The QRS Narrowing Index Predicts Reverse Left Ventricular Remodeling Following Cardiac Resynchronization Therapy

Rickard, John; Popović, Zoran B.; Verhaert, David; Sraow, Dan; Baranowski, Bryan; Martin, David O.; Lindsay, Bruce D.; Varma, Niraj; Tchou, Patrick; Grimm, Richard A.; Chung, Mina K.

doi:10.1111/j.1540-8159.2010.03022.x

Cited by 65 publications

(61 citation statements)

References 28 publications

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“…18,19) Increasing SS of LV pacing in CRT captures an enlarged myocardial area and provides a pacing response beyond a discrete region with conduction block, which thereby leads to more rapid electrical conduction in comparison with baseline. [7][8][9][10] This effect appears prominently in low-amplitude areas of electroanatomic voltage maps, such as infarct borders. 20) Recently, Tedrow, et al demonstrated that increasing SS of LV pacing in CRT reduces inter-ventricular conduction time and QRS duration.…”

Section: Discussionmentioning

confidence: 99%

“…7) If the capture of an enlarged myocardial area extends beyond a discrete region with conduction block, the increasing SS of LV pacing could provide more rapid electrical conduction in comparison with baseline. [8][9][10] Recent CRT studies have demonstrated that increasing SS of LV pacing reduces QRS duration on electrocardiograms (ECG). 10,11) The present study aimed to investigate whether increasing SS of LV pacing could improve LV mechanical dyssynchrony and cardiac function in patients treated with CRT.…”

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confidence: 99%

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Improvement of Cardiac Function by Increasing Stimulus Strength During Left Ventricular Pacing in Cardiac Resynchronization Therapy

et al. 2015

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SummaryCardiac resynchronization therapy (CRT) is an established therapy in patients with severe heart failure due to left ventricular (LV) dyssynchrony. Increasing stimulus strength (SS) of LV pacing could capture an enlarged myocardial area and provide rapid electrical conduction. The aim of the present study was to investigate whether increasing SS of LV pacing improves LV mechanical dyssynchrony and cardiac function in patients treated with CRT.We enrolled 26 patients with CRT and changed the SS of LV pacing: 2.5 V (standard SS) and 5 V (high SS). Electrocardiography and echocardiography were performed to assess QRS duration, LV mechanical dyssynchrony, and cardiac function under each condition.The QRS duration (138.6 ± 21.4 ms versus 126.8 ± 23.1 ms, P < 0.001), septal-posterior wall motion delay (126.5 ± 42.7 ms versus 111.4 ± 55.3 ms, P = 0.012), standard deviation of time from QRS (69.6 ± 21.8 ms versus 55.6 ± 19.4 ms, P < 0.001), LV ejection fraction (29.4 ± 10.6% versus 33.4 ± 11.6%, P = 0.005), and LV stroke volume (50.7 ± 15.5 mL versus 63.8 ± 18.3 mL, P < 0.001) improved significantly in high SS compared with standard SS.Increasing SS of LV pacing in CRT improves LV mechanical dyssynchrony and cardiac function. The capture of an enlarged myocardial area by increasing SS of LV pacing might offer an acute hemodynamic benefit to patients treated with CRT. (Int Heart J 2015; 56: 62-66)

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Improvement of Cardiac Function by Increasing Stimulus Strength During Left Ventricular Pacing in Cardiac Resynchronization Therapy

et al. 2015

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“…It is useful to know whether the QRS duration can be shortened when predicting the possibility of left ventricular structural remodeling or developing a prognosis for patients receiving CRT. [4][5][6][7] Moreover, the results of several small scale studies and also a case report have suggested that CRT can reverse ventricular electrical remodeling. [8][9][10][11] It is currently hypothesized that successful reverse structural remodeling of the left ventricle during cardiac resynchronization therapy may induce improved ventricular electrical conduction in heart failure patients without the need for pacing the dual ventricular chambers.…”

Section: T He Efficacy Of Cardiac Resynchronization Therapy (Crt)mentioning

confidence: 99%

Effects of Cardiac Resynchronization Therapy on Ventricular Electrical Remodeling in Patients With Heart Failure

et al. 2015

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SummaryCardiac resynchronization therapy (CRT) reverses structural remodeling of the left ventricle. We investigated whether CRT reverses left-ventricular electrical remodeling.Eighty patients were enrolled and implanted with CRT-devices. Echocardiography and electrocardiography data were obtained from each patient prior to implantation and two years after implantation. At two years after implantation, the patients were classified into a responder group and a non-responder group based on echocardiography.Over the next 2 years, 75 patients completed follow-up, and 5 patients had died. Echocardiography results showed that 23 patients could be classified as non-responders and 52 as responders. Larger numbers of non-responders were diagnosed with either ischemic cardiomyopathy (ICM) or nonspecific intraventricular conduction delay (NICD). The intrinsic QRS duration was not changed in responders, patients with dilated cardiomyopathy, or in the patient categories of male and female. However, the intrinsic QRS duration was significantly prolonged in non-responders and patients with ischemic cardiomyopathy (P = 0.041). The mean left ventricular end-diastolic diameter in the responder group was significantly decreased by CRT (P < 0.05), while there was no significant change in intrinsic QRS duration.While CRT does not reduce the intrinsic QRS duration, it can delay negative ventricular electrical remodeling. Continuous CRT is necessary. (Int Heart J 2015; 56: 495-499)

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“…However, up to one third of patients do not respond to CRT. In that regard, few initial studies presenting multisite pacing have shown encouraging results [2], demonstrating both feasibility and safety in placing a second CS lead in >80% of patients intended, with further QRS shortening, which is the most powerful predictor of LV reverse remodeling [3]. Such optimization of the resynchronization therapy might be able to improve the percentage of responders to CRT when applied to selected patients.…”

Section: Introductionmentioning

confidence: 99%

Not Enough QRS Shortening? Keep Calm and Add Another Lead

López¹,

Vallès²

2016

J Clin Case Rep

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Cardiac resynchronization therapy (CRT) diminishes symptoms and reduces hospitalization and mortality in patients with heart failure, LV dysfunction and left bundle branch block. However, up to one third of patients do not respond to CRT. In that regard, few initial studies presenting multisite pacing have shown encouraging results, demonstrating both feasibility and safety in placing a second CS lead in >80% of patients intended, with further QRS shortening, which is the most powerful predictor of LV reverse remodelling.

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The QRS Narrowing Index Predicts Reverse Left Ventricular Remodeling Following Cardiac Resynchronization Therapy

Abstract: After adjusting for potential confounders, QRS narrowing, indexed to baseline QRS duration, is associated with enhanced reverse ventricular remodeling following CRT.

Cited by 65 publications

References 28 publications

Improvement of Cardiac Function by Increasing Stimulus Strength During Left Ventricular Pacing in Cardiac Resynchronization Therapy

Improvement of Cardiac Function by Increasing Stimulus Strength During Left Ventricular Pacing in Cardiac Resynchronization Therapy

Effects of Cardiac Resynchronization Therapy on Ventricular Electrical Remodeling in Patients With Heart Failure

Not Enough QRS Shortening? Keep Calm and Add Another Lead

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