Feasibility and cardiac synchrony of permanent left bundle branch pacing through the interventricular septum

EP Europace ◽  
2019 ◽  
Vol 21 (11) ◽  
pp. 1694-1702 ◽  
Author(s):  
Xiaofeng Hou ◽  
Zhiyong Qian ◽  
Yao Wang ◽  
Yuanhao Qiu ◽  
Xing Chen ◽  
...  
Keyword(s):  
Interventricular Septum ◽  
Left Ventricular ◽  
Spect Myocardial Perfusion ◽  
Septal Pacing ◽  
Pacing Lead ◽  
Qrs Duration ◽  
Mechanical Synchrony ◽  
R Wave Amplitude ◽  
Normal Cardiac Function

Abstract Aims Left bundle branch pacing (LBBP) recently emerges as a novel pacing modality. We aimed to evaluate the feasibility and cardiac synchrony of permanent LBBP in bradycardia patients. Methods and results Left bundle branch pacing was successfully performed in 56 pacemaker-indicated patients with normal cardiac function. Left bundle branch pacing was achieved by penetrating the interventricular septum (IVS) into the left side sub-endocardium with the pacing lead. His-bundle pacing (HBP) was successfully performed in another 29 patients, 19 of whom had right ventricular septal pacing (RVSP) for backup pacing. The QRS duration, left ventricular (LV) activation time (LVAT), and mechanical synchrony using phase analysis of gated SPECT myocardial perfusion imaging were evaluated. Paced QRS duration in LBBP group was significantly shorter than that in RVSP group (117.8 ± 11.0 ms vs. 158.1 ± 11.1 ms, P < 0.0001) and wider than that in HBP group (99.7 ± 15.6 ms, P < 0.0001). Left bundle branch potential was recorded during procedure in 37 patients (67.3%). Left bundle branch pacing patients with potential had shorter LVAT than those without potential (73.1 ± 11.3 ms vs. 83.2 ± 16.8 ms, P = 0.03). Left bundle branch pacing patients with potential had similar LV mechanical synchrony to those in HBP group. R-wave amplitude and capture threshold of LBBP were 17.0 ± 6.7 mV and 0.5 ± 0.1 V, respectively at implant and remained stable during a mean follow-up of 4.5 months without lead-related complications. Conclusion Permanent LBBP through IVS is safe and feasible in bradycardia patients. Left bundle branch pacing could achieve favourable cardiac electrical and LV mechanical synchrony.

Left bundle branch pacing improved heart function in a 10-year-old child after a 3-month follow-up

EP Europace ◽  
2020 ◽  
Vol 22 (8) ◽  
pp. 1234-1239
Author(s):  
Wei Ji ◽  
Xueying Chen ◽  
Jie Shen ◽  
Diqi Zhu ◽  
Yiwei Chen ◽  
...  
Keyword(s):  
Heart Function ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Bundle Branch Block ◽  
Ventricular Ejection Fraction ◽  
Intracardiac Electrogram ◽  
Ventricular Activation ◽  
Pacing Lead

Abstract Aims As a physiological pacing strategy, left bundle branch pacing (LBBP) were used to correct left bundle branch block (LBBB), however, there is no relevant report in children. We aimed to evaluate the feasibility of LBBP in children. Methods and results Left bundle branch pacing was performed in a 10-year-old girl with a second-degree atrioventricular and LBBB. Under the guide of fluoroscopy, the pacing lead was deeply screwed into the interventricular septum to gain right bundle branch block (RBBB) pattern of paced QRS. Selective LBBP was achieved with a typical RBBB pattern of paced morphology and a discrete component between stimulus and ventricular activation in intracardiac electrogram and reached the standard of the stimulus to left ventricular activation time of 56 ms. At a 3-month follow-up, the LBBP acquired the reduction of left ventricular size and enhancement of left ventricular ejection fraction. Conclusion The application of LBBP in a child was first achieved with inspiring preliminary results. The LBBP can be carried out in children by cautiousness under the premise of strict grasp of indications.

P4528Feasibility and safety of left bundle branch area pacing by transvenous approach through the interventricular septum in patients with left bundle branch block

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
W J Huang ◽  
S J Wu ◽  
L Su ◽  
X Y Chen ◽  
B N Cai ◽  
...  
Keyword(s):  
Success Rate ◽  
Left Bundle Branch Block ◽  
Wave Amplitude ◽  
Interventricular Septum ◽  
Bundle Branch Block ◽  
His Bundle ◽  
Qrs Duration ◽  
Transvenous Approach ◽  
R Wave Amplitude

Abstract Background His bundle pacing (HBP) has been shown to correct left bundle branch block (LBBB), however it often requires high pacing output and the success rate is variable. Objective To assess the feasibility and safety of left bundle branch area pacing (LBBAP) in patients with LBBB. Methods From Apr 2014 to Aug 2018, patients with LBBB from multicenters indicated for CRT or pacing therapy were included. LBBAP was performed by advancing the MDT 3830 lead deep into the septum about 1 cm distal to the His bundle region (Figure 1F). Pacing characteristics, success rate, threshold and R-wave amplitude were assessed. Results A total of 94 patients aged 68.3±10.7 y with the native QRS duration of 167.2±17.2 ms were included. In 92 patients, LBBAP was successfully achieved and demonstrated RBBB pattern during unipolar tip pacing (UTP), with the paced QRS duration of 116.4±12.6ms (Figure 1C). Fusion of LBBAP and native conduction via the RBB eliminated RBBB and resulted in an average QRS duration of 103.2±10.1 ms (Figure 1D). LBB potential could be recorded from the LBB lead during correction of LBBB by HBP in 21 patients who used two leads method (His lead and LBB lead, Figure 1B). Output dependent selective and non-selective LBBAP were demonstrated in 48 patients (Figure 1C, D). The LBB capture threshold by UTP was 0.53±0.18V/0.5ms at acute and 0.62±0.17V/0.5ms at 6 months and 0.65±0.2V/0.5ms at 1 year. The R-wave amplitude were 11.4±5.2mV, 12.4±5.8mV and 12.0±5.8mV at acute, 6 month and 1 year. During follow-up, only one patient had an increase in LBB capture threshold to 2.5V/0.5ms at 3 months and there were no other complications such as dislodgment, infections, embolism or stroke associated with the implantation. Conclusion Permanent LBBAP is feasible and safe in patients with LBBB.

Lead performance and clinical outcomes of patients with permanent His-Purkinje system pacing: a single-centre experience

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii45-ii53
Author(s):  
Zhiyong Qian ◽  
Yuanhao Qiu ◽  
Yao Wang ◽  
Zeyu Jiang ◽  
Hongping Wu ◽  
...  
Keyword(s):  
Cardiac Function ◽  
Clinical Outcomes ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Purkinje System ◽  
Pacing Lead ◽  
Qrs Morphology

Abstract Aims His-Purkinje system (HPS) pacing, including His bundle (HB) and left bundle branch (LBB) pacing, has emerged as a highlighted topic in recent years. Comparisons in lead performance and clinical outcomes between HB and LBB pacing were seldom reported. We aimed to investigate the mid-long-term lead performance and clinical outcomes of permanent HPS pacing patients in our centre. Methods and results Permanent HB pacing was implemented by placing the pacing lead helix at the HB area. Left bundle branch pacing was achieved by placing the lead helix in the left-side sub-endocardium of the interventricular septum. Pacing parameters, 12-lead ECG, echocardiography, and clinical outcomes were evaluated during follow-up. A total of 64 patients with HB pacing and 185 with LBB pacing were included. Left bundle branch pacing exhibited a slightly longer paced QRS duration than HB pacing (117.7 ± 11.0 vs. 113.7 ± 19.8 ms, P = 0.04). Immediate post-operation, LBB pacing had a significant higher R-wave amplitude (16.5 ± 7.5 vs. 4.3 ± 3.6 mV, P &lt; 0.001) and lower capture threshold (0.5 ± 0.1 vs. 1.2 ± 0.8 V, P &lt; 0.001) compared with HB pacing. During follow-up, an increase in capture threshold of &gt;1.0 V from baseline was found in eight (12.5%) patients in the HB pacing group and none in LBB pacing. Paced QRS morphology changed from Qr to QS in lead V1 in seven patients (3.8%) with LBB pacing. Both HB and LBB pacing preserved cardiac function in patients with left ventricular ejection fraction (LVEF) over 50%. In patients with LVEF &lt;50%, both HB and LBB pacing improved clinical outcomes during follow-up. Conclusion His-Purkinje system pacing produced favourable electrical synchrony and improved cardiac function in patients with heart failure. Left bundle branch pacing showed superior pacing parameters over HB pacing. Lead micro-displacement with changes in paced QRS morphology posts a concern in LBB pacing.

scholarly journals Comparison of QRSarea and left ventricular activation time during left bundle branch pacing and left ventricular septal pacing

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
LIB Heckman ◽  
JGK Luermans ◽  
K Curila ◽  
AMW Van Stipdonk ◽  
S Westra ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Funding Sources ◽  
Septal Pacing ◽  
Ventricular Activation ◽  
Intrinsic Conduction ◽  
Qrs Morphology ◽  
Conversion Matrix ◽  
Qrs Duration ◽  
Normal Cardiac Function ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Background Left bundle branch area pacing (LBBAP) has recently been introduced as a novel physiological pacing strategy. Within LBBAP, distinction is made between left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP, no left bundle capture). Objective To compare acute electrocardiographic (ECG) and vectorcardiographic (VCG) effects of LBBP and LVSP as compared to intrinsic conduction. Methods In 50 patients with normal cardiac function and pacemaker indication for bradycardia, ECG characteristics of LBBP and LVSP were evaluated during RVSP and pacing at various depths in the septum: starting at the RV side of the septum: the last position with QS morphology, the first position with r’ morphology, LVSP and – in patients where LBB capture was achieved – LBBP. From the ECG’s QRS duration and QRS morphology in V1, and the stimulus-LVAT interval were measured. After conversion of the ECG into VCG (Kors conversion matrix), QRS area was calculated. Results In LVSP, QRS area significantly decreased from 82 ± 29 µVs during RVSP to 46 ± 12 µVs during LVSP. In patients where LBB capture was achieved QRS area significantly decreased from 78 ± 23 µVs to 38 ± 15 µVs in LBBP. In patients with LBB capture, QRS area was significantly smaller during LBBP compared to LVSP (figure A), but LVAT was not significantly different (figure B, p = 0.138). In patients with normal ventricular activation where LBBP was achieved (n = 20), QRS area was significantly larger during LVSP (48 ± 17) compared to LBBP (37 ± 16), the latter being not significantly different from normal intrinsic ventricular activation (35 ± 19 µVs). Conclusions ECG and VCG indices demonstrate that ventricular dyssynchrony is comparable but slightly more synchronous during LBBP compared to LVSP. Abstract Figure. QRS area and S-LVAT in LVSP and LBBP

scholarly journals Association between Neonatal Intakes and Hyperglycemia, and Left Heart and Aortic Dimensions at 6.5 Years of Age in Children Born Extremely Preterm

2021 ◽  
Vol 10 (12) ◽  
pp. 2554
Author(s):  
Jawwad Hamayun ◽  
Lilly-Ann Mohlkert ◽  
Elisabeth Stoltz Sjöström ◽  
Magnus Domellöf ◽  
Mikael Norman ◽  
...  
Keyword(s):  
Interventricular Septum ◽  
Posterior Wall ◽  
Root Diameter ◽  
Left Ventricular ◽  
Left Heart ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Nutritional Data ◽  
Aortic Dimensions

Survivors of extremely preterm birth (gestational age < 27 weeks) have been reported to exhibit an altered cardiovascular phenotype in childhood. The mechanisms are unknown. We investigated associations between postnatal nutritional intakes and hyperglycemia, and left heart and aortic dimensions in children born extremely preterm. Postnatal nutritional data and echocardiographic dimensions at 6.5 years of age were extracted from a sub-cohort of the Extremely Preterm Infants in Sweden Study (EXPRESS; children born extremely preterm between 2004–2007, n = 171, mean (SD) birth weight = 784 (165) grams). Associations between macronutrient intakes or number of days with hyperglycemia (blood glucose > 8 mmol/L) in the neonatal period (exposure) and left heart and aortic dimensions at follow-up (outcome) were investigated. Neonatal protein intake was not associated with the outcomes, whereas higher lipid intake was significantly associated with larger aortic root diameter (B = 0.040, p = 0.009). Higher neonatal carbohydrate intake was associated with smaller aorta annulus diameter (B = −0.016, p = 0.008). Longer exposure to neonatal hyperglycemia was associated with increased thickness of the left ventricular posterior wall (B = 0.004, p = 0.008) and interventricular septum (B = 0.004, p = 0.010). The findings in this study indicate that postnatal nutrition and hyperglycemia may play a role in some but not all long-lasting developmental adaptations of the cardiovascular system in children born extremely preterm.

scholarly journals Comparing Ventricular Synchrony in Left Bundle Branch and Left Ventricular Septal Pacing in Pacemaker Patients

2021 ◽  
Vol 10 (4) ◽  
pp. 822
Author(s):  
Luuk I.B. Heckman ◽  
Justin G.L.M. Luermans ◽  
Karol Curila ◽  
Antonius M.W. Van Stipdonk ◽  
Sjoerd Westra ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Activation Time ◽  
Ventricular Synchrony ◽  
Septal Pacing ◽  
Ventricular Activation ◽  
Qrs Morphology ◽  
Conversion Matrix ◽  
Qrs Duration ◽  
The Right ◽  
Electrophysiological Effects

Background: Left bundle branch area pacing (LBBAP) has recently been introduced as a novel physiological pacing strategy. Within LBBAP, distinction is made between left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP, no left bundle capture). Objective: To investigate acute electrophysiological effects of LBBP and LVSP as compared to intrinsic ventricular conduction. Methods: Fifty patients with normal cardiac function and pacemaker indication for bradycardia underwent LBBAP. Electrocardiography (ECG) characteristics were evaluated during pacing at various depths within the septum: starting at the right ventricular (RV) side of the septum: the last position with QS morphology, the first position with r’ morphology, LVSP and—in patients where left bundle branch (LBB) capture was achieved—LBBP. From the ECG’s QRS duration and QRS morphology in lead V1, the stimulus- left ventricular activation time left ventricular activation time (LVAT) interval were measured. After conversion of the ECG into vectorcardiogram (VCG) (Kors conversion matrix), QRS area and QRS vector in transverse plane (Azimuth) were determined. Results: QRS area significantly decreased from 82 ± 29 µVs during RV septal pacing (RVSP) to 46 ± 12 µVs during LVSP. In the subgroup where LBB capture was achieved (n = 31), QRS area significantly decreased from 46 ± 17 µVs during LVSP to 38 ± 15 µVs during LBBP, while LVAT was not significantly different between LVSP and LBBP. In patients with normal ventricular activation and narrow QRS, QRS area during LBBP was not significantly different from that during intrinsic activation (37 ± 16 vs. 35 ± 19 µVs, respectively). The Azimuth significantly changed from RVSP (−46 ± 33°) to LVSP (19 ± 16°) and LBBP (−22 ± 14°). The Azimuth during both LVSP and LBBP were not significantly different from normal ventricular activation. QRS area and LVAT correlated moderately (Spearman’s R = 0.58). Conclusions: ECG and VCG indices demonstrate that both LVSP and LBBP improve ventricular dyssynchrony considerably as compared to RVSP, to values close to normal ventricular activation. LBBP seems to result in a small, but significant, improvement in ventricular synchrony as compared to LVSP.

Prospective evaluation of clinical safety and efficacy of left bundle branch area pacing in comparison with right ventricular sepal pacing

2021 ◽  
Author(s):  
Xing Liu ◽  
Wenbin Li ◽  
Jianping Zeng ◽  
He Huang ◽  
Lei Wang ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Clinical Trial Registry ◽  
Clinical Safety ◽  
Ventricular Ejection Fraction ◽  
Safety And Efficacy ◽  
His Bundle ◽  
Mechanical Synchrony

Abstract BackgroundLeft bundle branch area pacing (LBBaP) has recently emerged as alternative a new physiologic strategy of pacing to His-bundle pacing (HBP) associated with difficulty of lead implantation, His bundle damage, high and unstable thresholds.ObjectiveThe purpose of this study is to compare clinical safety and efficacy of LBBaP with right ventricular sepal pacing (RVSP).MethodsFrom February 2019 to May 2020, consecutive pacing-indicated patients were prospectively enrolled and divided into two groups. Ventricular synchrony index such as QRS duration (QRSd), interventricular mechanical delay (IVMD) and septal-posterior wall motion delay (SPWMD), left ventricular function such as left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF), pacing parameters, and complications were evaluated in perioperative period and during follow-up.ResultsLBBaP was successful in 45 patients (88.2%), and finally 46 patients underwent RVSP. With LBBaP, the ventricular electrical- mechanical synchrony were similar with the native-conduction system (P = .784). However, the ventricular electrical synchrony (QRSd, 108.47 ± 7.64 vs 130.63 ± 13.63 ms, P < .0001) and mechanical synchrony (IVMD, 27.68 ± 4.33 vs 39.88 ± 5.83, P < .0001; SPWMD, 40.39 ± 23.21 vs 96.36 ± 11.55, P < .0001) in the LBBaP group were significantly superior to the RVSP group. No significant differences in LVEDD (46 [44-48.5] vs 47 [44–52] mm, P = .488) and LVEF% (66 [62.5–70] vs 64 [61–68], P = .759) were noted in both two groups at last follow-up. But, in the subgroup analysis, LVEDD was shorter (46 [44–49] vs 50 [47–58] mm, P = .032) and the LVEF% was higher (65 [62–68] vs 63 [58–65], P = .022) in the LBBaP-H (high ventricular pacing ratio > 40%) group compared with RVSP-H group at last follow-up. There was lower capture thresholds (0.59 ± 0.18V vs. 0.71 ± 0.26V, P = 0.011) at implantation in the LBBaP group than RVSP group, and R-wave amplitudes and pacing impedances did not differ between the two groups. No serious complications were found in both two groups at implantation and follow-ups.ConclusionThis study confirms the clinical safety and efficacy of LBBaP, and that produces better ventricular electrical-mechanical synchrony than RVSP. The event of pacing-induced left ventricular dysfunction is lower in the LBBaP-H group than RVSP-H group.Trial registrationTrial registration Chinese Clinical Trial Registry, ChiCTR2100046901, Registered 30 May 2021—Retrospectively registered, http://www.chictr.org.cn/searchproj.aspx?regstatus=1008001.

scholarly journals Antiarrhythmic Effect of Sacubitril-Valsartan: Cause or Consequence of Clinical Improvement?

2019 ◽  
Vol 8 (6) ◽  
pp. 869 ◽  
Author(s):  
António Valentim Gonçalves ◽  
Tiago Pereira-da-Silva ◽  
Ana Galrinho ◽  
Pedro Rio ◽  
Luísa Moura Branco ◽  
...  
Keyword(s):  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Antiarrhythmic Effect ◽  
Qtc Interval ◽  
Dispersion Index ◽  
Time Intervals ◽  
Mechanical Dispersion ◽  
Before And After ◽  
Qrs Duration

Sacubitril/Valsartan (LCZ696) reduced sudden cardiac death in the PARADIGM-HF trial. However, the mechanism by which LCZ696 reduces ventricular arrhythmias remains unclear. The aim of this study was to compare electrocardiographic (ECG) parameters and mechanical dispersion index, assessed by left ventricular (LV) global longitudinal strain (GLS), before and after LCZ696 therapy. We prospectively evaluated chronic Heart Failure (HF) patients with LV ejection fraction ≤40%, despite optimal medical and device therapy, in which LCZ696 therapy was started, while no additional HF treatment was expected to change. ECG and transthoracic echocardiographic data were gathered in the week before starting LCZ696 and at six months of therapy. A semiautomated analysis of LV GLS was performed and mechanical dispersion index was defined as the standard deviation from 16 time intervals corresponding to each LV segment. Of the 42 patients, 35 completed the six month follow-up, since two patients died and five discontinued treatment for adverse events. QTc interval (451.9 vs. 426.0 ms, p < 0.001), QRS duration (125.1 vs. 120.8 ms, p = 0.033) and mechanical dispersion index (88.4 vs. 78.1 ms, p = 0.036) were significantly reduced at six months. LCZ696 therapy is associated with a reduction in QTc interval, QRS duration and mechanical dispersion index as assessed by LV GLS.

Alcohol septal ablation in patients with severe septal hypertrophy

Heart ◽  
2019 ◽  
Vol 106 (6) ◽  
pp. 462-466 ◽  
Author(s):  
Josef Veselka ◽  
Morten Jensen ◽  
Max Liebregts ◽  
Robert M Cooper ◽  
Jaroslav Januska ◽  
...  
Keyword(s):  
Interventricular Septum ◽  
Heart Association ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Class Iii ◽  
Short Term ◽  
Alcohol Septal Ablation ◽  
Left Ventricular Outflow

ObjectiveThe current guidelines suggest alcohol septal ablation (ASA) is less effective in hypertrophic obstructive cardiomyopathy (HOCM) patients with severe left ventricular hypertrophy, despite acknowledging that systematic data are lacking. Therefore, we analysed patients in the Euro-ASA registry to test this statement.MethodsWe compared the short-term and long-term outcomes of patients with basal interventricular septum (IVS) thickness <30 mm Hg to those with ≥30 mm Hg treated using ASA in nine European centres.ResultsA total of 1519 patients (57±14 years, 49% women) with symptomatic HOCM were treated, including 67 (4.4%) patients with IVS thickness ≥30 mm. The occurrence of short-term major adverse events were similar in both groups. The mean follow-up was 5.4±4.3 years and 5.1±4.1 years, and the all-cause mortality rate was 2.57 and 2.94 deaths per 100 person-years of follow-up in the IVS <30 mm group and the IVS ≥30 mm group (p=0.047), respectively. There were no differences in dyspnoea (New York Heart Association class III/IV 12% vs 16%), residual left ventricular outflow tract gradient (16±20 vs 16±16 mm Hg) and repeated septal reduction procedures (12% vs 18%) in the IVS <30 mm group and IVS ≥30 mm group, respectively (p=NS for all).ConclusionsThe short-term results and the long-term relief of dyspnoea, residual left ventricular outflow obstruction and occurrence of repeated septal reduction procedures in patients with basal IVS ≥30 mm is similar to those with IVS <30mm. However, long-term all-cause and cardiac mortality rates are worse in the ≥30 mm group.

scholarly journals usefulness of the electrocardiogram and cardiac magnetic resonance to differentiate tachycardia induced cardiomyopathy from dilated cardiomyopathy in patients admitted for heart failure

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
A Vera Sainz ◽  
A Cecconi ◽  
P Martinez-Vives ◽  
MJ Olivera ◽  
S Hernandez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Dilated Cardiomyopathy ◽  
Left Ventricular ◽  
High Rate ◽  
Left Ventricular Ejection ◽  
Qrs Duration ◽  
Tachycardia Induced Cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: None. Background In patients admitted for heart failure (HF) with reduced left ventricular ejection fraction (LVEF) and a concomitant high-rate supraventricular tachyarrhythmia (SVT) it is challenging to predict LVEF recovery after heart rate control and distinguish tachycardia-induced cardiomyopathy (TIC) from dilated cardiomyopathy (DC). The role of cardiac magnetic resonance (CMR) and the electrocardiogram (ECG) in this setting remains unsettled. Methods Forty-three consecutive patients admitted for HF due to high-rate SVT and LVEF &lt;50% undergoing CMR in the acute phase were retrospectively included. Those who had LVEF &gt;50% at follow up were classified as TIC and those with LVEF &lt;50% were classified as DC. Clinical, laboratory, CMR and ECG findings were analyzed to predict LVEF recovery. Results Twenty-five (58%) patients were classified as TIC. Patients with DC had wider QRS (121.2 ± 26 vs 97.7 ± 17.35 ms; p = 0.003). On CRM the TIC group presented with higher LVEF (33.4 ± 11 vs 26.9 ± 6.4% p = 0.019) whereas late gadolinium enhancement (LGE) was more frequent in DC group (61 vs 16% p = 0.004). On multivariate analysis, QRS duration ≥100 ms (p = 0.027), LVEF &lt; 40% on CMR (p = 0.047) and presence of LGE (p = 0.03) were identified as independent predictors of lack of LVEF recovery. Furthermore, during clinical follow-up (median 60 months) DC patients were admitted more frequently for HF (44% vs 0%; p &lt; 0.001) than TIC patients (Figure 1). Conclusion In patients with reduced LVEF admitted for HF due to high-rate SVT, QRS duration ≥100 ms, LVEF &lt;40% on CMR and presence of LGE are independently associated with lack of LVEF recovery and worse clinical outcome.

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