Native Electrocardiographic QRS Duration after Cardiac Resynchronization Therapy: The Impact on Clinical Outcomes and Prognosis

Karaca, Oğuz; Çakal, Beytullah; Omaygenç, Mehmet Onur; Güneş, Hacı Murat; Çakal, Sinem; Kızılırmak, Filiz; Gökdeniz, Tayyar; Barutçu, İrfan; Boztosun, Bilal; Kılıçaslan, Fethi

doi:10.1016/j.cardfail.2016.04.001

Cited by 12 publications

(16 citation statements)

References 28 publications

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“…Yang et al (20) showed that native QRS narrowing was associated with beneficial response and greater improvements in echocardiography. Similarly, Karaca et al (21) showed that reversed ER, by means of narrowing of the intrinsic electrocardiographic QRS duration after CRT, has clinical and prognostic implications. A narrowed intrinsic QRS interval compared with that at baseline was found to be associated with improved functional status and higher CRT response.…”

Section: Discussionmentioning

confidence: 93%

Improvement in left ventricular intrinsic dyssynchrony with cardiac resynchronization therapy

Bozyel¹

2017

Anatol J Cardiol

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Objective:Cardiac resynchronization therapy (CRT) has been shown to induce a structural and electrical remodeling; the data on whether left ventricle (LV) reverse remodeling is associated with restitution of intrinsic contraction pattern are unknown. In this study, we investigated the presence of improvement in left ventricular intrinsic dyssynchrony in patients with CRT.Methods:A total of 45 CRT recipients were prospectively studied. Dyssynchrony indexes including interventricular mechanical delay (IVMD) and tissue Doppler velocity opposing-wall delay (OWD) as well as QRS duration on 12-lead surface electrocardiogram were recorded before CRT device implantation. After 1 year, patients with chronic biventricular pacing were reprogramed to VVI 40 to allow the resumption of native conduction and contraction pattern. After 4–6 h of intrinsic rhythm, QRS duration and all echocardiographic measurements were recorded. Dyssynchrony was defined as IVMD >40 ms and OWD >65 ms. CRT response was defined by a ≥15% reduction in left ventricular end-systolic volume (LVESV) at a 12-month follow-up.Results:Thirty-two patients (71%) showed response to CRT. The native QRS duration reduced significantly from 150±12 ms to 138±14 ms (p<0.001), and dyssynchrony indexes showed a significant improvement only in responders. The mean OWD reduced from 86±37 ms to 50±29 ms (p<0.001), and the mean IVMD decreased from 55±22 ms to 28±22 ms (p<0.001) in responders. The reduction in LVESV was significantly correlated with ΔOWD (r=0.47, p=0.001), ΔIVMD (r=0.45, p=0.001), and ΔQRS (r=0.34, p=0.022).Conclusion:Chronic CRT significantly improves LV native contraction pattern and causes reverse remodeling in dyssynchrony.

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Section: Discussionmentioning

confidence: 93%

Improvement in left ventricular intrinsic dyssynchrony with cardiac resynchronization therapy

Bozyel¹

2017

Anatol J Cardiol

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“…Furthermore, in this case, despite the increased heart rate, the prevalence of LBBB aberrant cardiac conduction was 0%, which also indicated an improvement in left bundle branch conduction. Karaca et al reported that reduction in QRS duration was seen in responders to CRT, indicating that cardiac conductive remodeling is associated with functional and structural remodeling [ 9 ]. Also, a previously published case report described the effective treatment of LBBB following CRT [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

A Patient with Left Bundle Branch Block and Persistent Atrial Fibrillation Treated with Cardiac Catheter Ablation and Pharmacologic Cardiac Resynchronization Therapy without the Use of an Implantable Cardiac Device

Hasebe

2018

Am J Case Rep

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Patient: Male, 68Final Diagnosis: Heart failureSymptoms: Short of breathMedication: —Clinical Procedure: Catheter ablation of AFSpecialty: CardiologyObjective:Rare co-existance of disease or pathologyBackground:Left bundle branch block (LBBB) is associated with atrial fibrillation (AF) and systolic heart failure, which can be treated with cardiac resynchronization therapy (CRT) that includes an implantable cardiac device (ICD). However, in some patients, LBBB may vary with heart rate, and during episodes of AF in LBBB, aberrant ventricular conduction, or wide QRS complex tachycardia (Ashman beats) can occur. This report is a case of LBBB treated with pharmacologic CRT, without the use of an ICD.Case Report:A 68-year-old man presented with persistent AF and systolic heart failure. Serial electrocardiograms (ECGs) showed AF and mixed narrow (116 ms) and wide (152 ms) QRS duration of LBBB. Echocardiography showed a left ventricular ejection fraction (LVEF) of 30%. Catheter ablation for AF resulted in the restoration of sinus rhythm. The patient was treated with step-wise decreasing doses of amiodarone, from 200 mg to 75 mg daily, and step-wise increasing doses of bisoprolol, from 3.75 mg to 5.0 mg daily, which effectively slowed heart rate, inhibited aberrant cardiac conduction due to LBBB, reduced the symptoms of heart failure, and improved LVEF to 60%, despite persistent sinus bradycardia and the inability of the heart rate to increase during activity (chronotropic incompetence).Conclusions:This report of a case of AF associated with LBBB shows that pharmacologic CRT can restore sinus rhythm following catheter ablation and can reduce heart rate and treat heart failure without the use of an ICD.

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“…26 Finally, as already mentioned, when native QRS narrowing is observed during follow-up of patients with CRT, it indicates electrical reversal and it is associated with reverse anatomical remodeling and favorable prognosis in these patients. 37,39,42 A QRS difference of ≤−25 ms compared to baseline QRS width indicates reverse remodeling and remodeling probability increases as this QRS difference takes on larger negative values. 24 In this context, a recent metaanalysis of 32 studies including 14 studies (1274 patients, mean age 64 years) using clinical CRT response and 18 studies (1270 patients, mean age 64 years) using echocardiographic CRT response, indicated that there was a significant association between QRS narrowing and shorter achieved QRS duration with clinical and echocardiographic CRT response, independent of the timing of QRS width measurement after CRT implantation.…”

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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Native Electrocardiographic QRS Duration after Cardiac Resynchronization Therapy: The Impact on Clinical Outcomes and Prognosis

Cited by 12 publications

References 28 publications

Improvement in left ventricular intrinsic dyssynchrony with cardiac resynchronization therapy

Improvement in left ventricular intrinsic dyssynchrony with cardiac resynchronization therapy

A Patient with Left Bundle Branch Block and Persistent Atrial Fibrillation Treated with Cardiac Catheter Ablation and Pharmacologic Cardiac Resynchronization Therapy without the Use of an Implantable Cardiac Device

Electrocardiography of cardiac resynchronization therapy: Pitfalls and practical tips

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