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. 2021 Nov 11;11(11):1176.
doi: 10.3390/jpm11111176.

Very Long-Term Follow-Up in Cardiac Resynchronization Therapy: Wider Paced QRS Equals Worse Prognosis

Patrick Leitz  1 , Julia Köbe  1 , Benjamin Rath  1 , Florian Reinke  1 , Gerrit Frommeyer  1 , Christian Andresen  1 , Fatih Güner  1 , Julian Wolfes  1 , Philipp S Lange  1 , Christian Ellermann  1 , Lars Eckardt  1 , Dirk G Dechering  1
Affiliations

Very Long-Term Follow-Up in Cardiac Resynchronization Therapy: Wider Paced QRS Equals Worse Prognosis

Patrick Leitz et al. J Pers Med. .

Abstract

Background: Different electrocardiogram (ECG) findings are known to be independent predictors of clinical response to cardiac resynchronization therapy (CRT). It remains unknown how these findings influence very long-term prognosis.

Methods and results: A total of 102 consecutive patients (75 males, mean age 65 ± 10 years) referred to our center for CRT implantation had previously been included in this prospective observational study. The same patient group was now re-evaluated for death from all causes over a prolonged median follow-up of 10.3 years (interquartile range 9.4-12.5 years). During follow-up, 55 patients died, and 82% of the clinical non-responders (n = 23) and 44% of the responders (n = 79) were deceased. We screened for univariate associations and found QRS width during biventricular (BIV) pacing (p = 0.02), left ventricular (LV) pacing (p < 0.01), Δ LV paced-right ventricular (RV) paced (p = 0.03), age (p = 0.03), New York Heart Association (NYHA) class (p < 0.01), CHA2DS2-Vasc score (p < 0.01), glomerular filtration rate (p < 0.01), coronary artery disease (p < 0.01), non-ischemic cardiomyopathy (NICM) (p = 0.01), arterial hypertension (p < 0.01), NT-proBNP (p < 0.01), and clinical response to CRT (p < 0.01) to be significantly associated with mortality. In the multivariate analysis, NICM, the lower NYHA class, and smaller QRS width during BIV pacing were independent predictors of better outcomes.

Conclusion: Our data show that QRS width duration during biventricular pacing, an ECG parameter easily obtainable during LV lead placement, is an independent predictor of mortality in a long-term follow-up. Our data add further evidence that NICM and lower NYHA class are independent predictors for better outcome after CRT implantation.

Keywords: ECG; cardiac resynchronization; heart failure; pacing; very long-term follow-up.

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Conflict of interest statement

The authors declare that they have no competing interest.

Figures

Figure 1
Figure 1
Follow-up design (formula image: in person physician contact; formula image: telephone physician contact; ECHO: trans-thoracic echocardiogram; formula image: electrocardiogram; formula image: Minnesota Living with Heart Failure Questionnaire; formula image: Device interrogation; formula image: Interrogation on current NYHA class, hospitalizations; formula image: Deceased; formula image: End of data collection and start statistical analysis).
Figure 2
Figure 2
Kaplan–Meier survival functions, with corresponding tables describing the number (N) of patients at risk at a given point of the follow-up, for presence of NICM vs. ICM (Panel A); patients with NYHA III vs. NYHA IV at the time of implantation (Panel B). Patients with upper vs. lower median of QRS width during biventricular pacing (Panel C), as well as clinical responders to CRT therapy vs. non-responders to CRT therapy (Panel D). (NICM: non-ischemic cardiomyopathy; NYHA: New York Heart Association; BIV: biventricular pacing; ICM: ischemic cardiomyopathy; Cum survival: cumulative survival; ms: milliseconds; CRT: cardiac resynchronization therapy).
Figure 2
Figure 2
Kaplan–Meier survival functions, with corresponding tables describing the number (N) of patients at risk at a given point of the follow-up, for presence of NICM vs. ICM (Panel A); patients with NYHA III vs. NYHA IV at the time of implantation (Panel B). Patients with upper vs. lower median of QRS width during biventricular pacing (Panel C), as well as clinical responders to CRT therapy vs. non-responders to CRT therapy (Panel D). (NICM: non-ischemic cardiomyopathy; NYHA: New York Heart Association; BIV: biventricular pacing; ICM: ischemic cardiomyopathy; Cum survival: cumulative survival; ms: milliseconds; CRT: cardiac resynchronization therapy).
See this image and copyright information in PMC

References

    1. Roger V.L. Epidemiology of heart failure. Circ. Res. 2013;113:646–659. doi: 10.1161/CIRCRESAHA.113.300268. - DOI - PMC - PubMed
    1. Bristow M.R., Krueger S., Carson P., White B.G. Cardiac-Resynchronization Therapy with or without an Implantable Defibrillator in Advanced Chronic Heart Failure. N. Engl. J. Med. 2004;350:2140–2150. doi: 10.1056/NEJMoa032423. - DOI - PubMed
    1. Cleland J.G.F., Erdmann E., Kappenberger L. The Effect of Cardiac Resynchronization on Morbidity and Mortality in Heart Failure. N. Engl. J. Med. 2005;352:1539–1549. doi: 10.1056/NEJMoa050496. - DOI - PubMed
    1. Köbe J., Dechering D.G., Rath B., Reinke F., Mönnig G., Wasmer K., Eckardt L. Prospective evaluation of electrocardiographic parameters in cardiac resynchronization therapy: Detecting nonresponders by left ventricular pacing. Heart Rhythm. 2012;9:499–504. doi: 10.1016/j.hrthm.2011.11.009. - DOI - PubMed
    1. Appert L., Menet A., Altes A., Ennezat P.V., Bardet-Bouchery H., Binda C., Guyomar Y., Delelis F., Castel A.-L., Goffic C.L., et al. Clinical Significance of Electromechanical Dyssynchrony and QRS Narrowing in Patients With Heart Failure Receiving Cardiac Resynchronization Therapy. Can. J. Cardiol. 2019;35:27–34. doi: 10.1016/j.cjca.2018.10.019. - DOI - PubMed