Normalization of QRS Duration to Left Ventricular Dimension Improves Patient Selection for Cardiac Resynchronization Therapy

Zweerink, Alwin; Friedman, Daniel; Klem, Igor; Vink, Caitlin; Biesbroek, P. Stefan; Hansen, Steen Møller; Kim, Woojin; Rossum, Albert C. van; Atwater, Brett D.; Nijveldt, Robin; Allaart, Cornelis P.

doi:10.1016/s0735-1097(18)31481-5

Cited by 17 publications

(30 citation statements)

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“…Previously we demonstrated that LV size was positively correlated with QRSd in patients with LBBB-type of conduction delay [7,8]. In the present study we found that LV size similarly influenced RVP-QRSd with larger LV dimensions leading to longer paced QRSd.…”

Section: Discussionsupporting

confidence: 74%

“…There is growing evidence to suggest that baseline QRS duration (QRSd) [3], and paced QRSd are related to RVP-induced cardiomyopathy [4][5][6]. Previously we showed that differences in left ventricular (LV) size significantly contribute to the variation in QRSd among patients with left bundle branch block (LBBB) and that LV size impacts benefit from biventricular pacing [7,8]. We hypothesized that LV size may also influence benefit from HBP compared to RVP in achieving electrical synchrony.…”

Section: Introductionmentioning

confidence: 99%

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His bundle pacing to avoid electrical dyssynchrony with traditional right ventricular pacing: Importance of heart size

Zweerink

Bakelants

Stettler

et al. 2020

International Journal of Cardiology

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Background: His Bundle Pacing (HBP) is attracting interest as an alternative to traditional right ventricular pacing (RVP) because it avoids electrical dyssynchrony induced by RVP. This study aims to evaluate the effect of heart size on benefit from HBP compared to RVP in terms of achieving electrical synchrony. Methods: Fifty-nine patients with HBP and a RVP back-up lead underwent pre-implantation echocardiography to measure left ventricular end-diastolic volume (LVEDV). Electrical benefit from HBP was calculated as the difference in QRS duration (QRSd) between RVP and HPB. Results: LVEDV was significantly correlated with RVP QRSd (R = 0.53; p b 0.001). In contrast, LVEDV was unrelated to HBP QRSd (R = 0.16; p = 0.24). Electrical benefit of HBP over RVP was directly related with LVEDV (R = 0.43; p = 0.001). In addition, electrical benefit of HBP was larger for patients with LVEDV above median (99 mL) than below (49 ± 27 ms vs. 34 ± 19 ms, p = 0.014). Conclusions: This study is the first to demonstrate that patients with larger LV size may benefit most from HBP as a replacement of traditional RVP to avoid electrical dyssynchrony. Our results indicate that LV size impacts QRSd during RVP with slow cell-to-cell conduction, whereas it does not affect electrical synchrony during HBP with fast His-Purkinje conduction.

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Section: Discussionsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

His bundle pacing to avoid electrical dyssynchrony with traditional right ventricular pacing: Importance of heart size

Zweerink

Bakelants

Stettler

et al. 2020

International Journal of Cardiology

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“…Indeed, accounting for such variables has resolved sex differences in CRT outcomes in other studies. 17,18 However, in the current study, women undergoing CRT-P implantations had more complications than women undergoing CRT-D implantations (6.6% vs 5.2%) and fewer complications than men undergoing CRT-P implantations (6.6% vs 7.3%). Equipment-or device-related factors are therefore unlikely to be the sole explanation, and patient selection is likely at play.…”

contrasting

confidence: 49%

“…In studies comparing CRT-Ds with AICDs in patients with HF and reduced LVEF, women have indeed generally derived more benefit from CRT than men, although this may vary by QRS characteristics and HF symptom severity, [13][14][15] and it may be that female sex acts as a surrogate for influential variables such as body or cardiac dimensions. [16][17][18] The Cardiac Resynchronization-Heart Failure (CARE-HF) trial demonstrated that CRT-P reduces mortality, including sudden death, relative to medical therapy to a similar extent in both men and women. 19,20 Whether CRT-D improves clinical outcomes above those of CRT-P is debated, however, especially in women.…”

mentioning

confidence: 99%

Sex Differences in Cardiac Resynchronization Therapy Device Implantations and Complications: Tough Questions, Tougher Answers

Ramirez

2021

Canadian Journal of Cardiology

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“…One plausible reason for this trend was the reclassification of the CRT indication in the 2012 updated American College of Cardiology Foundation/American Heart Association/ Hearth Rhythm Society guideline [6]. [15,18]. As described earlier, Japanese CRT recipients who are likely to be shorter than patients from Western countries may have a longer adjusted QRS.…”

Section: [ ( F I G _ 3 ) T D $ F I G ]mentioning

confidence: 99%

Design and results of aCRT MID-Q study: Adoption of adaptive CRT in patients with normal AV conduction and moderately wide left bundle branch block

Yamasaki

Sekiguchi

Gosho

et al. 2020

Journal of Cardiology

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Cardiac resynchronization therapy (CRT) is an established treatment for patients with drug-resistant heart failure. CRT provides substantial clinical benefits in patients with systolic heart failure who exhibit evidence of cardiac dyssynchrony and is shown to reduce mortality and hospitalization, reverse cardiac remodeling, and improve functional capacity and quality of life (QOL) [1-3].However, the magnitude of clinical and hemodynamic benefits of CRT varies significantly among recipients [4]. Previous randomized trials demonstrated that QRS morphology and width were the major determinant predictors of CRT response [5]. Based on these results, recent guidelines classified CRT implantation in patients with left bundle branch block (LBBB) and wide QRS [ 4 3 _ T D $ D I F F ] (!150 ms) as class I [6,7]. The efficacy of CRT was found to be inferior in patients with LBBB with moderately wide QRS (120-149 ms), classified as class IIa indication or class I indication with evidence level B. A novel adaptive CRT (aCRT) algorithm that provides ambulatory adjustment of pacing configuration [left ventricle (LV) pacing only or bi-ventricular (BiV) pacing] and AV and VV delays based on

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Normalization of QRS Duration to Left Ventricular Dimension Improves Patient Selection for Cardiac Resynchronization Therapy

Cited by 17 publications

References 0 publications

His bundle pacing to avoid electrical dyssynchrony with traditional right ventricular pacing: Importance of heart size

His bundle pacing to avoid electrical dyssynchrony with traditional right ventricular pacing: Importance of heart size

Sex Differences in Cardiac Resynchronization Therapy Device Implantations and Complications: Tough Questions, Tougher Answers

Design and results of aCRT MID-Q study: Adoption of adaptive CRT in patients with normal AV conduction and moderately wide left bundle branch block

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