Electrical Reverse Remodeling of the Native Cardiac Conduction System after Cardiac Resynchronization Therapy

Kwon, Hee Jin; Park, Kyoung-Min; Lee, Seong Soo; Park, Young Jun; On, Young Keun; Kim, June Soo; Park, Seung‐Jung

doi:10.3390/jcm9072152

Cited by 6 publications

(6 citation statements)

References 23 publications

(48 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition to QRS narrowing, we found shorter baseline pre-CRT intrinsic PR interval to be significantly associated with favorable post-CRT outcomes. Previous studies [ 20 , 21 , 22 ] have pointed to a possible correlation between shorter baseline PR interval and better prognosis following CRT implantation. Interestingly, in contrast with QRS narrowing characterizing CRT responders, post-CRT PR interval tends to prolong, regardless of CRT response [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies [ 20 , 21 , 22 ] have pointed to a possible correlation between shorter baseline PR interval and better prognosis following CRT implantation. Interestingly, in contrast with QRS narrowing characterizing CRT responders, post-CRT PR interval tends to prolong, regardless of CRT response [ 22 ]. Further research is thus needed to examine the prognostic effects of monitoring post-implantation changes in intrinsic PR interval.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

QRS Narrowing Following CRT Implantation: Predictors, Dynamics, and Association with Improved Long-Term Outcome

Lapidot

Rav

Bdolah‐Abram

et al. 2022

JCM

View full text Add to dashboard Cite

Background: Heart failure (HF) patients with wide QRS often benefit from cardiac resynchronization therapy (CRT), although QRS narrowing does not always occur. The current study investigates the incidence and predictors for QRS narrowing following CRT and its long-term impact on clinical outcomes. Methods: Among individuals undergoing clinically indicated CRT, pre-and post-implantation electrocardiographs were meticulously analyzed for QRS duration change. All-cause mortality and the composite of mortality and HF hospitalizations were retrieved. Results: For 104 patients, mean age 67 years, 25% females, QRS narrowed within days by 20.2 ± 24.7 ms. In 55/104 (53%) QRS narrowed by ≥20 ms (“acute narrowing”). Female gender and baseline QRS predicted acute narrowing. Acute narrowing persisted for 1–6 weeks in 18/20 (90%) and 3–12 months in 21/31 (68%) of patients. During the average follow-up of 41 months, 29/104 (28%) died and 50/104 (48%) met the composite outcome. In a multivariable analysis including comorbidities and cardiac history, prolonged baseline PR interval (HR 1.015, CI 1.008–1.021, p < 0.001) and acute narrowing < 20 ms (HR 3.243, CI 1.593–6.603, p = 0.001) were significant and independent predictors for the composite outcome. Conclusions: Post-CRT acute QRS narrowing ≥ 20 ms is independently associated with favorable long-term outcomes and might be considered as a novel measure for procedural success.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

QRS Narrowing Following CRT Implantation: Predictors, Dynamics, and Association with Improved Long-Term Outcome

Lapidot

Rav

Bdolah‐Abram

et al. 2022

JCM

View full text Add to dashboard Cite

show abstract

“…Nevertheless, after a mean follow-up of 59 ± 26 months, there was an increase in the number of patients treated and the dosage administered in the majority of patients. The variability of AV conduction was documented in both ways: shorter PR interval during physical exercise due to increased heart rate and the subsequent need to program rate-adaptive AV interval and increased intrinsic PR interval after resynchronization, irrespective of the CRT response status [27,28]. In the current study group, the main reasons for avoiding high BB doses were a longer baseline PR interval or a documented prolonged AV conduction during ET.…”

Section: Discussionmentioning

confidence: 68%

Betablockers and Ivabradine Titration According to Exercise Test in LV Only Fusion CRT Pacing

et al. 2022

View full text Add to dashboard Cite

Background: Betablockers (BB)/ivabradine titration in fusion CRT pacing (CRTP) is understudied. Aim: To assess drug optimization using systematic exercise tests (ET) in fusion CRTP with preserved atrioventricular conduction (AVc). Methods: Changes in drug management were assessed during systematic follow-ups in CRTP patients without right ventricle lead. Shorter AVc (PR interval) allowed BB up-titration, while longer AVc needed BB down-titration, favoring ivabradine. Constant fusion pacing was the goal to improve outcomes. Results: 64 patients, 62.5 ± 9.5 y.o divided into three groups: shorter PR (<160 ms), normal (160–200 ms), longer (200–240 ms); follow-up 59 ± 26 months. Drugs were titrated in case of: capture loss due to AVc shortening (14%), AVc lengthening (5%), chronotropic incompetence (11%), maximum tracking rate issues (9%), brady/tachyarrhythmias (8%). Interventions: BB up-titration (78% shorter PR, 19% normal PR, 5% longer PR), BB down-titration (22% shorter PR, 14% normal PR), BB exclusion (16% longer PR), adding/up-titration ivabradine (22% shorter PR, 19% normal PR, 5% longer PR), ivabradine down-titration (22% shorter PR, 3% normal PR), ivabradine exclusion (11% normal PR, 5% longer PR). Drug strategy was changed in 165 follow-ups from 371 recorded (42% patients). Conclusions: BBs/ivabradine titration and routine ET during follow-ups in patients with fusion CRTP should be a standard approach to maximize resynchronization response. Fusion CRTP showed a positive outcome with important LV reverse remodeling and significant LVEF improvement in carefully selected patients.

show abstract

“…In addition, we compared extent of iQRS duration change in patients with mechanical response versus without mechanical response. Data were extracted from six studies with 356 participants, of whom 231 (64.9%) were defined as mechanical responders [14,19,[21][22][23][24]. We found that while mechanical responders had a mean of iQRS shortening of 7.7 ms, mechanical non-responders experienced widening of iQRS by mean of 5.2 ms (Supplementary Fig.…”

Section: Association Between Electrical and Mechanical Responsementioning

confidence: 99%

Association between electrical and mechanical remodeling after cardiac resynchronization therapy: systematic review and meta-analysis of observational studies

et al. 2022

View full text Add to dashboard Cite

Cardiac resynchronization therapy (CRT) may improve not only impaired left ventricular contractility but can also induce reverse remodeling of native conduction system. Measurement of intrinsic QRS complex width during follow-up is the simplest method to assess reverse electrical remodeling (RER). We aimed to provide a literature review and meta-analysis on incidence and impact of RER and its association with mechanical remodeling. A systematic review and random-effect meta-analysis of studies reporting data on RER was performed. A total of 16 studies were included in this meta-analysis with 930 patients undergoing CRT (mean age 64.0 years, 64.1% males). The weighted mean incidence of RER was 42%. Reverse mechanical remodeling assessed by echocardiography was more frequently observed in patients with RER compared to patients without RER (75.7% vs. 46.6%; odds ratio [OR] 3.7, 95% confidence interval [CI] 2.24-6.09, p < 0.01). Mechanical responders had a mean iQRS shortening of 7.7 ms, while mechanical non-responders experienced a mean widening of iQRS by 5.2 ms (p < 0.01). Clinical improvement was more frequent in patients with RER vs. patients without RER (82.9% vs. 49.0%; OR 5.26; 95% CI 2.92-9.48; p < 0.01). No significant difference in all-cause mortality between patients with and without RER was found. Mean difference between baseline intrinsic QRS and post-implantation paced QRS was significant in patients with later RER (21.2 ms, 95% CI 9.4-32.9, p < 0.01), but not in patients without RER (6.6 ms, 95% CI -2.2-15.4, p = 0.14). Gender, initial left bundle block morphology and heart failure etiology were found not to be predictive for RER. Our meta-analysis demonstrates that shortening of iQRS duration is a common finding during follow-up of patients undergoing CRT and is associated with mechanical reverse remodeling and clinical improvement. Clinical Trial Registration: Prospero Database-CRD42021253336.

show abstract

Electrical Reverse Remodeling of the Native Cardiac Conduction System after Cardiac Resynchronization Therapy

Cited by 6 publications

References 23 publications

QRS Narrowing Following CRT Implantation: Predictors, Dynamics, and Association with Improved Long-Term Outcome

QRS Narrowing Following CRT Implantation: Predictors, Dynamics, and Association with Improved Long-Term Outcome

Betablockers and Ivabradine Titration According to Exercise Test in LV Only Fusion CRT Pacing

Association between electrical and mechanical remodeling after cardiac resynchronization therapy: systematic review and meta-analysis of observational studies

Contact Info

Product

Resources

About