QRS prolongation after cardiac resynchronization therapy is a predictor of persistent mechanical dyssynchrony

Purpose Prolonged QRS duration is the main selection criterion for cardiac resynchronization therapy (CRT) which ameliorates left ventricular mechanical dyssynchrony (MD). However, consequences of post-CRT QRS prolongation and residual MD have been poorly evaluated. We aimed to define the predictors...

Full description

Saved in:
Bibliographic Details
Published in:Journal of interventional cardiac electrophysiology 2016-08, Vol.46 (2), p.105-113
Main Authors: Karaca, Oguz, Omaygenc, Onur, Cakal, Beytullah, Cakal, Sinem Deniz, Barutcu, Irfan, Boztosun, Bilal, Kilicaslan, Fethi
Format: Article
Language:English
Subjects:
Bundle-Branch Block - complications
Bundle-Branch Block - diagnosis
Bundle-Branch Block - prevention & control
Cardiac Resynchronization Therapy - adverse effects
Cardiology
Chronic Disease
Defibrillators, Implantable - adverse effects
Electrocardiography
Female
Humans
Male
Medicine
Medicine & Public Health
Middle Aged
Outcome Assessment (Health Care)
Reproducibility of Results
Sensitivity and Specificity
Treatment Outcome
Ventricular Dysfunction, Left - diagnosis
Ventricular Dysfunction, Left - etiology
Ventricular Dysfunction, Left - prevention & control
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Purpose Prolonged QRS duration is the main selection criterion for cardiac resynchronization therapy (CRT) which ameliorates left ventricular mechanical dyssynchrony (MD). However, consequences of post-CRT QRS prolongation and residual MD have been poorly evaluated. We aimed to define the predictors of persistent MD and hypothesized that CRT-induced QRS change (ΔQRS) might have an impact on residual MD after CRT. Methods A total of 80 patients receiving CRT were included in the study. ΔQRS was calculated as the difference between the baseline and paced QRS intervals. Residual MD was assessed early after device implantation with a longitudinal dyssynchrony index (Yu index). Significant MD was defined as a Yu index ≥ 33 msec. Two groups were created based on residual MD and compared according to clinical, electrocardiographic and echocardiographic features. Results Patients with persistent MD had longer paced QRS durations (182.5 ± 16.2 vs. 165.4 ± 22.5 msec, p  = 0.03) and were less likely to have left ventricular (LV) leads located in the posterolateral vein (53 % vs. 85 %, p  = 0.002). The linear correlation between the ΔQRS and the Yu index values was modest (Spearman’s rho = −0.341, p  = 0.002); additionally, a prolonged QRS was strongly associated with MD after CRT ( p  = 0.00008). Both LV lead localization and CRT-induced QRS prolongation emerged as the significant predictors of persistent MD. A biventricularly paced QRS more than 10 msec longer than the pre-paced QRS width was predictive of persistent MD after CRT (sensitivity = 80 %, specificity = 62 %). Conclusions ΔQRS was found to be associated with residual MD after CRT. Ten milliseconds of QRS prolongation predicted persistent MD after CRT.
ISSN:1383-875X
1572-8595
DOI:10.1007/s10840-015-0080-7