Time Course of Electrical Remodeling of Native Conduction After Cardiac Resynchronization Therapy and Its Impact on Clinical Outcome

Cvijić, Marta; Žižek, David; Antolič, Bor; Zupan, Igor

doi:10.1016/j.cardfail.2016.10.014

Cited by 9 publications

(13 citation statements)

References 12 publications

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“…Third, baseline QRSp was evaluated a median of 1.8 months post CRT, which coincided with the patient’s early postoperative follow-up, rather than pre CRT. However, this time interval is unlikely to be associated with CRT-induced structural remodeling as demonstrated by Cvijic et al [23] where LV end systolic volume did not change before 3 months of CRT and native QRSd decreased by a median of only 5ms after 1 month of CRT. Regardless, our functional CRT responder rate was similar to prior studies [16] and QRSp remodeling still tracked functional CRT response.…”

Section: Discussionmentioning

confidence: 88%

Quantification of abnormal QRS peaks predicts response to cardiac resynchronization therapy and tracks structural remodeling

et al. 2019

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Background Although QRS duration (QRSd) is an important determinant of cardiac resynchronization therapy (CRT) response, non-responder rates remain high. QRS fragmentation can also reflect electrical dyssynchrony. We hypothesized that quantification of abnormal QRS peaks (QRSp) would predict CRT response. Methods Forty-seven CRT patients (left ventricular ejection fraction = 23±7%) were prospectively studied. Digital 12-lead ECGs were recorded during native rhythm at baseline and 6 months post-CRT. For each precordial lead, QRSp was defined as the total number of peaks detected on the unfiltered QRS minus those detected on a smoothed moving average template QRS. CRT response was defined as >5% increase in left ventricular ejection fraction post-CRT. Results Sixty-percent of patients responded to CRT. Baseline QRSd was similar in CRT responders and non-responders, and did not change post-CRT regardless of response. Baseline QRSp was greater in responders than non-responders (9.1±3.5 vs. 5.9±2.2, p = 0.001) and decreased in responders (9.2±3.6 vs. 7.9±2.8, p = 0.03) but increased in non-responders (5.5±2.3 vs. 7.5±2.8, p = 0.049) post-CRT. In multivariable analysis, QRSp was the only independent predictor of CRT response (Odds Ratio [95% Confidence Interval]: 1.5 [1.1–2.1], p = 0.01). ROC analysis revealed QRSp (area under curve = 0.80) to better discriminate response than QRSd (area under curve = 0.67). Compared to QRSd ≥150ms, QRSp ≥7 identified response with similar sensitivity but greater specificity (74 vs. 32%, p<0.05). Amongst patients with QRSd <150ms, more patients with QRSp ≥7 responded than those with QRSp <7 (75 vs. 0%, p<0.05). Conclusions Our novel automated QRSp metric independently predicts CRT response and decreases in responders. Electrical dyssynchrony assessed by QRSp may improve CRT selection and track structural remodeling, especially in those with QRSd <150ms.

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Section: Discussionmentioning

confidence: 88%

Quantification of abnormal QRS peaks predicts response to cardiac resynchronization therapy and tracks structural remodeling

et al. 2019

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“…The electrical remodeling assessed by QRS duration appeared first, as early as at 3 months in the CeP group, although it is noteworthy that this was a self‐controlled comparison of native QRS duration in the CeP group. This was partly in accordance with a previous study demonstrating significant native QRS narrowing after CRT before LV mechanical remodeling and highlighted the nature of CRT as an electrical therapy. LV structural remodeling, specifically LVEF reduction, appeared 6 months after cessation of pacing.…”

Section: Discussionmentioning

confidence: 99%

Cessation of pacing in super‐responders of cardiac resynchronization therapy: A randomized controlled trial

Liang

Wang

Zhang

et al. 2018

Cardiovasc electrophysiol

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“…Second, baseline study performed at a median 2 months after CRT initiation may not have captured true baseline TWA as some patients may already have had substantial electrical and mechanical remodelling within weeks of CRT [ 18 , 26 – 29 ]. However, Cvijic et al demonstrated minimal early structural remodeling such that LV end systolic volume did not change before 3 months of CRT [ 30 ]. Despite this, a further decrease in TWA at the follow-up study supported our primary hypothesis that long-term CRT attenuates TWA in cardiomyopathy patients.…”

Section: Discussionmentioning

confidence: 99%

Reduced T wave alternans in heart failure responders to cardiac resynchronization therapy: Evidence of electrical remodeling

et al. 2018

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BackgroundT-wave alternans (TWA), a marker of electrical instability, can be modulated by cardiac resynchronization therapy (CRT). The relationship between TWA and heart failure response to CRT has not been clearly defined.Methods and resultsIn 40-patients (age 65±11 years, left ventricular ejection-fraction [LVEF] 23±7%), TWA was evaluated prospectively at median of 2 months (baseline) and 8 months (follow-up) post-CRT implant. TWA-magnitude (Valt >0μV, k≥3), its duration (d), and burden (Valt ·d) were quantified in moving 128-beat segments during incremental atrial (AAI, native-TWA) and atrio-biventricular (DDD-CRT) pacing. The immediate and long-term effect of CRT on TWA was examined. Clinical response to CRT was defined as an increase in LVEF of ≥5%. Native-TWA was clinically significant (Valt ≥1.9μV, k≥3) in 68% of subjects at baseline. Compared to native-TWA at baseline, DDD-CRT pacing at baseline and follow-up reduced the number of positive TWA segments, peak-magnitude, longest-duration and peak-burden of TWA (44±5 to 33±5 to 28±4%, p = 0.02 and 0.002; 5.9±0.8 to 4.1±0.7 to 3.8±0.7μV, p = 0.01 and 0.01; 97±9 to 76±8 to 67±8sec, p = 0.004 and <0.001; and 334±65 to 178±58 to 146±54μV.sec, p = 0.01 and 0.004). In addition, the number of positive segments and longest-duration of native-TWA diminished during follow-up (44±5 to 35±6%, p = 0.044; and 97±9 to 81±9sec, p = 0.02). Clinical response to CRT was observed in 71% of patients; the reduction in DDD-CRT paced TWA both at baseline and follow-up was present only in responders (interaction p-values <0.1).ConclusionLong-term CRT reduces the prevalence and magnitude of TWA. This CRT induced beneficial electrical remodeling is a marker of clinical response after CRT.

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Time Course of Electrical Remodeling of Native Conduction After Cardiac Resynchronization Therapy and Its Impact on Clinical Outcome

Cited by 9 publications

References 12 publications

Quantification of abnormal QRS peaks predicts response to cardiac resynchronization therapy and tracks structural remodeling

Quantification of abnormal QRS peaks predicts response to cardiac resynchronization therapy and tracks structural remodeling

Cessation of pacing in super‐responders of cardiac resynchronization therapy: A randomized controlled trial

Reduced T wave alternans in heart failure responders to cardiac resynchronization therapy: Evidence of electrical remodeling

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