Reduction in the QRS area after cardiac resynchronization therapy is associated with survival and echocardiographic response

Ghossein, Mohammed A.; Stipdonk, Antonius M.W. van; Plešinger, Filip; Kloosterman, Mariëlle; Wouters, Philippe C; Salden, Odette A.E.; Meine, Mathias; Maass, Alexander H.; Prinzen, Frits W.; Vernooy, Kevin

doi:10.1111/jce.14910

Cited by 24 publications

(35 citation statements)

References 21 publications

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“…In addition to baseline QRS area of the intrinsic rhythm, it was recently demonstrated that also reduction in QRS area after CRT is of clinical importance. A larger reduction in QRS area was associated with echocardiographic and clinical response after CRT [6][7][8]. Although these data were obtained using single measurements per patient, the results raised the question whether reduction in QRS area might be used to guide LV lead positioning in the individual patient.…”

Section: Of 12mentioning

confidence: 95%

“…Okafor et al found that a reduction in QRS area in combination with a reduction in QRS duration was significantly associated with long-term cardiac and total mortality, major adverse cardiac events, and ventricular arrhythmias [6]. More recently, a study from our institute showed that in a large cohort of 1299 patients, ∆QRS area was independently associated with long-term survival and echocardiographic response [8]. The current analysis shows that ∆QRS area also correlates with acute hemodynamic improvement during biventricular pacing at various LV pacing sites.…”

Section: Qrs Area Reduction Represents Resynchronization Better Than ...mentioning

confidence: 96%

“…ECGs at baseline and per LV pacing location were digitally stored for offline analysis [8]. For QRS area calculations, 12-lead ECG signals were extracted from digitally stored PDF files and converted into three orthogonal VCG (X-, Y-, and Z-) leads using the Kors conversion matrix in the custom made Matlab software (Mathworks Inc.) as previously described [8]. QRS area was calculated as (X area 2 + Y area 2 + Z area 2 ) 1/2 (Figure 1).…”

Section: Electrocardiographic Datamentioning

confidence: 99%

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Left Ventricular Lead Placement Guided by Reduction in QRS Area

Ghossein

Zanon

Salden

et al. 2021

JCM

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Background: Reduction in QRS area after cardiac resynchronization therapy (CRT) is associated with improved long-term clinical outcome. The aim of this study was to investigate whether the reduction in QRS area is associated with hemodynamic improvement by pacing different LV sites and can be used to guide LV lead placement. Methods: Patients with a class Ia/IIa CRT indication were prospectively included from three hospitals. Acute hemodynamic response was assessed as the relative change in maximum rate of rise of left ventricular (LV) pressure (%∆LVdP/dtmax). Change in QRS area (∆QRS area), in QRS duration (∆QRS duration), and %∆LVdP/dtmax were studied in relation to different LV pacing locations within a patient. Results: Data from 52 patients paced at 188 different LV pacing sites were investigated. Lateral LV pacing resulted in a larger %∆LVdP/dtmax than anterior or posterior pacing (p = 0.0007). A similar trend was found for ∆QRS area (p = 0.001) but not for ∆QRS duration (p = 0.23). Pacing from the proximal electrode pair resulted in a larger %∆LVdP/dtmax (p = 0.004), and ∆QRS area (p = 0.003) but not ∆QRS duration (p = 0.77). Within patients, correlation between ∆QRS area and %∆LVdP/dtmax was 0.76 (median, IQR 0.35; 0,89). Conclusion: Within patients, ∆QRS area is associated with %∆LVdP/dtmax at different LV pacing locations. Therefore, QRS area, which is an easily, noninvasively obtainable and objective parameter, may be useful to guide LV lead placement in CRT.

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Section: Of 12mentioning

confidence: 95%

Section: Qrs Area Reduction Represents Resynchronization Better Than ...mentioning

confidence: 96%

Section: Electrocardiographic Datamentioning

confidence: 99%

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Left Ventricular Lead Placement Guided by Reduction in QRS Area

Ghossein

Zanon

Salden

et al. 2021

JCM

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“…Alternatively, preimplantation ECG imaging (eg, body surface mapping or ECG imaging) or paced reduction of QRS AREA may allow for more accurate distinction between optimal and suboptimal cardiac segments. 9,43…”

Section: Electrically Guidedmentioning

confidence: 99%

Optimizing lead placement for pacing in dyssynchronous heart failure: The patient in the lead

et al. 2021

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Cardiac resynchronization therapy (CRT) greatly reduces morbidity and mortality in patients with dyssynchronous heart failure. However, despite tremendous efforts, response has been variable and can be further improved. Although optimizing left ventricular lead placement (LVLP) is arguably the cornerstone of CRT, the procedure of LVLP using the transvenous approach has remained largely unchanged for more than 2 decades. Improvements have been developed using scar location and electrical and/or mechanical mapping. Interest in conduction system pacing as an alternative to biventricular pacing has emerged recently. Conduction system pacing is promising but may not be suitable for all patients with dyssynchronous heart failure. This review underscores the importance of a patient-tailored approach and discusses the potential applications of both conduction system pacing and targeted biventricular CRT.

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“…In addition, QRS area has also been shown to have a strong association with clinical and echocardiographic response to CRT [8]. More recently, Ghossein et al showed that the decrease in QRSarea due to CRT is a strong independent predictor of echocardiographic and clinical CRT response [20]. In the present study, QRS area also correlated significantly with LVAT, and Figure 5 illustrates that the transseptal behavior of QRS area and LVAT are very similar, altogether validating QRS area as measurement for ventricular synchrony.…”

Section: Qrs Area As Measurement For Ventricular Synchronymentioning

confidence: 99%

Comparing Ventricular Synchrony in Left Bundle Branch and Left Ventricular Septal Pacing in Pacemaker Patients

Heckman

Luermans

Čurila

et al. 2021

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Background: Left bundle branch area pacing (LBBAP) has recently been introduced as a novel physiological pacing strategy. Within LBBAP, distinction is made between left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP, no left bundle capture). Objective: To investigate acute electrophysiological effects of LBBP and LVSP as compared to intrinsic ventricular conduction. Methods: Fifty patients with normal cardiac function and pacemaker indication for bradycardia underwent LBBAP. Electrocardiography (ECG) characteristics were evaluated during pacing at various depths within the septum: starting at the right ventricular (RV) side of the septum: the last position with QS morphology, the first position with r’ morphology, LVSP and—in patients where left bundle branch (LBB) capture was achieved—LBBP. From the ECG’s QRS duration and QRS morphology in lead V1, the stimulus- left ventricular activation time left ventricular activation time (LVAT) interval were measured. After conversion of the ECG into vectorcardiogram (VCG) (Kors conversion matrix), QRS area and QRS vector in transverse plane (Azimuth) were determined. Results: QRS area significantly decreased from 82 ± 29 µVs during RV septal pacing (RVSP) to 46 ± 12 µVs during LVSP. In the subgroup where LBB capture was achieved (n = 31), QRS area significantly decreased from 46 ± 17 µVs during LVSP to 38 ± 15 µVs during LBBP, while LVAT was not significantly different between LVSP and LBBP. In patients with normal ventricular activation and narrow QRS, QRS area during LBBP was not significantly different from that during intrinsic activation (37 ± 16 vs. 35 ± 19 µVs, respectively). The Azimuth significantly changed from RVSP (−46 ± 33°) to LVSP (19 ± 16°) and LBBP (−22 ± 14°). The Azimuth during both LVSP and LBBP were not significantly different from normal ventricular activation. QRS area and LVAT correlated moderately (Spearman’s R = 0.58). Conclusions: ECG and VCG indices demonstrate that both LVSP and LBBP improve ventricular dyssynchrony considerably as compared to RVSP, to values close to normal ventricular activation. LBBP seems to result in a small, but significant, improvement in ventricular synchrony as compared to LVSP.

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Reduction in the QRS area after cardiac resynchronization therapy is associated with survival and echocardiographic response

Cited by 24 publications

References 21 publications

Left Ventricular Lead Placement Guided by Reduction in QRS Area

Left Ventricular Lead Placement Guided by Reduction in QRS Area

Optimizing lead placement for pacing in dyssynchronous heart failure: The patient in the lead

Comparing Ventricular Synchrony in Left Bundle Branch and Left Ventricular Septal Pacing in Pacemaker Patients

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