Magnitude of QRS duration reduction after biventricular pacing identifies responders to cardiac resynchronization therapy

Coppola, Giuseppe; Ciaramitaro, Gianfranco; Stabile, Giuseppe; D’Onofrio, Antonio; Palmisano, Pietro; Carità, Patrizia; Mascioli, Giosuè; Pecora, Domenico; Simone, Antonio De; Marini, Massimiliano; Rapacciuolo, Antonio; Savarese, Gianluca; Maglia, Giampiero; Pepi, Patrizia; Padeletti, Luigi; Pierantozzi, Attilio; Arena, Giuseppe; Giovannini, Tiziana; Caico, Salvatore Ivan; Nugara, Cinzia; Ajello, Laura; Malacrida, Maurizio; Corrado, Egle

doi:10.1016/j.ijcard.2016.06.203

Cited by 39 publications

(35 citation statements)

References 37 publications

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“…10,13,14 However, QRSd narrowing is an important indicator of the correction of electrical conduction disturbance and is currently the most important measure of the CRT effect on electromechanical resynchronization. 20 In our study, LBBAP achieved a QRSd ≤ 130 ms in only 25 of 30 patients who had met the current criteria of successful LBBAP, while partial narrowing of the QRSd was observed in five patients. Our previous study included criteria with a QRSd ≤ 130 ms into the definition of successful LBBAP in patients with atrioventricular block and normal heart structure.…”

Section: Discussioncontrasting

confidence: 46%

Left bundle branch area pacing delivery of cardiac resynchronization therapy and comparison with biventricular pacing

et al. 2020

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Aims This multicentre observational study aimed to prospectively assess the efficacy of left bundle branch area pacing (LBBAP) in heart failure patients with left bundle branch block (LBBB) and compare the 6-month outcomes between LBBAP and biventricular pacing (BVP). Methods and results Consecutive patients with LBBB and left ventricular ejection fraction (LVEF) ≤ 35% were prospectively recruited if they had undergone LBBAP as a primary or rescue strategy from three separate centres from March to December 2018. Patients who received BVP in 2018 were retrospectively selected by using 2 to 1 propensity score matching to minimize bias. Implant characteristics and echocardiographic parameters were assessed during the 6-month follow-up. LBBAP procedure succeeded in 81.1% (30/37) of patients, with selective LBBAP in 10 patients, and 3 of 20 patients combined non-selective LBBAP and LV lead pacing for further QRS narrowing. LBBAP resulted in significant QRS narrowing (from 178.2 ± 18.8 to 121.8 ± 10.8 ms, P < 0.001, paced QRS duration ≤ 130 ms in 27 patients) and improved LVEF (from 28.8 ± 4.5% to 44.3 ± 8.7%, P < 0.001) during the 6-month follow-up. The comparison between 27 patients with LBBAP alone and 54 of 130 matching patients with BVP showed that LBBAP delivered a greater reduction in the QRSd (58.0 vs. 12.5 ms, P < 0.001), a greater increase in LVEF (15.6% vs. 7.0%, P < 0.001), and greater echocardiographic (88.9% vs. 66.7%, P = 0.035) and super response (44.4% vs. 16.7%, P = 0.007) to cardiac resynchronization therapy. Conclusions LBBAP could deliver cardiac resynchronization therapy in most patients with heart failure and LBBB, and might be a promising alternative resynchronization approach to BVP.

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Section: Discussioncontrasting

confidence: 46%

Left bundle branch area pacing delivery of cardiac resynchronization therapy and comparison with biventricular pacing

et al. 2020

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“…A reduction in QRS duration after CRT has been shown to acutely improve hemodynamics and as well as left ventricular reverse remodeling . In addition, narrowing of the QRS has been associated with a reduction in functional mitral regurgitation as well as a reduction in cardiovascular hospitalizations and mortality . Our findings of a negative moderate correlation between change in QRS duration and change in LVEF further support the significance of QRS narrowing after CRT.…”

Section: Discussionsupporting

confidence: 72%

Predicting response to cardiac resynchronization therapy: Use of strict left bundle branch block criteria

Hadjis

AlTurki

Proietti

et al. 2019

Pacing Clinical Electrophis

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Background Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in heart failure with reduced ejection fraction (HFrEF). CRT efficacy is greater in left bundle branch block (LBBB). This study aimed to determine if strict LBBB criteria predict an improved QRS duration and left ventricular ejection fraction (LVEF) response after CRT. Methods HFrEF patients who received a CRT device at a single quaternary center were included. Patients were divided into three groups based on baseline QRS morphology. Group 1 consisted of patients with strict LBBB. Group 2 had conventional LBBB, and group 3 had non‐LBBB morphology. Outcomes assessed included change in QRS duration after CRT, change in LVEF, and all‐cause mortality. Results In 231 patients, 56% of patients were in group 1, 29% were in group 2, and 15% were in group 3. Patients with strict LBBB had a significant reduction in QRS duration (–20.9 ± 12.4 ms) compared to conventional LBBB (6.7 ± 19.4 ms; P < 0.0001) and non‐LBBB (3.9 ± 29.3 ms; P < 0.0001). Patients with strict LBBB had a significant increase in LVEF (19.5 ± 10.2) compared to conventional LBBB (5.3 ± 12.6; P < 0.0001) and non‐LBBB (–1.3 ± 10.9; P < 0.0001). There was moderate negative correlation between changes in QRS duration and LVEF (correlation coefficient = –0.63, P < 0.0001). Strict LBBB criteria were associated with a significant reduction in mortality compared to conventional LBBB (odds ratio 0.49, 95% confidence interval 0.24 to 0.99; P = 0.046). Conclusions Strict LBBB predicted a reduction in QRS duration and an increase in LVEF compared to conventional LBBB and non‐LBBB morphology in patients with HFrEF who received CRT.

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“…Several authors equal to several approaches. The main thing is that interventricular delay, in general, has been proven as it has its role in left ventricular remodeling [6] or prediction of CRT clinical response many times [7,8,9]. Other studies worked with RV to LV measurements.…”

Section: Discussionmentioning

confidence: 99%

Differences in right-to-left vs left-to-right interventricular conduction times in patients indicated to cardiac resynchronization therapy

et al. 2020

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Introduction Differences in conduction times from right ventricle to left ventricle and from left ventricle to right ventricle respectively were observed during biventricular devices implantation when changing pacing vector direction. In this article the phenomenon of interventricular conduction time differences is described and assessed in relationship to various clinical and electrophysiological parameters. Methods In 62 consecutive patients (9 females) interventricular conduction times between right and left ventricle in both directions were measured during cardiac resynchronization therapy device implantation procedure. Complex pacing protocol was performed. Results Investigated individuals was divided into 3 subgroups according to type of interventricular conduction pattern and statistically tested with various clinical data. Substantial differences in right-to-left vs left-to-right conduction times (> 5 ms, range 7-72 ms) were observed in 24 (39%) of all patients. They were more common in patients with dilated cardiomyopathy (20 of 38, 53%) compared to 4 (17%) of 24 patients with coronary artery disease (p = 0.011). The phenomenon occurred more often in hypertensive patients (p = 0.012). Other tested factors were nonsignificant. Conclusions There are almost no data on this topic. The occurrence of conduction difference phenomenon is quite common in dilated cardiomyopathy while it is rare in coronary artery disease.

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Magnitude of QRS duration reduction after biventricular pacing identifies responders to cardiac resynchronization therapy

Cited by 39 publications

References 37 publications

Left bundle branch area pacing delivery of cardiac resynchronization therapy and comparison with biventricular pacing

Left bundle branch area pacing delivery of cardiac resynchronization therapy and comparison with biventricular pacing

Predicting response to cardiac resynchronization therapy: Use of strict left bundle branch block criteria

Differences in right-to-left vs left-to-right interventricular conduction times in patients indicated to cardiac resynchronization therapy

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