Prominent R wave in ECG lead V1 predicts improvement of left ventricular ejection fraction after cardiac resynchronization therapy in patients with or without left bundle branch block.
Heart Rhythm
; 12(10): 2141-7, 2015 Oct.
Article
en En
| MEDLINE
| ID: mdl-26048194
ABSTRACT
BACKGROUND:
QRS morphology on postprocedural ECG indicating posterolateral left ventricular pacing may be predictive of response to cardiac resynchronization therapy (CRT).OBJECTIVE:
The purpose of this study was to assess whether a positive vector in V1 and/or negative vector in lead I on the first postprocedural ECG, suggesting posterolateral capture from CRT, correlates with improvement in left ventricular ejection fraction (LVEF).METHODS:
A retrospective chart review was conducted on all patients who underwent CRT implantation at our institution between April 2008 and December 2011. Biventricular (BiV) paced QRS morphology was defined as R/S ≥1 in V1 and/or R/S ≤ 1 in lead I. The primary outcome was improvement of LVEF ≥7.5%. The χ(2) and t tests were used for analysis.RESULTS:
Of 68 patients, 49 (72%) met our BiV paced QRS morphology criteria. Thirty-four of these 49 patients (69%) had improvement in LVEF. Of the 19 patients who did not meet our criteria, 17 (89%) did not have an improvement in LVEF (sensitivity 94%, specificity 53%, χ(2) = 19.04, P < .0001). The average LVEF improvement in patients who met our BiV paced QRS morphology criteria was significantly greater than in those who did not (14.27% vs 2.63%, P = .0001). Preprocedural left bundle branch block was not a predictor of echocardiographic response.CONCLUSION:
Our results highlight the importance of periprocedural ECG analysis to optimize response to CRT. Moreover, patients without left bundle branch block still benefited from CRT if they met our BiV paced morphology criteria. This suggests that postprocedural left ventricular activation as reflected on the ECG may supersede the baseline conduction delay.Palabras clave
Texto completo:
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Banco de datos:
MEDLINE
Asunto principal:
Volumen Sistólico
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Bloqueo de Rama
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Función Ventricular Izquierda
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Electrocardiografía
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Terapia de Resincronización Cardíaca
Tipo de estudio:
Diagnostic_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Heart Rhythm
Año:
2015
Tipo del documento:
Article