Effect of QRS area reduction and myocardial scar on the hemodynamic response to cardiac resynchronization therapy

Okafor, Osita; Umar, Fraz; Zegard, Abbasin; Dam, Peter van; Walton, Jamie; Stegemann, Berthold; Marshall, Howard; Leyva, Francisco

doi:10.1016/j.hrthm.2020.07.025

Cited by 8 publications

(8 citation statements)

References 21 publications

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“…It is precisely because of the presence of cardiac chambers that the density of the myocardium is small, and the resulting depolarization vector is bound to be small, thus forming troughs. In the f-LBBB group, because a local slow conduction area exists in the left ventricle (probably caused by a myocardial scar), this part is depolarized later than the rest of the myocardium (20, 21) and the second peak of the notch is formed by a staggering peak.…”

Section: Discussionmentioning

confidence: 99%

“…The copyright holder for this preprint this version posted February 21, 2023. ; https://doi.org/10.1101/2023.02. 20.23286204 doi: medRxiv preprint but its specificity is still too low to accurately diagnose t-LBBB (6). Approximately one third of patients diagnosed with LBBB by conventional ECG criteria are likely to receive a false positive diagnosis (7).…”

Section: Introductionmentioning

confidence: 99%

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Redefining Left Bundle Branch Block from High-density Electroanatomical Mapping

Zou

Hua

Shao

et al. 2023

Preprint

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Background: The current ECG criteria for diagnosing left bundle branch block (LBBB) still cannot fully differentiate between true and false blocks. The absence or presence of an LBBB is key in improving the response rate of clinical cardiac resynchronization therapy. Methods: We hypothesized that the notch width of the QRS complex in the lateral leads (I, avL, V5, V6) on the LBBB-like ECG could further confirm the diagnosis of true LBBB. We performed high-density, three-dimensional electroanatomical mapping in the cardiac chambers of 37 patients scheduled to undergo CRT and whose preoperative electrocardiograms met the ACC/AHA/HRS guidelines for the diagnosis of complete LBBB. We compared the clinical characteristics, the real-time correspondence between the spread of ventricular electrical excitation and the QRS wave, the QRS notch width of the lateral leads, and the notch width/left ventricular end-diastolic diameter (Nw/LVd)ratio between the two groups. Results: Twenty-five patients were recruited to the t-LBBB group, and 12 to the f-LBBB group. In the t-LBBB group, the first peak of the QRS notch corresponded to the depolarization of the right ventricle and septum, the trough corresponded to the depolarization of the left ventricle across the left ventricle,and the second peak corresponded to the depolarization of the left ventricular free wall. In the f-LBBB group,the first peak corresponded to the depolarization of the right ventricle and most of the left ventricle,the second peak corresponded to the depolarization of the latest, locally-activated myocardium of the left ventricle,and the trough was caused by the off-peak delayed activation of the left ventricle. The QRS Nw (45.2 ± 12.3 ms vs.52.5 ±9.2 ms, P<0.05) and the Nw/LVd (0.65 ± 0.19 ms/mm vs. 0.81 ± 0.17 ms/mm, P<0.05) were compared between the two groups.Through ROC correlation analysis, the sensitivity (88%),specificity (58%),and cut-off value (0.56) for Nw/LVd diagnosis of t-LBBB was obtained.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Redefining Left Bundle Branch Block from High-density Electroanatomical Mapping

Zou

Hua

Shao

et al. 2023

Preprint

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“…The highest percentage of CRT response was observed in patients with low focal scar CMR values and high QRSarea, indicating that combined CMR-VCG parameters may improve prediction to CRT response. The issue dealing with QRS area and CMR was also dealt by Okafor et al (2020) . The purpose of their study was to determine in patients with ideally deployed quadripolar left ventricular lead whether a reduction QRS area leads to an acute hemodynamic response (AHR) and whether the scar affects this interaction.…”

Section: Heart Disease Analysis From Vectorcardiographymentioning

confidence: 99%

“…However, there are cases where a standard ECG does not achieve the necessary success rate of detecting various ischemia using automated detection. Therefore, VCG is approached as a method that can provide additional information Edenbrand et al (1990) , Stovicek et al (1993) , Warner et al (1982) , Filos et al (2017) , Iwaniec et al (2018) , Okafor et al (2020) , Jimenez et al (2021) . Standardized VCG leads using Frank lead system are rarely used nowadays, and for this reason trends are shifting to a derivation solution.…”

Section: Current Problemsmentioning

confidence: 99%

Review of Processing Pathological Vectorcardiographic Records for the Detection of Heart Disease

Vondrak

Penhaker

2022

Front. Physiol.

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Vectorcardiography (VCG) is another useful method that provides us with useful spatial information about the electrical activity of the heart. The use of vectorcardiography in clinical practice is not common nowadays, mainly due to the well-established 12-lead ECG system. However, VCG leads can be derived from standard 12-lead ECG systems using mathematical transformations. These derived or directly measured VCG records have proven to be a useful tool for diagnosing various heart diseases such as myocardial infarction, ventricular hypertrophy, myocardial scars, long QT syndrome, etc., where standard ECG does not achieve reliable accuracy within automated detection. With the development of computer technology in recent years, vectorcardiography is beginning to come to the forefront again. In this review we highlight the analysis of VCG records within the extraction of functional parameters for the detection of heart disease. We focus on methods of processing VCG functionalities and their use in given pathologies. Improving or combining current or developing new advanced signal processing methods can contribute to better and earlier detection of heart disease. We also focus on the most commonly used methods to derive a VCG from 12-lead ECG.

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“…Previous studies have suggested a positive correlation between QRS area and the degree of response to CRT 7,8 . QRS area could be added as a criterion for selecting suitable CRT patients 9,10 . However, clinical use of QRS area remains unclear.…”

Section: Introductionmentioning

confidence: 99%

QRS area as a predictor of cardiac resynchronization therapy response: A systematic review and meta‐analysis

Tokavanich

Prasitlumkum

Mongkonsritragoon

et al. 2022

Pacing Clinical Electrophis

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Background: QRS area, a three-dimensional QRS complex, is a novel vectorcardiography method of measuring the magnitude of electrical forces in the heart. Hypothetically, a greater QRS area denotes higher dyssynchrony and indicates potential benefits from cardiac resynchronization therapy (CRT). Previous studies suggest a positive correlation between QRS area and the degree of response to CRT, but its clinical use remains unclear. We performed a meta-analysis of the relationship between QRS area and survival benefit following CRT. Methods:We comprehensively searched the MEDLINE, EMBASE, and Cochrane databases from inception to August 2021. We included studies with prospective and retrospective cohort designs that reported QRS area before CRT and total mortality. Data from each study were analyzed using a random-effects model. The results were reported as a hazard ratio (HR) and 95% confidence intervals.Results: Five observational studies including 4931 patients were identified. The cut-off values between large and small QRS areas ranged from 102 to 116 µVs. Our analysis showed a larger QRS area was statistically associated with increased 5-year survival in patients implanted with CRT (HR pooled 0.48, 95% CI 0.46-0.51, I 2 = 54%, p < .0001).Greater QRS area reduction (pre-and post-implantation) were associated with a lower total mortality rate (HR pooled 0.45, 95% CI 0.38-0.52, I 2 = 0%, p < .0001). Conclusion:Larger pre-implantation QRS area was associated with increased survival after CRT. QRS area reduction following CRT implantation was also associated with lower mortality. QRS area may potentially become an additional selection criterion for CRT implantations.

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Effect of QRS area reduction and myocardial scar on the hemodynamic response to cardiac resynchronization therapy

Cited by 8 publications

References 21 publications

Redefining Left Bundle Branch Block from High-density Electroanatomical Mapping

Redefining Left Bundle Branch Block from High-density Electroanatomical Mapping

Review of Processing Pathological Vectorcardiographic Records for the Detection of Heart Disease

QRS area as a predictor of cardiac resynchronization therapy response: A systematic review and meta‐analysis

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