Association between changes in QRS width and echocardiographic responses to cardiac resynchronization therapy

Ma, Jing; Liu, Yi; Dong, Yun; Chen, Ming; Xia, Lianghua; Xu, Min

doi:10.1097/md.0000000000018684

Cited by 5 publications

(3 citation statements)

References 32 publications

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“…Prior studies have shown that reduction in QRS width is predictive of response to CRT with a prior meta-analysis showing a mean QRS reduction of 20.5 ms greater in responders versus nonresponders. [37][38][39][40] Within our cohort, there was not as significant a reduction, potentially secondary to many with an intrinsically paced rhythm before CRT upgrade.…”

Section: Discussionmentioning

confidence: 68%

Cardiac resynchronization therapy response in cardiac sarcoidosis

Shabtaie

Sehrawat

Lee

et al. 2022

Cardiovasc electrophysiol

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Introduction: Cardiac sarcoidosis (CS) is a nonischemic cardiomyopathy (NICM) characterized by infiltration of noncaseating granulomas involving the heart with highly variable clinical manifestations that can include conduction abnormalities and systolic heart failure. Cardiac resynchronization therapy (CRT) has shown significant promise in NICM, though little is known about its efficacy in patients with CS. Objective: To determine if CRT improved cardiac remodeling in patients with CS. Methods: We retrospectively reviewed all patients with a clinical or histological diagnosis of CS who underwent CRT implantation at the Mayo Clinic enterprise from 2000 to 2021. Baseline characteristics, imaging parameters, heart failure hospitalizations and need for advanced therapies, and major adverse cardiac events (MACE) were assessed.Results: Our cohort was comprised of 55 patients with 61.8% male and a mean age of 58.7 ± 10.9 years. Eighteen (32.7%) patients had definite CS, 21 (38.2%) had probable CS, while 16 (29.1%) had presumed CS, and 26 (47.3%) with extracardiac sarcoidosis. The majority underwent CRT-D implantation (n = 52, 94.5%) and 3(5.5%) underwent CRT-P implantation with 67.3% of implanted devices being upgrades from prior pacemakers or implantable cardioverter defibrillators. At 6 months postimplantation there was no significant improvement in ejection fraction (34.8 ± 10.9% vs. 37.7 ± 14.2%, p = .331) or left ventricular end-diastolic diameter (58.5 ± 10.2 vs. 57.5 ± 8.1 mm, p = .236), though mild improvement in left ventricular end systolic diameter (49.1 ± 9.9 vs. 45.7± 9.9 mm, p < .0001). Within the first 6 months postimplantation, 5 (9.1%) patients sustained a heart failure hospitalization.At a mean follow-up of 4.1± 3.7 years, 14 (25.5%) patients experienced a heart

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Section: Discussionmentioning

confidence: 68%

Cardiac resynchronization therapy response in cardiac sarcoidosis

Shabtaie

Sehrawat

Lee

et al. 2022

Cardiovasc electrophysiol

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“…This is further supported by a recent meta-analysis of 11 (five prospective and six retrospective) studies, investigating the changes of QRS width with the incidence of echocardiographic response to CRT in 1524 patients, in whom QRS narrowing was significantly greater in responders than non-responders (weighted mean difference: −20.54 ms; p < .001). 36 By monitoring QRS duration, one can easily detect loss of capture in one ventricle with effectual capture in the other ventricle, as this will cause a change in the paced QRS morphology and duration (widening) in the 12-lead ECG similar to that of either single chamber RV or LV pacing (Table 3). Of course, complete loss of capture in both ventricles will expose the preprocedural baseline ECG morphology.…”

Section: Qrs Durationmentioning

confidence: 99%

Electrocardiography of cardiac resynchronization therapy: Pitfalls and practical tips

Manolis¹,

Manolis

Manolis³

et al. 2021

Cardiovasc electrophysiol

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Cardiac resynchronization therapy (CRT) has been established as an effective mode of therapy in patients with heart failure and concurrent cardiac dyssynchrony, principally in the form of left bundle branch block (LBBB). The widespread use of CRT has ushered in a new landscape in 12-lead electrocardiography (ECG). ECG readings in these patients are most important to guide troubleshooting and also appropriate device programming, as well as discerning and managing nonresponders. A set of four ECG recordings need to accompany each patient with a CRT device, including a baseline ECG and recordings from monochamber (right and left ventricular) and biventricular pacing, which can be compared against a new recording to facilitate the evaluation of proper versus problematic biventricular pacing. Precordial ECG leads V1/2 acquired at the fourth intercostal space and limb leads, I and III, together with a quick assessment of perpendicular leads I and aVF to determine the quadrant of the QRS axis in the hexaxial diagram, may provide the framework for proper ECG interpretation in these patients. This important issue of 12lead ECG in CRT patients is herein reviewed, pitfalls are pointed out and practical tips are provided for ECG reading to help recognize and manage problems with CRT device function. Furthermore, several pertinent ECG recordings and tabulated data are provided, and an algorithm is suggested that integrates prior algorithms and relevant information from current literature.

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“…8 ). The narrowing of the QRS complex after the biventricular pacing is associated with clinical and echocardiographic improvement [ 37 , 38 ]. This demonstrates the prognostic significance attributed to the ECG in patients with these devices.…”

Section: Surface Ecg In Patients With Cardiac Implantable Electronic ...mentioning

confidence: 99%

Conduction Disorders: The Value of Surface ECG

Silva

Maciel

2021

CCR

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Purpose of review: The purpose of the current mini-review is to describe the importance of surface ECG for the diagnosis of conduction disorder. Methods: The MEDLINE/PubMed database was used, with the keywords "ECG" and "conduction disorders"; over the past 10 years. Other documents were included because of their relevance. Main findings: Data on the anatomy and function of the cardiac electrical system have been described. Conduction disorders including sinus node dysfunction, atrioventricular blocks, intraventricular conduction disorders are exposed as to their epidemiology, etiology, presentation, anatomical site of impaired conduction of the electrical stimulus. The importance of ECG in patients with a cardiac implantable electronic device was also discussed, in addition to future perspectives. Conclusion: Surface ECG allows the diagnosis of atrioventricular and intraventricular conduction disorder and its anatomical block site most of the time, without the need for invasive tests such as electrophysiological study. Dysfunctions of cardiac implantable electronic devices can be diagnosed by ECG, as well as the prediction of response to cardiac resynchronization therapy.

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Association between changes in QRS width and echocardiographic responses to cardiac resynchronization therapy

Cited by 5 publications

References 32 publications

Cardiac resynchronization therapy response in cardiac sarcoidosis

Cardiac resynchronization therapy response in cardiac sarcoidosis

Electrocardiography of cardiac resynchronization therapy: Pitfalls and practical tips

Conduction Disorders: The Value of Surface ECG

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