Po-02-235 Moving Beyond QRS Duration: QRS Voltage-Time-Integral (Area) Is a Superior Predictor of Clinical Response to Cardiac Resynchronization Therapy

Gahona, Christian Toquica; Morey, Tucker; Harvey, Christopher J.; DeBauge, Ashley; Fairbank, Tyan; Ranka, Sagar; Jiwani, Sania; Sheldon, Seth H.; Reddy, Y. V. Kishore; Noheria, Amit

doi:10.1016/j.hrthm.2023.03.1603

Cited by 1 publication

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“…34,45 However, a change in 3D QRS area post CRT has been shown to predict clinical benefit with CRT, with a greater reduction in QRSarea correlating with improved clinical outcomes. [46][47][48][49] 4.6 | Clinical implications of our study ECGI provides a much more detailed and higher-resolution evaluation of the electrical activation of the heart and may be superior to routine ECG for evaluating and optimizing biventricular pacing. 50…”

Section: Optimizing Lv-rv Offset Programmingmentioning

confidence: 99%

Pilot study to evaluate left‐to‐right ventricular offset in biventricular pacing—comparison of electrocardiographic imaging and ECG

Noheria,

Shahab,

Andrews

et al. 2024

Cardiovasc electrophysiol

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IntroductionBiventricular pacing (BiVp) improves outcomes in systolic heart failure patients with electrical dyssynchrony. BiVp is delivered from epicardial left ventricular (LV) and endocardial right ventricular (RV) electrodes. Acute electrical activation changes with different LV‐RV stimulation offsets can help guide individually optimized BiVp programming. We sought to study the BiVp ventricular activation with different LV‐RV offsets and compare with 12‐lead ECG.MethodsIn five patients with BiVp (63 ± 17‐year‐old, 80% male, LV ejection fraction 27 ± 6%), we evaluated acute ventricular epicardial activation, varying LV‐RV offsets in 20 ms increments from −40 to 80 ms, using electrocardiographic imaging (ECGI) to obtain absolute ventricular electrical uncoupling (VEUabs, absolute difference in average LV and average RV activation time) and total activation time (TAT). For each patient, we calculated the correlation between ECGI and corresponding ECG (3D‐QRS‐area and QRS duration) with different LV‐RV offsets.ResultsThe LV‐RV offset to attain minimum VEUabs in individual patients ranged 20–60 ms. In all patients, a larger LV‐RV offset was required to achieve minimum VEUabs (36 ± 17 ms) or 3D‐QRS‐area (40 ± 14 ms) than that for minimum TAT (−4 ± 9 ms) or QRS duration (−8 ± 11 ms). In individual patients, 3D‐QRS‐area correlated with VEUabs (r 0.65 ± 0.24) and QRS duration correlated with TAT (r 0.95 ± 0.02). Minimum VEUabs and minimum 3D‐QRS‐area were obtained by LV‐RV offset within 20 ms of each other in all five patients.ConclusionsLV‐RV electrical uncoupling, as assessed by ECGI, can be minimized by optimizing LV‐RV stimulation offset. 3D‐QRS‐area is a surrogate to identify LV‐RV offset that minimizes LV‐RV uncoupling.

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