Marek Jastrzebski1, Adrian Baranchuk2, Kamil Fijorek3, Roksana Kisiel1, Piotr Kukla4, Tomasz Sondej1, Danuta Czarnecka1. 1. First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Kopernika str. 17, Krakow 31-052, Poland. 2. Heart Rhythm Service, Kingston Heart Sciences Center, Kingston, ON, Canada. 3. Department of Statistics, Cracow University of Economics, Krakow, Poland. 4. Department of Cardiology, H. Klimontowicz Specialistic Hospital, Gorlice, Poland.
Abstract
AIMS: QRS narrowing with initiation of biventricular pacing might be an acute electrocardiographic indicator of correction of left bundle branch block (LBBB)-induced depolarization delay and asynchrony. However, its impact on prognosis remains controversial, especially in non-LBBB patients. Our goal was to evaluate the impact of QRS narrowing on long-term mortality and morbidity in a large cohort of patients undergoing cardiac resynchronization therapy (CRT) with different pre-implantation QRS types: LBBB, non-LBBB, and permanent right ventricular pacing. METHODS AND RESULTS: This study included consecutive patients who underwent CRT device implantation. Study endpoints: death from any cause or urgent heart transplantation and death from any cause/urgent heart transplantation or hospital admission for heart failure. All pre- and post-implantation electrocardiograms were analysed using digital callipers, high-amplitude augmentation, 100 mm/s paper speed, and global QRS duration measurement method. A total of 552 CRT patients entered the survival analysis. During the 9 years observation period, 232 (42.0%) and 292 (52.9%) patients met primary and secondary endpoints, respectively. QRS narrowing predicted survival in the Kaplan-Meier analysis only in patients with LBBB. Multivariate Cox regression model showed that QRS narrowing was the major determinant of both study endpoints, with hazard ratios of 0.46 and 0.43, respectively. There was a strong relationship between mortality risk and shortening/widening of the QRS, albeit only in the LBBB group. Patients with non-LBBB morphologies had unfavourable prognosis similar to that in LBBB patients without QRS narrowing. CONCLUSION: Acute QRS narrowing in patients with LBBB might be a desirable endpoint of CRT device implantation.
AIMS: QRS narrowing with initiation of biventricular pacing might be an acute electrocardiographic indicator of correction of left bundle branch block (LBBB)-induced depolarization delay and asynchrony. However, its impact on prognosis remains controversial, especially in non-LBBB patients. Our goal was to evaluate the impact of QRS narrowing on long-term mortality and morbidity in a large cohort of patients undergoing cardiac resynchronization therapy (CRT) with different pre-implantation QRS types: LBBB, non-LBBB, and permanent right ventricular pacing. METHODS AND RESULTS: This study included consecutive patients who underwent CRT device implantation. Study endpoints: death from any cause or urgent heart transplantation and death from any cause/urgent heart transplantation or hospital admission for heart failure. All pre- and post-implantation electrocardiograms were analysed using digital callipers, high-amplitude augmentation, 100 mm/s paper speed, and global QRS duration measurement method. A total of 552 CRT patients entered the survival analysis. During the 9 years observation period, 232 (42.0%) and 292 (52.9%) patients met primary and secondary endpoints, respectively. QRS narrowing predicted survival in the Kaplan-Meier analysis only in patients with LBBB. Multivariate Cox regression model showed that QRS narrowing was the major determinant of both study endpoints, with hazard ratios of 0.46 and 0.43, respectively. There was a strong relationship between mortality risk and shortening/widening of the QRS, albeit only in the LBBB group. Patients with non-LBBB morphologies had unfavourable prognosis similar to that in LBBB patients without QRS narrowing. CONCLUSION: Acute QRS narrowing in patients with LBBB might be a desirable endpoint of CRT device implantation.
Authors: Daniel Lapidot; Moshe Rav-Acha; Tali Bdolah-Abram; Rivka Farkash; Michael Glikson; Tal Hasin Journal: J Clin Med Date: 2022-02-26 Impact factor: 4.241
Authors: Kamil Sedláček; Rostislav Polášek; Helena Jansová; Domenico Grieco; Pavel Kučera; Josef Kautzner; Darrel P Francis; Dan Wichterle Journal: PLoS One Date: 2022-09-26 Impact factor: 3.752
Authors: Ahmed AlTurki; Pedro Y Lima; Martin L Bernier; Daniel Garcia; Alejandro Vidal; Bruno Toscani; Sergio Diaz; Mauricio Montemezzo; Alaa Al-Dossari; Tomy Hadjis; Jacqueline Joza; Vidal Essebag Journal: CJC Open Date: 2020-01-21