scholarly journals The development of a new, simple electrocardiographic method for the estimation of the latest activated left ventricular site

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Vereckei ◽  
G Katona
Keyword(s):  
Ventricular Tachycardia ◽  
Heart Association ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Adjacent Segment ◽  
Conduction Disturbance ◽  
Patient Response ◽  
Optimal Position ◽  
Intraventricular Conduction ◽  
Qrs Duration

Abstract Background Current cardiac resynchronization therapy (CRT) works by pacing the latest activated left ventricular (LV) site. The estimation of the location of the latest activated LV site (LALVS) may be important to determine the optimal position of the LV electrode during CRT or to predict the patient response to the current CRT technique devised to pace the LALVS usually present in patients with left bundle branch block (LBBB) pattern. Methods We used a modified 12-lead ECG algorithm originally devised and used by other authors* for a different purpose, to identify the segment of origin of ventricular tachycardia in the 16-segment American Heart Association LV model by analyzing the QRS axis in the limb and chest leads. We hypothesized that modifying this ECG algorithm by using the secondary ST vector axis instead of the QRS axis in the limb and chest leads, we can apply this ECG method to estimate the LALVS instead of the site of origin of the ventricular tachycardia. The resultant secondary ST vector is directed 180o away from the LALVS. Using this ECG method we determined the LALVS in 22 patients with LBBB and 20 patients with nonspecific intraventricular conduction disturbance (NICD) patterns and heart failure. To validate the ECG method, we also estimated the LALVS by echocardiography using 3D parametric imaging and 2D speckle tracking. Results The LALVS determined by the electrocardiographic method and echocardiogrpahy in the 16-segment model matched (was in the same or adjacent segment) in 38/42 (90.5%) patients and among these patients complete matching (the LALVSs were in the same segment) was found in 16/38 (42%) and partial matching (the LALVSs were in adjacent segments) in 22/38 (58%) patients. When the LBBB and NICD groups were separated to patients with ≥150 ms and <150 ms QRS duration subgroups, the LALVSs of the ≥150 ms subgroup were almost exclusively in the anterolateral (or anterior) or inferolateral areas and those of the <150 ms subgroup were in the above mentioned areas or sometimes at other sites located remote from these areas. Conclusions The novel, simple surface electrocardiographic method could as reliably estimate the approximate location of LALVS as echocardiography. The possible explanation for the effectivity of CRT in patients with sinus rhythm with intraventricular conduction disturbance and ≥150 ms QRS duration is that their LALVS is at the same most distant areas (anterolateral, anterior, inferolateral) from the initial septal activation site where the LV electrodes are positioned during application of the current CRT technique. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals A different cardiac resynchronization therapy technique might be needed in some patients with nonspecific intraventricular conduction disturbance pattern-final results

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Vereckei ◽  
G Katona ◽  
Z Szelenyi ◽  
B Kozman ◽  
G Szenasi
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Frontal Plane ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Electrode Position ◽  
Resynchronization Therapy ◽  
Conduction Disturbance ◽  
Intraventricular Conduction ◽  
St Segment ◽  
Surface Ecg

Abstract Background Current cardiac resynchronization therapy (CRT) works by pacing the latest activated left ventricular (LV) site. We hypothesized that the greater nonresponse rate of patients with nonspecific intraventricular conduction disturbance (NICD) than with left bundle branch block (LBBB) pattern to CRT might be due, besides less dyssynchrony, to the inability of the current CRT technique, devised to eliminate dyssynchrony caused by LBBB pattern, to eliminate dyssynchrony in some patients with NICD pattern, because their latest activated LV site is far away from that in LBBB. Methods We devised a novel surface ECG method to estimate the approximate location of the latest activated LV site based on the principle that the resultant ST vector of secondary ST segment alterations associated with wide QRS complexes is directed 180o away from the latest activated LV site. By measuring the amplitude and polarity of secondary ST segment alterations in two optional frontal and horizontal plane ECG leads and using a software, we determined the resultant 3D spatial secondary ST vector in 88 patients with LBBB and 57 patients with NICD patterns and heart failure. To validate the ECG method, we also estimated the latest activated LV region by echocardiography using 3D parametric imaging and 2D speckle tracking in 16 LBBB and 13 NICD patients. Patients with NICD pattern were subdivided according to their non-overlapping frontal plane resultant secondary ST vector ranges to NICD-1 (n=35) and NICD-2 (n=22) subgroups. Results The resultant 3D spatial secondary ST vector coordinates in the LBBB group were: (x axis: −0.228 mV, y axis: −0.062 mV, z axis: 0.63 mV); in the NICD-1 and NICD-2 subgroups: (x: 0.154 and 0.198 mV, y: −0.198 and 0.162 mV, z: 0.422 and 0.398 mV respectively). Consequently the latest activated LV sites were located leftward, posterosuperior in the LBBB group, right, posterosuperior in the NICD-1 and right, posteroinferior in the NICD-2 subgroups. The latest activated LV region determined by ECG and echocardiography matched in all patients, except 1. Conclusions The latest activated LV site was at the expected position in the LBBB group, while it was at an almost opposite site in the NICD-2 group [22/57 (39%)]. Thus, one potential reason for the unfavorable response to CRT, occurring in approx. 40% of patients with NICD pattern with a QRS duration of 120–149 ms in randomized studies, is that the current CRT technique using a left posterolateral LV electrode position may not be able to eliminate dyssynchrony in these patients. Funding Acknowledgement Type of funding source: None

scholarly journals The relation between cardiac 123I-mIBG scintigraphy and functional response 1 year after CRT implantation

2020 ◽  
Vol 22 (1) ◽  
pp. 49-57 ◽  
Author(s):  
D O Verschure ◽  
E Poel ◽  
G De Vincentis ◽  
V Frantellizzi ◽  
K Nakajima ◽  
...  
Keyword(s):  
Nyha Class ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Mibg Scintigraphy ◽  
Ventricular Ejection Fraction ◽  
Qrs Duration ◽  
Crt Response

Abstract Aims  Cardiac resynchronization therapy (CRT) is a disease-modifying therapy in patients with chronic heart failure (CHF). Current guidelines ascribe CRT eligibility on three parameters only: left ventricular ejection fraction (LVEF), QRS duration, and New York Heart Association (NYHA) functional class. However, one-third of CHF patients does not benefit from CRT. This study evaluated whether 123I-meta-iodobenzylguanidine (123I-mIBG) assessed cardiac sympathetic activity could optimize CRT patient selection. Methods and results  A total of 78 stable CHF subjects (age 66.8 ± 9.6 years, 73% male, LVEF 25.2 ± 6.7%, QRS duration 153 ± 23 ms, NYHA 2.2 ± 0.7) referred for CRT implantation were enrolled. Subjects underwent 123I-mIBG scintigraphy prior to implantation. Early and late heart-to-mediastinum (H/M) ratio and 123I-mIBG washout were calculated. CRT response was defined as either an increase of LVEF to >35%, any improvement in LVEF of >10%, QRS shortening to <150 ms, or improvement in NYHA class of >1 class. In 33 patients LVEF increased to >35%, QRS decreased <150 ms in 36 patients, and NYHA class decreased in 33 patients. Late H/M ratio and hypertension were independent predictors of LVEF improvement to >35% (P = 0.0014 and P = 0.0149, respectively). In addition, early H/M ratio, LVEF, and absence of diabetes mellitus (DM) were independent predictors for LVEF improvement by >10%. No independent predictors were found for QRS shortening to <150 ms or improvement in NYHA class. Conclusion  Early and late H/M ratio were independent predictors of CRT response when improvement of LVEF was used as measure of response. Therefore, cardiac 123I-mIBG scintigraphy may be used as a tool to optimize selection of subjects that might benefit from CRT.

Time interval from left ventricular stimulation to QRS onset is a predictor of mortality in patients with cardiac resynchronization therapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Yagishita ◽  
Y Yagishita ◽  
S Kataoka ◽  
K Yazaki ◽  
M Kanai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Independent Predictor ◽  
Total Mortality ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Time Interval ◽  
Heart Failure Hospitalization ◽  
Conduction Disturbance ◽  
Secondary Endpoints ◽  
Fibrotic Lesion

Abstract Introduction In our previous report, the time interval from left ventricular (LV) pacing to the earliest onset of QRS (S-QRS interval) has been found to be an independent predictor of mechanical response to cardiac resynchronization therapy (CRT). The S-QRS interval may indicate the conduction disturbance relevant to the localized tissue property such as scar or fibrotic lesion. Therefore, S-QRS interval longer than 37ms was associated with poor response to CRT, and proposed as suboptimal LV lead position. Then, we hypothesized that the longer S-QRS interval at the LV pacing site could be related to long term mortality and heart failure events in patients with CRT. Methods This retrospective study included 82 consecutive heart failure patients with sinus rhythm, reduced LV ejection fraction (≤35%), and a wide QRS complex (≥120ms), who undergone CRT implantation between 2012 January and 2017 December. Patients were divided into Short S-QRS group (<37ms, SS-QRS) and Long S-QRS group (≥37ms, LS-QRS) according to the previously reported optimal cut off value. A responder was defined as one with ≥15% reduction in LV end-systolic volume assessed by echocardiography at 6 months after CRT. The primary endpoint was total mortality, which included LV assist device implantation or heart transplantation. The secondary endpoints included the composite endpoint of total mortality or heart failure hospitalization. Results The study patients were divided into SS-QRS (N=43, age 65.9±13.2 years, 77% male) and LS-QRS (N=39, age 63.0±13.4, 85% male). In the electrocardiographic measurements, there were no significant differences in baseline QRS duration (162.4±30.3ms in SS-QRS vs. 154.5±31.6ms in LS-QRS, P=0.19) and LV local activation time assessed as Q-LV interval (118.3±34.3ms in SS-QRS vs. 115.3±32.0ms in LS-QRS, P=0.71). S-QRS interval was 25.9±5.3ms in SS-QRS and 51.5±13.7ms in LS-QRS (P<0.01), and the responder rate was significantly higher in SS-QRS compared with LS-QRS (79% vs. 29%, P<0.01). During mean follow up of 47.7±22.4 months, 24 patients (29%) reached to the primary endpoint, while the secondary endpoints were observed in 47 patients (57%). LS-QRS patients had significantly worse event-free survival for both primary and secondary endpoints (Figure). After the multivariate Cox regression analysis, LS-QRS (≥37ms) was an independent predictor of total mortality (HR=2.6, 95% CI: 1.11 to 6.12, P=0.03) and the secondary composite events (HR=2.4, 95% CI: 1.31 to 4.33, P<0.01). Conclusion The S-QRS interval longer than 37ms, which may reflect the conduction disturbance relevant to the scar or fibrotic lesion at the LV pacing site, was a significant predictor of the total mortality and heart failure hospitalization. These findings have implications for the optimal LV lead placement in patients with CRT device. Clinical outcomes according to S-QRS Funding Acknowledgement Type of funding source: None

Cathodic-anodal left ventricular stimulation during cardiac resynchronization therapy: haemodynamic evaluation and electrocardiographic analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Gravellone ◽  
G Dell' Era ◽  
F De Vecchi ◽  
E Boggio ◽  
E Prenna ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Arterial Pressure ◽  
Cardiac Resynchronization Therapy ◽  
Right Ventricle ◽  
Single Point ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Biventricular Stimulation ◽  
Qrs Duration

Abstract Background Cardiac resynchronization therapy (CRT) is an established treatment for heart failure with reduced ejection fraction (HFrEF). However, one third of patients are “non responders”. Cathodic-anodal (CA) left ventricle (LV) capture is a multisite pacing occurring during CRT using both bipolar and quadripolar LV lead. It allows depolarization to arise simultaneously from the cathode and the anode of the bipole located on the LV epicardium, activating a larger volume of myocardium than cathodal pacing alone, thus potentially improving electromechanical synchrony (figure 1). We have previously proven that CA-LV stimulation is feasible and similar to bicathodic multipoint pacing (MPP) in terms of QRS wavefront activation. Purpose We aimed to evaluate both the acute intraprocedural haemodynamic and electrical effects of CA biventricular stimulation (CA-BS), comparing it with right-ventricle only pacing (Right Ventricle-Stimulation: RV-S), single-point CRT (Single Point-Biventricular Stimulation: SP-BS) and multipoint bicathodic biventricular stimulation (Multi Point-Biventricular Stimulation:MP-BS) in de novo CRT implants. Methods Ten patients candidates to CRT (LV ejection fraction ≤35% and left bundle branch block) received a quadripolar LV lead. Four pacing configurations were tested: RV-S, SP-BS, MP-BS and CA-BS, where cathode and the anode were the same electrodes used as cathodes in MP-BS. QRS duration by 12-lead ECG was defined as the time from the earliest ventricular deflection until the return to the isoelectric line. Haemodynamic assessment by radial artery catheterization using Pressure Recording Analytical Method processed the following parameters: dP/dT max (mmHg/msec), systolic arterial pressure (aPsys, mmHg), diastolic arterial pressure (aPdia, mmHg), mean arterial pressure (aPmean, mmHg), Cardiac Index (CI, l/min/m2), Stroke Volume Index (SVI, ml/min/m2). Results dP/dT max and aPmean increased significantly from RV-S to SP-BS (mean dP/dT max 0,82±0,28 versus 0,87±0,29 mmHg/msec, p=0,02; mean aPmean 89±19 versus 93±20 mmHg, p=0,01), but not from RV-S to MP-BS. Comparing RV-S to CA-BS, only aPmean exhibited a significant increase (mean aPmean 89±19 versus 92±20 mmHg, p=0,01). There were no haemodynamic differences between SP-BS, MP-BS and CA-BS. QRS duration reduced significantly from RV-S (167±10 msec) to each biventricular stimulation (135±14 msec, p=0,0002 for SP-BS; 130±17 msec, p=0,0001 for MP-BS; 129±18 msec, p=0,0002 for CA-BS) and from SP-BS to MP-BS and CA-BS (p=0,03 for both), whereas there were no difference comparing MP-BS and CA-BS. Conclusions CA-LV stimulation is not superior to single-point CRT in terms of acute haemodynamic performance, whereas it reduces the duration of ventricular electrical activation, showing an electrohaemodynamic mismatch. Long-term studies are needed to evaluate if acute electrical benefits of CA stimulation can predict chronic benefits, in terms of reverse cardiac remodelling. Cathodic-anodal left ventricular capture Funding Acknowledgement Type of funding source: None

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.

Multisite, multipoint pacing

2017 ◽  
Vol 2 (43) ◽  
pp. 9-13
Author(s):  
Przemysław Mitkowski
Keyword(s):  
Nyha Class ◽  
Standard Of Care ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Ventricular Pacing ◽  
Reduced Ejection Fraction ◽  
Clinical Benefits ◽  
Qrs Duration ◽  
Left Ventricular Pacing ◽  
Rv Pacing

Cardiac resynchronization therapy in patients with heart failure, reduced ejection fraction and prolonged QRS duration has become standard of care. Unfortunately, despite improvements in delivery of this treatment still approximately 30% of patients are non-responders. Among causes of this phenomenon one can find an inability to deliver hemodynamically effective left ventricular pacing. There were proposed several solutions to solve the problem, including: multisite RV pacing, multisite LV pacing, multipoint LV pacing. Multisite RV pacing (two RV leads positioned in RV: apex and RVOT), although causes some hemodynamic improvement in LVEF or distance in 6MWT and reduction of LVESD or number of hospitalizations in comparison to no paced patients, but its efficacy is significantly worse than normal CRT. So it should not be considered as an alternative to CRT even to surgically placed LV lead. Multisite LV pacing (two leads iv cardiac veins) gives significant benefits over standard CRT, especially in patients with poor heart vein system, which preclude optimal LV lead placement. Clinical benefits of this mode of therapy were observed in non-responders to classical CRT, and were proved in: higher responder rates, improved EF, VO2, distance in 6MWT, reduction of NYHA class, LVESV, LVEDD and increase of dP/dt. Multipoint LV pacing (different pacing point located on the same LV lead) is encouraging way of CRT delivery and does not require any additional lead. Benefits of MP pacing over classical CRT were proved in numerous trails in acute tests by improvement in dP/dt, increase in maximal strain rate, shortening of total activation time, reduction in QRS duration and after mid- and long term follow-up in reduction of LVESV, increase in EF, reduction of asynchrony and higher percentage of responders. Multipoint left ventricular pacing should be a standard of CRT delivery in first implantations.

scholarly journals Imaging predictive factors and exercise training in CRT patients

2016 ◽  
Vol 86 (1-2) ◽  
Author(s):  
Ana Abreu ◽  
Helena Santa Clara
Keyword(s):  
Single Photon ◽  
Imaging Techniques ◽  
Photon Emission ◽  
Mechanical Dyssynchrony ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Conduction Delay ◽  
Lv Function ◽  
Scar Burden ◽  
Intraventricular Conduction

<p>Cardiac resynchronization therapy (CRT) is an established treatment for patients with moderate-to-severe chronic heart failure (CHF) and intraventricular conduction delay, which is identified by a QRS interval of 120msec or more on a 12-lead electrocardiogram (ECG). CRT improved functional capacity, reduced hospitalizations for worsening CHF and increased survival. However, about 30-40% of patients who underwent CRT were non-responders with no clinical or echocardiographic improvement. Imaging parameters for prediction of CRT response have been reviewed. Cardiac magnetic resonance (CMR), recognized as the gold standard to assess viability, has shown to obtain good results regarding quantification of scar burden. CMR-derived measures of mechanical dyssynchrony appear to predict the outcome of CRT, however they have not been externally validated. Nuclear imaging techniques, namely single-photon emission cardiac tomography (SPECT) provide data on scar burden and location, left ventricular (LV) function, LV contraction and mechanical dyssynchrony from a single scan. The presence, location and burden of myocardial scar have been shown to affect response to CRT. However, compared to CMR, the low spatial resolution of scintigraphy might overestimate the scar extent. This problem can be overcome by positron emission tomography (PET). SPECT has also been used to quantify dyssynchrony, using phase analysis. Imaging investigation is ongoing, trying to better identifying CRT non-responders. The combination of ExT in CRT has not been well investigated; however some data show different aerobic exercise modes and intensities can further improve CRT benefits. Data available on the effects of ExT in patients with CRT have been reviewed.</p>

Abstract 5935: Influence of Recent Advances in the Management of Heart Failure and Ventricular Arrhythmias on Survival in Patients with Cardiac Sarcoidosis

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Yoshikazu Yazaki ◽  
Mitsuaki Horigome ◽  
Kazunori Aizawa ◽  
Takeshi Tomita ◽  
Hiroki Kasai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Tachycardia ◽  
Cardiac Sarcoidosis ◽  
Severe Heart Failure ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Predictors Of Mortality ◽  
Recent Advances

Background : We previously described severity of heart failure and ventricular tachycardia (VT) as independent predictors of mortality in patients with cardiac sarcoidosis (CS). Medical treatment for chronic heart failure has been established over the last few decades. Prophylactic use of implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT or CRT-D) have been introduced in patients with severe heart failure. We therefore hypothesized that the prognosis of CS improves due to such advances in the management of heart failure and VT. Methods : To confirm our hypothesis, we analyzed 43 CS patients diagnosed between 1988 and 2006 and treated with corticosteroids. We classified two sequential referral patients diagnosed between 1988 and 1997 (n=19) and between 1998 and 2006 (n=24), and compared treatment and prognosis between the two cohorts. Results : Left ventricular ejection fraction (LVEF) and dimensions were similar between the two cohorts. Although age in the 1988–1997 referral cohort was significantly younger than that in the 1998–2006 referral cohort (54±14years versus 62±10years, p<0.05), survival in the earlier cohort was significantly worse (log-rank=4.41, p<0.05). The 1- and 5-year mortality rates were 88% and 71% in the 1988–1997 referral cohort, and 96% and 92% in the 1998–2006 referral cohort, respectively. The 1998–2006 referral cohort showed significantly higher incidence of ICD or CRT-D implantation (29% versus 6%, p<0.05), β-blocker use (46% versus 6%, p<0.01) and addition of methotrexate (21% versus 0%, p<0.05), and increased maintenance dose (7.0±1.9mg/day versus 5.0±0.9mg/day, p<0.01) compared to the 1988–1997 referral cohort. Multivariate analysis including age, LVEF, and sustained ventricular tachycardia (sVT) identified diagnosis between 1988 and 1997 (hazard ratio [HR]: 19.8, p<0.01) and LVEF (HR: 0.83/1% increase, p<0.01) as independent predictors of mortality. Conclusions : Survival in the recent CS patients is significantly better than previously described. Recent advances in the device therapies and medical treatments including modified immunosuppression alter the clinical outcome in patients with CS.

scholarly journals Narrower QRS may be enough to respond to cardiac resynchronization therapy in lightweight patients

2019 ◽  
Vol 35 (6) ◽  
pp. 835-841 ◽  
Author(s):  
Toshiko Nakai ◽  
Hiroaki Mano ◽  
Yukitoshi Ikeya ◽  
Yoshihiro Aizawa ◽  
Sayaka Kurokawa ◽  
...  
Keyword(s):  
Body Size ◽  
Cardiac Resynchronization Therapy ◽  
Response Rate ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Conduction Disturbances ◽  
Body Sizes ◽  
Qrs Duration ◽  
Crt Response

AbstractA prolonged QRS duration (QRSd) is promising for a response to cardiac resynchronization therapy (CRT). The variation in human body sizes may affect the QRSd. We hypothesized that conduction disturbances may exist in Japanese even with a narrow (< 130 ms)-QRS complex; such patients could be CRT candidates. We investigated the relationships between QRSd and sex and body size in Japanese. We retrospectively analyzed the values of 338 patients without heart failure (HF) (controls) and 199 CRT patients: 12-lead electrocardiographically determined QRSd, left ventricular diastolic and systolic diameters (LVDd and LVDs), body surface area (BSA), body mass index (BMI), and LVEF. We investigated the relationships between the QRSd and BSA, BMI, and LVD. The men’s and women’s BSA values were 1.74 m2 and 1.48 m2 in the controls (p < 0.0001), and 1.70 m2 and 1.41 m2 in the CRT patients (p < 0.0001). The men’s and women’s QRSd values were 96.1 ms and 87.4 ms in the controls (p < 0.0001), and 147.8 ms and 143.9 ms in the CRT group (p = 0.4633). In the controls, all body size and LVD variables were positively associated with QRSd. The CRT response rate did not differ significantly among narrow-, mid-, and wide-QRS groups (83.6%, 91.3%, 92.4%). An analysis of the ROC curve provided a QRS cutoff value of 114 ms for CRT responder. The QRSd appears to depend somewhat on body size in patients without HF. The CRT response rate was better than reported values even in patients with a narrow QRSd (< 130 ms). When patients are considered for CRT, a QRSd > 130 ms may not be necessary, and the current JCS guidelines appear to be appropriate.

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