Relationship between fragmented QRS and response to cardiac resynchronization therapy

Ağaçdiken, Ayşen; Şahı̇n, Tayfun; Al, Neslihan Özlem; Vural, Ahmet; Ural, Dilek

doi:10.1007/s10840-012-9715-0

Cited by 16 publications

(16 citation statements)

References 33 publications

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“…This is similar to the study by Çelikyurt et al (23) which showed reverse remodeling after 6 months follow-up was significantly more common in patients with non-fragmented wide-QRS (35% vs. 89%, p=0.001). However in a study by Rickard et al (24) they found no difference in indices of LV remodeling or rates of all-cause mortality between patients with and without fQRS.…”

Section: Discussionsupporting

confidence: 91%

“…Therefore, these factors, especially wide baseline QRS duration, which portend favorable outcomes, may overcome the negative influence that fQRS may have. As we see in Table 1 in our study similar to Çelikyurt et al (23) study, there was no significant difference between patients gender and baseline mean QRS duration in fQRS and non fQRS group. Our study showed; sensitivity, specificity, positive predictive value and negative predictive value of fQRS in predicting non-responsiveness to CRT were 91.3%, 47.3%, 80.7% and 69.2%, respectively.…”

Section: Discussionsupporting

confidence: 88%

“…Although patients are selected according to current patient selection criteria, an important proportion of them do not respond to CRT (23, 30). However, results of many CRT studies indicates that 30-40% of the patients failed to respond to CRT (13).…”

Section: Discussionmentioning

confidence: 99%

“…Çelikyurt et al (23) evaluated relationship between fragmented QRS and response to CRT and their findings were very interesting and they suggested further studies to confirm the findings. On the other hand, Rickard (24) reported fQRS is not a predictor of progressive ventricular remodeling in HF patients undergoing CRT.…”

Section: Introductionmentioning

confidence: 96%

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The role of the fragmented QRS complexes on a routine 12-lead ECG in predicting non-responsiveness to cardiac resynchronization therapy

Rad

Baboli²,

Barzigar³

et al. 2015

Anatol J Cardiol

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Objective:Cardiac resynchronization therapy (CRT) is introduced as a promising therapeutic option in heart failure (HF) patients with ventricular dyssynchrony. The challenge, however, is identifying the patients who are suitable candidates for this procedure. Fragmented QRS (fQRS) is associated with subendocardial fibrosis and myocardial scars. In this study, we aimed to evaluate the role of fragmented QRS complex on a routine 12-lead ECG as a predictor of response to CRT.Methods:Sixty-five consecutive patients with HF who underwent CRT, were studied. Patients’ resting 12-lead ECGs were analyzed to find presence of fQRS by a cardiologist. Echocardiographic response to CRT was defined as ≥15% decrease in left ventricular end-systolic volume (LVESV) after CRT implantation. Response to CRT was compared between patients with and without fQRS.Results:The study group included 27 women (41.5%) and 38 men (58.5%) with a mean (±SD) age of 62±12 years. 27 patients (41.5%) had fQRS in their basal ECGs. Totally 46 patients (70.8%) responded to CRT in a way that the mean left ventricular ejection fraction (%) significantly increased, and left ventricular end diastolic volume (LVEDV) significantly decreased after CRT (p<0.001 and p=0.001 respectively). In multivariate logistic analysis, lack of fQRS was found to be a predictor of response to CRT (OR: 4.553, 95% CI: 1.345-15.418, p=0.015).Conclusion:We showed that the fQRS complex, as a sign of myocardial scar, predicts non-responsiveness to CRT. Therefore, fQRS may help selecting of CRT candidates.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

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The role of the fragmented QRS complexes on a routine 12-lead ECG in predicting non-responsiveness to cardiac resynchronization therapy

Rad

Baboli²,

Barzigar³

et al. 2015

Anatol J Cardiol

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“…Based on this evidence, current class I recommendations were restricted to patients with complete LBBB. However, recent studies showed that fragmented QRS complexes in the electrocardiograms of patients with nonischemic dilated cardiomyopathy and narrow QRS complexes are associated with significant intraventricular dyssynchrony [58,59], and other studies suggested that fragmented QRS complexes might be useful in predicting response to CRT [60,61]. Ongoing studies are investigating the possibility of maximizing CRT benefits by refining ECG selection criteria [62].…”

Section: Patient Selectionmentioning

confidence: 99%

Six Sigma DMAIC for Shaking Stagnant Construction Cultures – A Conceptual Perspective

A¹

2015

J Civ Eng Environ Sci

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Heart Failure is the result of heterogeneous structural heart diseases, especially ischemic disease, and is becoming increasingly common in all Western countries.Many patients continue to be symptomatic in spite of progress in pharmacological therapy, and the risk of mortality remains high in the most advanced functional classes. Cardiac resynchronization therapy can be used as a therapeutic strategy for alleviating symptoms and reducing mortality in selected patients with heart failure.Cardiac resynchronization therapy provides both immediate and medium/long-term results. The immediate results are the reduced QRS duration, the synchrony restoration between the ventricles and between the lateral and septal walls of the left ventricle, the reduced mitral regurgitation and the increased stroke volume. In the medium/long term, left ventricular reverse remodeling occurs and left ventricular ejection fraction is increased.Several trials have documented both increased functional capacity and improvements in quality of life and New York Heart Association class. Moreover, cardiac resynchronization therapy has been seen to reduce HF hospitalizations and mortality and the total number of days of hospitalization.In order to reduce the percentage of non-responders to cardiac resynchronization therapy, it is necessary to optimize the prognostic stratification of candidates for implantation through multi-parameter evaluations and to ensure correct device programming with periodic updates which are widely recommended but not so often performed.Whether indications should be extended will need to be evaluated in view of the known complications mainly associated with lead implantation. RationaleIt is well known that QRS duration is inversely correlated with survival in HF patients in functional classes II-IV, and patients with QRS ≥200 ms have a 5-fold higher risk of death than those with a narrow QRS [7]. In particular, left bundle branch block (LBBB) usually delays activation of the posterior/lateral wall of the left ventricle, leading to asynchronous contraction between the septum and posterior-lateral wall and reducing the left ventricular ejection fraction (LVEF).CRT can correct this asynchronous contraction through the preexcitation of the posterior-lateral wall of the left ventricle, thereby improving systolic function [8,9]. Indeed, the dyssynchrony due to prolonged QRS duration involves the heterogeneous propagation of electrical activity in the ventricle, which determines various degrees of impaired coordination in filling and contraction [10]. Consequently the contractile efficiency of the heart is compromised and the myocardial oxygen consumption increases, worsening the clinical course of HF.

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The role of fQRS in coronary artery disease

Qiu

Bao

et al. 2014

Herz

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Relationship between fragmented QRS and response to cardiac resynchronization therapy

Abstract: Presence of dyssynchrony is necessary but not sufficient to select appropriate candidates for CRT. Presence of f-wQRS on baseline ECG may play a role in identifying patients who may not respond to CRT.

Cited by 16 publications

References 33 publications

The role of the fragmented QRS complexes on a routine 12-lead ECG in predicting non-responsiveness to cardiac resynchronization therapy

The role of the fragmented QRS complexes on a routine 12-lead ECG in predicting non-responsiveness to cardiac resynchronization therapy

Six Sigma DMAIC for Shaking Stagnant Construction Cultures – A Conceptual Perspective

The role of fQRS in coronary artery disease

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