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. 2016 Aug;13(8):1636-43.
doi: 10.1016/j.hrthm.2016.05.018. Epub 2016 May 25.

Prognostic importance of postoperative QRS widening in patients with heart failure receiving cardiac resynchronization therapy

Aymeric Menet  1 , Hélène Bardet-Bouchery  2 , Yves Guyomar  3 , Pierre Graux  3 , François Delelis  3 , Anne-Laure Castel  3 , Sébastien Heuls  3 , Estelle Cuvelier  3 , Cécile Gevaert  3 , Pierre-Vladimir Ennezat  4 , Christophe Tribouilloy  5 , Sylvestre Maréchaux  6
Affiliations

Prognostic importance of postoperative QRS widening in patients with heart failure receiving cardiac resynchronization therapy

Aymeric Menet et al. Heart Rhythm. 2016 Aug.

Abstract

Background: Landmark reports have suggested that patients with QRS widening immediately after cardiac resynchronization therapy (CRT) experienced less frequently reverse left ventricular remodeling during follow-up.

Objective: We sought to investigate the relationship between postoperative QRS widening relative to baseline and mortality in a prospective cohort of heart failure patients receiving CRT.

Methods: A 12-lead electrocardiogram was recorded for 237 heart failure patients (New York Heart Association class II to IV, left ventricular ejection fraction ≤35%, and QRS width ≥120 ms) before and immediately after CRT device implantation. The relationships between QRS widening, all-cause and cardiovascular mortality, and echocardiographic response to CRT were studied.

Results: During a median follow-up of 24 months, 39 patients died. Fifty patients (21%) experienced QRS widening after CRT [QRS(+) group]. During follow-up, all-cause mortality was higher in QRS(+) patients than in QRS(-) patients (36-month survival free from death 81% ± 7% vs 64% ± 16%; log rank, P = .029). After adjustment for important prognostic confounders, QRS(+) patients remained associated with an excess overall mortality (adjusted hazard ratio [HR] 2.67; 95% confidence interval 1.07-6.65; P = .035) and cardiovascular mortality (adjusted hazard ratio 3.63; 95% confidence interval 1.13-11.65; P = .03). QRS(+) patients were less frequent responders to CRT than were QRS(-) patients (20 [47%] vs 136 [83%]; P < .0001).

Conclusion: Postoperative QRS widening relative to baseline after CRT is associated with a considerable increased mortality risk during follow-up. Whether QRS narrowing should be achieved to optimize CRT placement, and thereby increase the rate of CRT responders and improve outcome, deserves further research.

Keywords: Cardiac resynchronization therapy; Electrocardiogram; Heart failure; Outcome; QRS duration.

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