Cardiac resynchronization therapy-induced acute shortening of QRS duration predicts long-term mortality only in patients with left bundle branch block

Jastrzębski, Marek; Baranchuk, Adrián; Fijorek, Kamil; Kisiel, Roksana; Kukla, Piotr; Sondej, Tomasz; Czarnecka, Danuta

doi:10.1093/europace/euy254

Cited by 62 publications

(54 citation statements)

References 22 publications

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“…4 Narrowing of the QRS complex with biventricular pacing (the paced QRS duration [QRSd]) has been shown to correlate with clinical and echocardiographic improvement, 6,7 as well as long-term mortality. 8 One study has also reported that ECG-based optimization using the measurement of the narrowest QRS is comparable to echocardiography-based optimization with regard to left ventricle (LV) reverse remodeling. 9 SyncAV is a device-based algorithm that is available in some CRT devices manufactured by Abbott (Chicago, IL).…”

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confidence: 99%

Optimization of Chronic Cardiac Resynchronization Therapy Using Fusion Pacing Algorithm Improves Echocardiographic Response

et al. 2020

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Background: Whether reprogramming of cardiac resynchronization therapy (CRT) to increase electrical synchrony translates into echocardiographic improvement remains unclear. SyncAV is an algorithm that allows fusion of intrinsic conduction with biventricular pacing. We aimed to assess whether reprogramming chronically implanted CRT devices with SyncAV is associated with improved echocardiographic parameters. Methods: Patients at a quaternary center with previously implanted CRT devices with a programmable SyncAV algorithm underwent routine electrocardiography-based SyncAV optimization during regular CJC Open 2 (2020) 62e70

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confidence: 99%

Optimization of Chronic Cardiac Resynchronization Therapy Using Fusion Pacing Algorithm Improves Echocardiographic Response

et al. 2020

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“…33 The QRS duration of CRT responders was shortened by 21 ms when compared with nonresponders, a phenomenon closely related to clinical outcomes that underscores the importance of multiparametric selection criteria. 29,30 There are important limitations to the present study and data.…”

Section: Discussionmentioning

confidence: 84%

“…We hypoth- propriate CRT candidates and monitor response to therapy. 29,30 It is important to note that while CRT responders and nonresponders had a similar pre-CRT QRS duration, the responders had a far greater number of patients with a left bundle branch block. In left bundle branch block, there is pre-ejection septal contraction (also known as "septal flash"), followed by rebound septal re-lengthening and stretch due to late posterolateral LV activation; the result is impaired septal pump function and LV ejection.…”

Section: Discussionmentioning

confidence: 99%

Left ventricle and mitral valve reverse remodeling in response to cardiac resynchronization therapy in nonischemic cardiomyopathy

et al. 2020

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Background Cardiac resynchronization therapy (CRT) improves left heart geometry and function in nonischemic cardiomyopathy (NICMP). We aimed to detail the effects of CRT on left ventricular (LV) and mitral valve (MV) remodeling using 2‐dimensional transthoracic echocardiography. Methods Forty‐five consecutive patients with NICMP who underwent CRT implantation between 2009 and 2012, and had pre‐CRT and follow‐up echocardiograms available, were included. Paired t test, linear and logistic regression, and Kaplan–Meier survival analyses were used for statistical assessment. Results The mean age and QRS duration were 60 years and 157 ms, respectively, and 13 (28.9%) were female. At a mean follow‐up of 3 years, there were 22 (48.9%) “CRT responders” (≥15% reduction in LV end‐systolic volume index [LVESVi]). Significant improvements were observed in LV ejection fraction (26.3% vs 34.3%) and LVESVi (87.7 vs 71.1 mL/m2), as well as mitral regurgitation vena contracta width, MV tenting height and area, and end‐systolic interpapillary muscle distance. Five‐year actuarial survival was 87.5%. Multivariate regression analyses revealed the pre‐CRT LVESVi (β = 0.52), and MV coaptation length (β = −0.34) and septolateral annular diameter (β = 0.25) as good correlates of follow‐up LVESVi. Variables associated with CRT response were pre‐CRT MV coaptation length (OR 1.75, 95% CI 1.0‐3.1) and posterior leaflet tethering angle (OR 1.07, 95% CI 1.0‐1.14), irrespective of baseline QRS morphology and duration (all P < .05). Conclusions Cardiac resynchronization therapy improves LV and MV geometry and function in half of patients with NICMP, which is paralleled by decreased mitral regurgitation severity. The extent of pre‐CRT LV remodeling and MV tethering are associated with CRT response.

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“…With the development of pacing technology, researches on physiological pacing have made some achievements. Heart failure (HF) patients with left bundle branch block (LBBB) can benefit from the cardiac resynchronization therapy (CRT), 1 but the rate of non‐response to CRT is 30‐40% 2 . His bundle pacing (HBP) can correct bundle branch block 3 and improve the electrical and mechanical synchronization of the patients with HF 4,5 .…”

Section: Introductionmentioning

confidence: 99%

LBBAP in patients with normal intrinsic QRS duration: Electrical and mechanical characteristics

Wang

Lan

Zhang

et al. 2021

Pacing Clinical Electrophis

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Background Left bundle branch area pacing (LBBAP) is an innovative pacing technology, which needs further study. Methods Seventy LBBAP patients with intrinsic QRS duration (QRSd) less than 120 ms were consecutively enrolled in our center. According to whether the left bundle branch potential (LBBp) was recorded or not, the patients were divided into the potential positive group (LBBAP+) and the potential negative group (LBBAP−). Electrocardiographic and echocardiographic parameters were used to evaluate electrical and mechanical characteristics. Lead parameters and complications were followed‐up. Results There were 52 patients in LBBAP+ and 18 patients in LBBAP−. The QRSd and the left ventricular activation time (LVAT) were wider after LBBAP. QRSd showed no significant difference between LBBAP+ and LBBAP−. LVAT was significantly shorter in LBBAP+ than in LBBAP−. Frontal QRS axis shifted leftward and the V1 morphologies changed after LBBAP. QRS axis and V1 morphologies showed no significant differences between two groups. Paced R‐wave transition moved forward compared with intrinsic R‐wave transition in both groups. Peak systolic strain of left ventricle (LVPSS) increased, and peak systolic dispersion of left ventricle (LVPSD) did not change significantly after LBBAP. Systolic and diastolic function as well as mechanical synchronism had no significant differences between two groups. LBBAP had great pacing parameters. Conclusion LBBAP changes electrical and mechanical characteristics and has good safety in patients with normal intrinsic QRSd. LBBAP+ and LBBAP− show no significant differences in mechanical synchronization and interventricular electrical synchronization. The LBBAP+ shows better left ventricular electrical synchronicity.

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Cardiac resynchronization therapy-induced acute shortening of QRS duration predicts long-term mortality only in patients with left bundle branch block

Cited by 62 publications

References 22 publications

Optimization of Chronic Cardiac Resynchronization Therapy Using Fusion Pacing Algorithm Improves Echocardiographic Response

Optimization of Chronic Cardiac Resynchronization Therapy Using Fusion Pacing Algorithm Improves Echocardiographic Response

Left ventricle and mitral valve reverse remodeling in response to cardiac resynchronization therapy in nonischemic cardiomyopathy

LBBAP in patients with normal intrinsic QRS duration: Electrical and mechanical characteristics

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