Different Methods to Measure QRS Duration in CRT Patients: Impact on the Predictive Value of QRS Duration Parameters

Abstract

Different methods to measure QRSD yield not only different nominal values but also influence the value of QRSD in predicting CRT response. Measuring QRSD by a global method can help to standardize QRSD measurements in future studies.

Biventricular Paced QRS Area Predicts Acute Hemodynamic CRT Response Better Than QRS Duration or QRS Amplitudes

“…This is in line with our findings. Additionally, it has been shown in the literature that shortening in QRS duration with BV pacing is a marker to predict chronic CRT response . As QRS area is the result of both QRS duration and amplitude, reducing paced QRS duration certainly reduces also the paced QRS area.…”

“…QRSD was measured on the surface ECG using global QRS duration, defined as the interval between the earliest onset of the QRS waveform in any lead till the latest offset in any lead . With ventricular paced QRS complexes, the onset of the QRS complex and not the pacing spike was considered as the beginning of the QRS complex.…”

“…Additionally, it has been shown in the literature that shortening in QRS duration with BV pacing is a marker to predict chronic CRT response. 14,21,22 As QRS area is the result of both QRS duration and amplitude, reducing paced QRS duration certainly reduces also the paced QRS area. As our study demonstrated that reduction in QRS area is more predictive than shortening in QRS duration for acute CRT response, this reduction in paced QRS area seems promising to predict chronic CRT response.…”

Narrowing filtered QRS duration on signal‐averaged electrocardiogram predicts outcomes in cardiac resynchronization therapy patients with nonischemic heart failure

“…However, a previous study reported that there was low concordance between automated QRS duration measurements and manual QRS duration measurements (De Guillebon et al., ). Another study reported that automated QRS durations measured by commercial ECG devices were significantly different from those measured by digitally assisted measurements and that automated QRS duration measurements showed a low predictive value for the CRT response (De Pooter et al., ). In addition, an SAECG can detect ventricular late potentials.…”

Do novel noninvasive ECG techniques improve patient selection for CRT?

“…Because of the limited number of leads, it only allows gross approach of the activation process and may not capture the entire activation sequence. Although QRSd measurement had a good reproducibility in controlled studies with core center analysis (mean intra-and inter-observer variability of 1.6% and 1.4% on native QRS 4 ), non-controlled studies reported significant variations according to the lead(s) used, a poor reproducibility and a low concordance between manual and computerized measures 5,6 . There is therefore a need for novel non-invasive ECG techniques, more efficient and less investigator-dependent A first alternative could be the automated vectocardiogram (VCG) that contains 3D information of the cardiac electrical forces.…”