Congestive Heart Failure and QRS Duration

Shenkman, Heather J.; Pampati, Vijayamalini; Khandelwal, Akshay; McKinnon, John; Nori, David; Kaatz, Scott; Sandberg, Keisha R.; McCullough, Peter A.

doi:10.1378/chest.122.2.528

Cited by 219 publications

(162 citation statements)

References 32 publications

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“…[21][22][23] In fact, an inverse relationship between QRSd and EF has been described. 21 Shenkman et al found a progressive decrease in EF as QRSd lengthened above 120 ms. 32 Furthermore, Sandhu and Bahler noted that mean EF decreased from 41% to 29% and 25% as QRSd increased from <100 ms to 120 ms to 149 ms and >150 ms, respectively. 33 Similarly, QRSd correlated with NYHA class.…”

Section: Comparison To Previous Registries and Reportsmentioning

confidence: 98%

QRS Duration Is Associated With Atrial Fibrillation in Patients With Left Ventricular Dysfunction

El‐Chami

Brancato²,

Langberg

et al. 2010

Clinical Cardiology

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Background: QRSduration (QRSd) is associated with higher mortality and morbidity in patients with left ventricular (LV) dysfunction. The association between QRSd and atrial fibrillation (AF) has not been studied in this patient population. Objectives: To investigate the association between QRSd and AF in patients with LV dysfunction. Methods: Data were obtained from the National Registry to Advance Heart Health (ADVANCENT) registry, a prospective multicenter registry of patients with left ventricular ejection fraction (LVEF) ≤40%. A total of 25 268 patients from 106 centers in the United States, were enrolled between June 2003 and November 2004. Demographic and clinical characteristics of patients were collected from interviews and medical records. Results: Mean age was 66.3 ± 13 years, 71.5% were males, and 81.9% were white. A total of 14 452 (57.8%) patients had a QRSd <120 ms, 5304 (21.2%) had a QRSd between 120 and 150 ms, and 5269 (21%) had a QRSd >150 ms. Atrial fibrillation occurred in 20.9%, 27.5%, and 35.5% of patients in the QRS groups, respectively (P < 0.0001). After adjusting for potential AF risk factors (age, gender, race, body mass index, hypertension, diabetes, renal failure, cancer, lung disease, New York Heart Association [NYHA] class, ejection fraction, etiology of cardiomyopathy) and the use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, and lipid lowering drugs, QRS duration remained independently associated with AF (odds ratio: 1.20, 95% confidence interval: 1.14-1.25). Conclusion:In this large cohort of patients, QRSd was strongly associated with AF and therefore may predict the occurrence of this arrhythmia in patients with LV dysfunction. This association persisted after adjusting for disease severity, comorbid conditions, and the use of medications known to be protective against AF.

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Section: Comparison To Previous Registries and Reportsmentioning

confidence: 98%

QRS Duration Is Associated With Atrial Fibrillation in Patients With Left Ventricular Dysfunction

El‐Chami

Brancato²,

Langberg

et al. 2010

Clinical Cardiology

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“…33 Shenkman et al also documented this finding. 34 Previous reports have shown that AF incidences varies with severity of systolic dysfunction among the heart failure patients. 35 There is strong association between duration of QRS complex and AF.…”

Section: Discussionmentioning

confidence: 98%

Heart Failure; Co-Relation of QRS Duration With Atrial Fibrillation in Patients With Reduced Ejection Fraction

Mir

Asghar²,

Javed

2017

TPMJ

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ABSTRACT… Introduction: Atrial fibrillation (AF) and wider QRS duration have long been identified to worsen heart failure and LV dysfunction and increase cardiovascular morbidity and mortality. Therefore, it is necessary to identify those patients of heart failure who are at greater risk for cardiovascular morbidity and mortality so that such subjects may be focused for preventive strategies. An association exists between QRS duration and AF with greater incidences of cardiovascular events in patients of heart failure with LV systolic dysfunction. Sampling technique was non-probability, purposive sampling. Result: The study population consisted of male (72.3%) and female (27.7%). Mean LA diameter was 40.3±6.08 mm and mean LV ejection fraction 31.8±6.6 % in the study population. Ischemic heart disease was the most common cause of LV dysfunction (88.3%) followed by non-ischemic cardiomyopathy (8.75%) and non-Ischemic valvular heart disease (3.5%). The frequency of Narrow QRSd (<120 ms) was 62%, Intermediate QRSd (120-150 ms) was 26.5% and Wide QRSd (>150 ms) was 11.5%. The frequency of atrial fibrillation in study population was 15.75%. The frequency of atrial fibrillation was highest in Wide QRSd group (>150 ms) i.e. (60.9%), followed by Intermediate QRSd group (120-150 ms) i.e. (18.9%) and narrow QRSd group (<120 ms) i.e. (6.04%). Patient with atrial fibrillation were more likely to have poor ejection fraction (P<0.0023) and wider QRS duration (P<0.0001). Frequency of atrial fibrillation was highest in Valvular Cardiomyopathy (non-ischemic valvular heart disease) patients (42.8%) as compared to coronary artery disease group (15.3%) and non-ischemic cardimyopathy group (9.4%). Conclusion: In patients of heart failure with reduced ejection fraction (HFrEF), the frequency of atrial fibrillation increases as QRS duration widens. This group of patients must be focused for AF preventive strategies. Key words:Atrial fibrillation (AF), Left ventricular (LV), QRS duration (QRSd). Article Citation: Mir N, Asghar N, Javed S. Heart failure; co-relation of QRS duration with atrial fibrillation in patients with reduced ejection fraction. Professional Med J 2017;24(6):912-918.

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“…Nega- tive remodelling of the left ventricle can result in complete LBBB and a prolonged QRS duration, both of which adversely affect the prognosis of patients with heart failure. [17][18][19] In cardiomyopathy, the intrinsic QRS duration progressively increases over time, and both the initial QRS and extent of QRS prolongation are linked to patient mortality. [19][20][21] CRT can decrease the QRS duration by providing biventricular pacing and reducing left ventricular volume.…”

Section: Discussionmentioning

confidence: 99%

Effects of Cardiac Resynchronization Therapy on Ventricular Electrical Remodeling in Patients With Heart Failure

et al. 2015

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SummaryCardiac resynchronization therapy (CRT) reverses structural remodeling of the left ventricle. We investigated whether CRT reverses left-ventricular electrical remodeling.Eighty patients were enrolled and implanted with CRT-devices. Echocardiography and electrocardiography data were obtained from each patient prior to implantation and two years after implantation. At two years after implantation, the patients were classified into a responder group and a non-responder group based on echocardiography.Over the next 2 years, 75 patients completed follow-up, and 5 patients had died. Echocardiography results showed that 23 patients could be classified as non-responders and 52 as responders. Larger numbers of non-responders were diagnosed with either ischemic cardiomyopathy (ICM) or nonspecific intraventricular conduction delay (NICD). The intrinsic QRS duration was not changed in responders, patients with dilated cardiomyopathy, or in the patient categories of male and female. However, the intrinsic QRS duration was significantly prolonged in non-responders and patients with ischemic cardiomyopathy (P = 0.041). The mean left ventricular end-diastolic diameter in the responder group was significantly decreased by CRT (P < 0.05), while there was no significant change in intrinsic QRS duration.While CRT does not reduce the intrinsic QRS duration, it can delay negative ventricular electrical remodeling. Continuous CRT is necessary. (Int Heart J 2015; 56: 495-499)

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Congestive Heart Failure and QRS Duration

Cited by 219 publications

References 32 publications

QRS Duration Is Associated With Atrial Fibrillation in Patients With Left Ventricular Dysfunction

QRS Duration Is Associated With Atrial Fibrillation in Patients With Left Ventricular Dysfunction

Heart Failure; Co-Relation of QRS Duration With Atrial Fibrillation in Patients With Reduced Ejection Fraction

Effects of Cardiac Resynchronization Therapy on Ventricular Electrical Remodeling in Patients With Heart Failure

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