Association of QRS narrowing with response to cardiac resynchronization therapy—a systematic review and meta-analysis of observational studies

Bazoukis, George; Naka, Katerina K.; Alsheikh‐Ali, Alawi A.; Tse, Gary; Letsas, Κonstantinos P.; Korantzopoulos, Panagiotis; Liu, Tong; Yeung, Cynthia; Efremidis, Michael; Tsioufis, Κonstantinos; Baranchuk, Adrián; Stavrakis, Stavros

doi:10.1007/s10741-019-09839-5

Cited by 28 publications

(27 citation statements)

References 72 publications

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“…They defined a cutoff value at 86 milliseconds. In accordance with our results, in a meta‐analysis 34 both acute and late QRS narrowing – that is, better electrical synchronization – was associated with clinical and echocardiographic improvements.…”

Section: Discussionsupporting

confidence: 90%

Cardiac resynchronization therapy with intraoperative epicardial mapping via minithoracotomy: 10 years’ experience

Hejjel

Németh

Melczer

et al. 2020

Pacing Clinical Electrophis

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Background Cardiac resynchronization therapy (CRT) is considered an efficient method to improve the left ventricular (LV) dysfunction with left bundle branch block. However, coronary venous anatomy is not appropriate in about 10% of the cases; thus other alternatives, such as epicardial lead implantation via minithoracotomy are needed. Methods During the period 2007‐2017, a total of 57 patients were operated at our institute via left anterior minithoracotomy after an unsuccessful transvenous CRT. The best position of the LV epicardial electrode was determined by intraoperative epicardial mapping, that is locating the latest activation spot relative to the right ventricular (RV) electrode. The authors analyzed the survival by Kaplan‐Meier estimator with Tarone‐Ware equality test and multiple Cox regression analysis, the changes of the LV ejection fraction (LVEF) and dimensions, the development of the impedance and threshold of the LV epicardial electrode, the possible associations between the survival and intraoperative sensed RV‐LV activation delay. Results The intraoperative RV‐LV activation delay was 92.250 ± 26.538 milliseconds. There were no intraoperative complications except ventricular fibrillation in three patients. Within 30 days there were neither wound healing complications nor pocket hematoma. There was no significant difference in survival with regard to gender or etiology, but significantly better survival was found in the cohort with intraoperative sensed RV‐LV activation delay >86 milliseconds. The LVEF and dimensions improved following the operation and continued to be improved in the survivors. Conclusion CRT via minithoracotomy with epicardial mapping is a safe, efficient, simple, and reproducible second‐line alternative to the transvenous method.

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Section: Discussionsupporting

confidence: 90%

Cardiac resynchronization therapy with intraoperative epicardial mapping via minithoracotomy: 10 years’ experience

Hejjel

Németh

Melczer

et al. 2020

Pacing Clinical Electrophis

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“…In this meta-analysis, greater improvement of LVEF was achieved by LBBAP delivered CRT compared with BVP delivered CRT, which is paralleled with the more remarkable shortened QRSd in patients after LBBAP delivered CRT. Since a significant association between QRS narrowing and shorter attained QRSd with clinical and echocardiographic CRT responses has been indicated in previous studies, the further shortened QRSd may explain the benefits of LBBAP over BVP on cardiac function and clinical symptoms in HF patients, as well as the increased CRT response during follow-up ( 24 ). No significant difference in adverse events, such as HF hospitalization, was observed between groups.…”

Section: Discussionmentioning

confidence: 93%

Left Bundle Branch Area Pacing vs. Biventricular Pacing for Cardiac Resynchronization Therapy: A Meta-Analysis

Liu

Sun

Wang

et al. 2021

Front. Cardiovasc. Med.

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Background: Left bundle branch area pacing (LBBAP) is a recently proposed method for conduction system pacing. We performed a meta-analysis of controlled studies to compare the clinical outcome in patients who received LBBAP vs. biventricular pacing (BVP) for cardiac resynchronization therapy (CRT).Methods: PubMed, Embase, and Cochrane's Library databases were searched for relevant controlled studies. A random-effect model incorporating the potential heterogeneity was used to synthesize the results.Results: Four non-randomized controlled studies including 249 patients with heart failure (HF) for CRT were included, and the patients were followed for 6–12 months. Compared with BVP, LBBAP was associated with significantly shortened QRS duration [mean difference (MD): −29.18 ms, 95% confidence interval (CI): −33.55–24.80, I2 = 0%, P < 0.001], improved left ventricular ejection fraction (MD: 6.93%, 95% CI: 4.69–9.17, I2 = 0%, P < 0.001), reduced left ventricular end-diastolic dimension (MD: −2.96 mm, 95% CI: −5.48 to −0.44, I2 = 0%, P = 0.02), and improved New York Heart Association class (MD: −0.54, 95% CI: −0.84 to −0.24, I2 = 65%, P < 0.001). Moreover, patients who received LBBAP were more likely to achieve echocardiographic [odds ratio (OR): 5.04, 95% CI: 2.17–11.69, I2 = 0%, P < 0.001] and clinical (OR: 7.33, 95% CI: 1.62–33.16, I2 = 0%, P = 0.01) CRT responses.Conclusion: Current evidence from non-randomized studies suggests that LBBAP appears to be a promising method for CRT, which is associated with more remarkable improvements of symptoms and cardiac function in HF patients with indication for CRT.

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“…24 In this context, a recent metaanalysis of 32 studies including 14 studies (1274 patients, mean age 64 years) using clinical CRT response and 18 studies (1270 patients, mean age 64 years) using echocardiographic CRT response, indicated that there was a significant association between QRS narrowing and shorter achieved QRS duration with clinical and echocardiographic CRT response, independent of the timing of QRS width measurement after CRT implantation. 44 The authors concluded that acute and late improvement of electrical dyssynchrony as reflected by QRS narrowing following biventricular pacing is associated with clinical and echocardiographic response to CRT. 4).…”

Section: Qrs Durationmentioning

confidence: 99%

Electrocardiography of cardiac resynchronization therapy: Pitfalls and practical tips

Manolis¹,

Manolis

Manolis³

et al. 2021

Cardiovasc electrophysiol

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Cardiac resynchronization therapy (CRT) has been established as an effective mode of therapy in patients with heart failure and concurrent cardiac dyssynchrony, principally in the form of left bundle branch block (LBBB). The widespread use of CRT has ushered in a new landscape in 12-lead electrocardiography (ECG). ECG readings in these patients are most important to guide troubleshooting and also appropriate device programming, as well as discerning and managing nonresponders. A set of four ECG recordings need to accompany each patient with a CRT device, including a baseline ECG and recordings from monochamber (right and left ventricular) and biventricular pacing, which can be compared against a new recording to facilitate the evaluation of proper versus problematic biventricular pacing. Precordial ECG leads V1/2 acquired at the fourth intercostal space and limb leads, I and III, together with a quick assessment of perpendicular leads I and aVF to determine the quadrant of the QRS axis in the hexaxial diagram, may provide the framework for proper ECG interpretation in these patients. This important issue of 12lead ECG in CRT patients is herein reviewed, pitfalls are pointed out and practical tips are provided for ECG reading to help recognize and manage problems with CRT device function. Furthermore, several pertinent ECG recordings and tabulated data are provided, and an algorithm is suggested that integrates prior algorithms and relevant information from current literature.

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Association of QRS narrowing with response to cardiac resynchronization therapy—a systematic review and meta-analysis of observational studies

Cited by 28 publications

References 72 publications

Cardiac resynchronization therapy with intraoperative epicardial mapping via minithoracotomy: 10 years’ experience

Cardiac resynchronization therapy with intraoperative epicardial mapping via minithoracotomy: 10 years’ experience

Left Bundle Branch Area Pacing vs. Biventricular Pacing for Cardiac Resynchronization Therapy: A Meta-Analysis

Electrocardiography of cardiac resynchronization therapy: Pitfalls and practical tips

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