QRS Narrowing Following CRT Implantation: Predictors, Dynamics, and Association with Improved Long-Term Outcome

Lapidot, Daniel; Rav, Moshe; Bdolah‐Abram, Tali; Farkash, Rivka; Glikson, Michael; Hasin, Tal

doi:10.3390/jcm11051279

Cited by 9 publications

(9 citation statements)

References 31 publications

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“…The short-survival group tended to have a reduced QRS width at 1 year after CRT-D implantation. It has been reported that a shortening of the QRS width by more than 20 ms after CRT implantation improved the long-term prognosis, 21 but the proportion of underlying cardiac disease was different from the present study, which had less ischemic heart disease. However, a paired T test showed that there was no significant difference between the changes before and after CRT-D implantation in both the short-survival group (p = .11) and the long-survival group (p = .33).…”

Section: Predictors Of Long-term Survival In the Present Studycontrasting

confidence: 87%

Predictors of long‐term survival in Japanese patients with heart failure with reduced ejection fraction (HFrEF) treated with cardiac resynchronization therapy‐defibrillators (CRT‐D)

Sakaguchi,

Izumi,

Wada

et al. 2023

Pacing Clinical Electrophis

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BackgroundReports on the factors predicting long‐term survival of CRT‐D cases from Western countries are increasing, however, those from Asia including Japan are still sparse. We aimed to clarify the factors predicting long‐term survival of Japanese CRT‐D cases.MethodsWe retrospectively analyzed consecutive 133 patients who underwent CRT‐D implantation between 2006 and 2021. We compared clinical factors between patients who died within 5 years after implantation (short‐survival group: n = 31) and who had survived for more than 5 years (long‐survival group: n = 36) after implantation.ResultsMajor underlying heart diseases were dilated cardiomyopathy (45%) and ischemic heart disease (12%). There was no difference between the short‐survival group and the long‐survival group in incidence of CLBBB (32% vs. 30%), whereas CRBBB was more common in the short‐survival group (26% vs. 0%, p = .004). Mechanical dyssynchrony at implantation was more frequent in the long‐survival group (48% vs. 78%, p = .02). The incidence of response to CRT at 1 year after implantation was higher in long‐survival group (19% vs. 50%, p = .02). Multiple logistic regression analysis identified NYHA class, mechanical dyssynchrony at implantation, and response at one year as predictors of long‐term survival.ConclusionsIn Japanese CRT‐D cases, lower NHYA class, preexisting mechanical dyssynchrony, and 1‐year response to CRT predict long‐term survival.

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Section: Predictors Of Long-term Survival In the Present Studycontrasting

confidence: 87%

Predictors of long‐term survival in Japanese patients with heart failure with reduced ejection fraction (HFrEF) treated with cardiac resynchronization therapy‐defibrillators (CRT‐D)

Sakaguchi,

Izumi,

Wada

et al. 2023

Pacing Clinical Electrophis

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“…35 QRS duration >150 msec, especially with LBBB, is one of the main indications for implanting CRT in heart failure patients along with left ventricular EF and NYHA functional class, with its prognostication on a long-term response of CRT. 36 Our study showed that CRT could shorten QRS duration in patients with CHD with a mean QRS duration decrease up to 28.7 msec, which implies that CRT would probably mitigate dyssynchrony in ventricular contraction. Further, our study showed that the EF after implant CRT also increased (mean difference 11.8%).…”

Section: Chd Is the Most Common Embryonic Defect In Neonates Accountingmentioning

confidence: 52%

Outcomes of cardiac resynchronization therapy in congenital heart disease: A meta‐analysis and systematic review

Tokavanich,

Mongkonsritragoon,

Sattawatthamrong

et al. 2023

Cardiovasc electrophysiol

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IntroductionCardiac resynchronization therapy (CRT) is a standard treatment for patients with heart failure with reduced ejection fraction. However, there is still a gap of evidence in congenital heart disease (CHD) patients regarding resynchronization therapy.MethodsWe performed a meta‐analysis and systematic review of CHD patients who received CRT implantation. We comprehensively searched the databases of MEDLINE, EMBASE, and Cochrane database from inception to June 2023. Studies that reported response rate to CRT, total mortality rate, change in QRS duration, change in left ventricular ejection fraction, and change in New York Heart Association functional class were included.ResultsA total of 14 studies were included in the study. There were 10 studies that reported response rates after implantation. The overall response rate to CRT in CHD patients was 68% (95% confidence interval [CI] 61%–75%, I2 32%). The response rates in patients with systemic right ventricle (RV), systemic left ventricle (LV), and single ventricle were 58% (95% CI 46%–70%, I2 0%), 80% (95% CI 74%–86% I2 14%), and 67% (95% CI 49%–80% I2 0%). Response to CRT in systemic RV was inferior to systemic LV with an odds ratio of 0.38 (95% CI 0.15–0.95, I2 38%). The total mortality rate from seven studies was 12% (95% CI 8%–18%, I2 55%). The parameters which represented ventricular dyssynchrony improved after CRT implantation.ConclusionThe overall response rate to CRT in CHD was 68%. Patients with systemic RV had a lower response rate to CRT when compared to patients with systemic LV. The total mortality rate after CRT implantation was 12%.

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“…It has been shown that QRS width reduction after BiV implantation is associated with favourable long-term outcomes. [11] Average shortening of QRS and shortening of equivalent dipole lengths were similar in both groups. However, there was a significant difference in the shift of trajectory orientations.…”

Section: Discussionmentioning

confidence: 76%

Conduction System Pacing Versus Biventricular Pacing For Cardiac Resynchronization

Starc¹,

Zlahtic²,

Žižek³

et al. 2022

Computing in Cardiology Conference (CinC)

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Cardiac resynchronization therapy with biventricular pacing (BiV) is the cornerstone treatment for heart failure patients with ventricular dyssynchrony. Recently, the conduction system pacing (CSP) has being introduced as a possible alternative. We hypothesized that CSP could produce a more complete electrical resynchronization compared to conventional BIV pacing.To trace the spreading of myocardial depolarization, we assessed equivalent dipole (ED) trajectories utilizing the BEM method with a tailored human torso from the high resolution 12-lead ECG before and after device implantation in 17 patients included in our ongoing randomized CSP-SYNC study.We observed a similar relative shortening of the QRS duration (0,23 in CSP and 0,25 in BiV) and relative ED trajectory length (0,16 in CSP and 0,20 in BiV). However, a significant change of ED trajectory direction occurred after the therapy. In BiV pacing, the trajectory direction shifted more towards the base of the heart, but more apically in CSP, mimicking normal heart depolarization Resynchronization with CSP seems to restore more physiological depolarization compared to BiV pacing. The assessment of the ED trajectories provides additional insight into the electrical heart remodelling after the therapy.

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QRS Narrowing Following CRT Implantation: Predictors, Dynamics, and Association with Improved Long-Term Outcome

Cited by 9 publications

References 31 publications

Predictors of long‐term survival in Japanese patients with heart failure with reduced ejection fraction (HFrEF) treated with cardiac resynchronization therapy‐defibrillators (CRT‐D)

Predictors of long‐term survival in Japanese patients with heart failure with reduced ejection fraction (HFrEF) treated with cardiac resynchronization therapy‐defibrillators (CRT‐D)

Outcomes of cardiac resynchronization therapy in congenital heart disease: A meta‐analysis and systematic review

Conduction System Pacing Versus Biventricular Pacing For Cardiac Resynchronization

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