared to those with LBBB. Still, a substantial part of these patients can benefit from therapy and additional selection criteria are needed to identify these patients. Purpose To evaluate the association of additional baseline 12-lead ECG features; with clinical and echocardiographic outcomes in CRT-treated non-LBBB patients. Methods Pre-implantation 12-lead ECGs from 790 consecutive non-LBBB CRT patients from 3 implanting centres in the Netherlands were evaluated for the presence of predefined ECG parameters. QRS morphology (right bundle branch block and intraventricular conduction delay), QRS duration (≥/<150ms), QRS area (≥/<109μVs), left ventricular activation time ((≥/<125ms), and the presence of fragmented QRS (fQRS). The association with the primary endpoint, the combination of left ventricular assist device implantation, cardiac transplantation and all-cause mortality, was evaluated. Results There was a significantly lower occurrence of the primary endpoint in non-LBBB patients with QRS area ≥109 μVs (p<0.001) and in those without fQRS present (p=0.004) (figure 1). Figure 1 Conclusion A large QRS area and the absence of fQRS are positively associated to event free survival in non-LBBB patients treated with CRT. Whereas currently used patient selection cut-off QRS duration is not associated to outcome in these patients. These data may provide additional value for the non-LBBB patient selection for CRT and warrant prospective evaluation of these ECG features. Acknowledgement/Funding None

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The impact of left ventricular lead position on left ventricular reverse remodelling and improvement in mechanical dyssynchrony in cardiac resynchronization therapy

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jes114 ◽

2012 ◽

Vol 13 (12) ◽

pp. 991-1000 ◽

Cited By ~ 7

Author(s):

H. M. Kristiansen ◽

G. Vollan ◽

T. Hovstad ◽

H. Keilegavlen ◽

S. Faerestrand

Keyword(s):

Cardiac Resynchronization Therapy ◽

Mechanical Dyssynchrony ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Lead Position ◽

Left Ventricular Lead Position ◽

Ventricular Lead ◽

Reverse Remodelling ◽

The Impact

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Regarding the impact of left ventricular size on response to cardiac resynchronization therapy

American Heart Journal ◽

10.1016/j.ahj.2012.01.001 ◽

2012 ◽

Vol 163 (4) ◽

pp. e11 ◽

Cited By ~ 2

Author(s):

Gaetano Santulli ◽

Salvatore D'Ascia ◽

Cristofaro D'Ascia

Keyword(s):

Cardiac Resynchronization Therapy ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Ventricular Size ◽

Resynchronization Therapy ◽

Left Ventricular Size ◽

The Impact

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The impact of the left ventricular pacing polarity and localization during cardiac resynchronization therapy on depolarization and repolarization parameters

The Anatolian Journal of Cardiology ◽

10.14744/anatoljcardiol.2018.62357 ◽

2018 ◽

Author(s):

Emin Evren Özcan

Keyword(s):

Cardiac Resynchronization Therapy ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Ventricular Pacing ◽

Resynchronization Therapy ◽

Left Ventricular Pacing ◽

The Impact

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The value of septal rebound stretch analysis for the prediction of volumetric response to cardiac resynchronization therapy

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa190 ◽

2020 ◽

Vol 22 (1) ◽

pp. 37-45 ◽

Cited By ~ 1

Author(s):

Odette A E Salden ◽

Alwin Zweerink ◽

Philippe Wouters ◽

Cornelis P Allaart ◽

Bastiaan Geelhoed ◽

...

Keyword(s):

Cardiac Resynchronization Therapy ◽

Patient Selection ◽

Predictive Value ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Clinical Trial Registration ◽

Systolic Volume ◽

End Systolic Volume ◽

Qrs Morphology

Abstract Aims Patient selection for cardiac resynchronization therapy (CRT) may be enhanced by evaluation of systolic myocardial stretching. We evaluate whether systolic septal rebound stretch (SRSsept) derived from speckle tracking echocardiography is a predictor of reverse remodelling after CRT and whether it holds additive predictive value over the simpler visual dyssynchrony assessment by apical rocking (ApRock). Methods and results The association between SRSsept and change in left ventricular end-systolic volume (ΔLVESV) at 6 months of follow-up was assessed in 200 patients. Subsequently, the additive predictive value of SRSsept over the assessment of ApRock was evaluated in patients with and without left bundle branch block (LBBB) according to strict criteria. SRSsept was independently associated with ΔLVESV (β 0.221, P = 0.002) after correction for sex, age, ischaemic cardiomyopathy, QRS morphology and duration, and ApRock. A high SRSsept (≥optimal cut-off value 2.4) also coincided with more volumetric responders (ΔLVESV ≥ −15%) than low SRSsept in the entire cohort (70.0% and 56.4%), in patients with strict LBBB (83.3% vs. 56.7%, P = 0.024), and non-LBBB (70.7% vs. 46.3%, P = 0.004). Moreover, in non-LBBB patients, SRSsept held additional predictive information over the assessment of ApRock alone since patients that showed ApRock and high SRSsept were more often volumetric responder than those with ApRock but low SRSsept (82.8% vs. 47.4%, P = 0.001). Conclusion SRSsept is strongly associated with CRT-induced reduction in left ventricular end-systolic volume and holds additive prognostic information over QRS morphology and ApRock. Our data suggest that CRT patient selection may be improved by assessment of SRSsept, especially in the important subgroup without strict LBBB. Clinical trial registration The MARC study was registered at clinicaltrials.gov: NCT01519908.

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