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Precision of automated QRS duration measurement in patients treated with cardiac resynchronization therapy

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Abstract

Purpose

Shortening of the QRS duration (QRSd) is often used to guide device optimization and reprogramming in patients with cardiac resynchronization therapy (CRT). Detecting the small changes expected during reprogramming requires that the QRSd can be measured with high precision, but this has never been studied in patients with CRT.

In this study, we wanted to assess the precision of automated QRSd measurement in patients treated with CRT using two commonly available electrocardiographs.

Methods

Patients treated with CRT were recruited during routine follow-up in our pacemaker clinic. In all participants, a number of immediate successive ECGs were recorded with the GE MAC 5500 (Mac55) and the GE MAC 1600 (Mac16). Data were analyzed with a linear mixed model.

Results

A total of 785 12-lead ECGs were recorded in 36 patients with an average of 11.2 and 10.6 ECGs per patient with the Mac55 and Mac16, respectively. The Mac55 measured the QRSd longer by 10.3 milliseconds (ms) (95% CI 7.1–13.5 ms, p < 0.001) and with significantly smaller standard deviation for repeated measurements (6.3 vs. 10.4 ms, p < 0.001). Limits of agreement were ± 17.5 and ± 28.8 ms for the Mac55 and Mac16, respectively.

Conclusions

Automated measurement of QRSd in patients with CRT shows low precision with limits of agreement of ± 17.5 and ± 28.8 ms for repeated measurements in two commercially available electrocardiographs. Device programming solely by QRSd changes should be done with caution, and clinical effects should be demonstrated in future trials. Device programming based on QRSd changes should be done with caution until the ability of this measure to predict clinical outcome can be demonstrated in prospective study.

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Funding

This work was supported by “Innovationsfonden” (grant no. 72-2014-1).

Author information

Authors and Affiliations

  1. Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark

    Casper Lund-Andersen, Helen H. Petersen, Christian Jøns, Berit T. Philbert, Jacob Tfelt-Hansen & Jesper H. Svendsen

  2. Department of Biostatistics, University of Copenhagen, Øster Farimagsgade 5, Building 10.2 entr. A, P.O. Box 2099, DK-1014, Copenhagen, Denmark

    Lene T. Skovgaard

Author notes

  1. Helen H. Petersen is deceased. This paper is dedicated to his memory.

    • Helen H. Petersen
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  1. Casper Lund-Andersen
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Corresponding author

Correspondence to Casper Lund-Andersen.

Ethics declarations

This study was approved by the regional ethics committee and conforms to the Declaration of Helsinki. All authors had full access to data and have read and agreed to the final manuscript.

Informed consent

All participants provided written, informed consent. The study is approved by the Danish Data protection authorities.

Conflict of interest

C. Lund-Andersen has received congress fees from Medtronic and St. Jude Medical. Jesper H. Svendsen has received grants from Medtronic, Biotronik, Gilead, and St. Jude Medical and speaker fees from Medtronic, Biotronik, Astra Zeneca, Boehringer Ingelheim, and Bayer. C. Jønz has received consultant fees from Biotronik.

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Lund-Andersen, C., Petersen, H.H., Jøns, C. et al. Precision of automated QRS duration measurement in patients treated with cardiac resynchronization therapy. J Interv Card Electrophysiol 52, 103–110 (2018). https://doi.org/10.1007/s10840-018-0334-2

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  • DOI: https://doi.org/10.1007/s10840-018-0334-2

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