Native QRS narrowing reflects electrical reversal and associates with anatomical reversal in cardiac resynchronization therapy
- 225 Downloads
Abbreviation of paced QRS duration has been taken as electrical resynchronization imposed by cardiac resynchronization therapy (CRT). However, little is known about alteration in native QRS duration and its correlation with therapeutic response as well as anatomical remodeling post-CRT.
Data of 74 consecutive patients with complete ECG records were reviewed. Response was defined as absolute improvement in LVEF by ≥10 % from baseline. Changes in native QRS duration (native ΔQRS) were analyzed to CRT response and to changes in echocardiography.
Over median follow-up of 13 months, 47 patients had response to CRT and 30 subjects had abbreviation in native QRS duration. Native ΔQRS correlated positively with QRS duration pre- and post-CRT as well as with changes in echocardiography. Reversal of electrical remodeling as assessed by native QRS narrowing accompanied with greater improvements in LVEF (20 % ± 11 % vs 10% ± 10 %, p = 0.000) and LVEDD (14 ± 11 mm vs. 4 ± 10 mm, p = 0.000). Multivariate analysis indicated that native ΔQRS was the lone independent factor of ECG in association to response to CRT (OR1.049, 95%CI 1.015–1.085, p = 0.004): 83.3 % of patients with native QRS reduction were responders. Among the non-responders, 18.5 % had native QRS narrowing at follow-ups.
Native QRS narrowing associated with beneficial response and greater improvements in echocardiography. Abbreviation in native QRS duration could reflect electrical reversal imposed by CRT.
KeywordsChronic heart failure Cardiac resynchronization therapy Native QRS duration Electrical remodeling
There is no financial disclosure to report.
Conflict of interest
There is no conflict of interest related to this manuscript.
- 2.Linde, C., Abraham, W. T., Gold, M. R., St John Sutton, M., Ghio, S., & Daubert, C. (2008). Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms. Journal of the American College of Cardiology, 52(23), 1834–1843.PubMedCrossRefGoogle Scholar
- 4.Daubert, C., Gold, M. R., Abraham, W. T., Ghio, S., Hassager, C., Goode, G., et al. (2009). Prevention of disease progression by cardiac resynchronization therapy in patients with asymptomatic or mildly symptomatic left ventricular dysfunction: insights from the European cohort of the REVERSE (Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction) trial. Journal of the American College of Cardiology, 54(20), 1837–1846.PubMedCrossRefGoogle Scholar
- 6.Gervais, R., Leclercq, C., Shankar, A., Jacobs, S., Eiskjaer, H., Johannessen, A., et al. (2009). Surface electrocardiogram to predict outcome in candidates for cardiac resynchronization therapy: a sub-analysis of the CARE-HF trial. European Journal of Heart Failure, 11(7), 699–705.PubMedCrossRefGoogle Scholar
- 8.Iler, M. A., Hu, T., Ayyagari, S., Callahan, T. D., 4th, Civello, K. C., Thal, S. G., et al. (2008). Prognostic value of electrocardiographic measurements before and after cardiac resynchronization device implantation in patients with heart failure due to ischemic or nonischemic cardiomyopathy. American Journal of Cardiology, 101(3), 359–363.PubMedCrossRefGoogle Scholar
- 12.Serdoz, L. V., Daleffe, E., Merlo, M., Zecchin, M., Barbati, G., Pecora, D., et al. (2011). Predictors for restoration of normal left ventricular function in response to cardiac resynchronization therapy measured at time of implantation. American Journal of Cardiology, 108(1), 75–80.PubMedCrossRefGoogle Scholar
- 13.Hsing, J. M., Selzman, K. A., Leclercq, C., Pires, L. A., McLaughlin, M. G., McRae, S. E., et al. (2011). Paced left ventricular QRS width and ECG parameters predict outcomes after cardiac resynchronization therapy: PROSPECT-ECG substudy. Circulation Arrhythmia and Electrophysiology, 4(6), 851–857.PubMedCrossRefGoogle Scholar
- 15.Gold, M. R., Thébault, C., Linde, C., Abraham, W. T., Gerritse, B., Ghio, S., et al. (2012). Effect of QRS duration and morphology on cardiac resynchronization therapy outcomes in mild heart failure: results from the Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) study. Circulation, 126(7), 822–829.PubMedCrossRefGoogle Scholar
- 17.Birnie, D. H., Ha, A., Higginson, L., Sidhu, K., Green, M., Philippon, F., et al. (2013). Impact of QRS morphology and duration on outcomes following cardiac resynchronization therapy: results from the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT). Circulation. Heart Failure, 6(6), 1190–1198.PubMedCrossRefGoogle Scholar
- 18.Yeim, S., Bordachar, P., Reuter, S., Laborderie, J., O'Neill, M. D., Lafitte, S., et al. (2007). Predictors of a positive response to biventricular pacing in patients with severe heart failure and ventricular conduction delay. Pacing and Clinical Electrophysiology, 30(8), 970–975.PubMedCrossRefGoogle Scholar
- 20.Rickard, J., Cheng, A., Spragg, D., Cantillon, D., Chung, M. K., Tang, W. H., et al. (2013). QRS narrowing is associated with reverse remodeling in patients with chronic right ventricular pacing upgraded to cardiac resynchronization therapy. Heart Rhythm, 10(1), 55–60.PubMedCrossRefPubMedCentralGoogle Scholar
- 21.Alonso, C., Leclercq, C., Victor, F., Mansour, H., de Place, C., Pavin, D., et al. (1999). Electrocardiographic predictive factors of long-term clinical improvement with multisite biventricular pacing in advanced heart failure. American Journal of Cardiology, 84(12), 1417–1421.PubMedCrossRefGoogle Scholar
- 23.Yu, C. M., Chan, Y. S., Zhang, Q., Yip, G. W., Chan, C. K., Kum, L. C., et al. (2006). Benefits of cardiac resynchronization therapy for heart failure patients with narrow QRS complexes and coexisting systolic asynchrony by echocardiography. Journal of the American College of Cardiology, 48(11), 2251–2257.PubMedCrossRefGoogle Scholar