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. 2023 Nov;66(8):1799-1806.
doi: 10.1007/s10840-022-01463-y. Epub 2023 Jan 11.

Maximizing QRS duration reduction in contemporary cardiac resynchronization therapy is feasible and shorter QRS duration is associated with better clinical outcome

Rasmus Borgquist  1 , Sofia Marinko  2   3 , Pyotr G Platonov  2   3 , Lingwei Wang  2   3 , Uzma Chaudhry  2   3 , Johan Brandt  2   3 , David Mörtsell  2   3
Affiliations

Maximizing QRS duration reduction in contemporary cardiac resynchronization therapy is feasible and shorter QRS duration is associated with better clinical outcome

Rasmus Borgquist et al. J Interv Card Electrophysiol. 2023 Nov.

Abstract

Background: We aimed to evaluate if optimization by maximizing QRS duration (QRSd) reduction is feasible in an all-comer cardiac resynchronization therapy (CRT) population, and if reduced, QRSd is associated with a better clinical outcome.

Methods: Patients with LBBB receiving CRT implants during the period 2015-2020 were retrospectively evaluated. Implants from 2015-2017 were designated as controls. Starting from 2018, an active 12-lead electrogram-based optimization of QRSd reduction was implemented (intervention group). QRSd reduction was evaluated in a structured way at various device AV and VV settings, aiming to maximize the reduction. The primary endpoint was a composite of heart failure hospitalization or death from any cause.

Results: A total of 254 patients were followed for up to 6 years (median 2.9 [1.8-4.1]), during which 82 patients (32%) reached the primary endpoint; 53 deaths (21%) and 58 (23%) heart failure hospitalizations. Median QRS duration pre-implant was 162 ms [150-174] and post-implant 146ms [132-160]. Mean reduction in QRS duration was progressively larger for each year during the intervention period, ranging from - 9.5ms in the control group to - 24 in the year 2020 (p = 0.005). QRS reduction > 14 ms (median value) was associated with a lower risk of death or heart failure hospitalization (adjusted HR 0.54 [0.29-0.98] (p = 0.04).

Conclusions: Implementing a general strategy of CRT device optimization by aiming for shorter QRS duration is feasible in a structured clinical setting and results in larger reductions in QRS duration post-implant. In patients with a larger QRS reduction, compared to those with a smaller QRS reduction, there is an association with a better clinical outcome.

Keywords: CRT; Device optimization; Heart failure; Heart failure hospitalization; Mortality.

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Conflict of interest statement

RB has received speaker’s fees from Medtronic, Abbott, and Biotronik, and has research grants from Boston Scientific. DM has received advisory board fees and speaker fees from Abbott and Medtronic. The other authors have no conflicts of interests.

Figures

Fig. 1
Fig. 1
ECG optimization scheme
Fig. 2
Fig. 2
QRS duration reduction per implant period (years)
Fig. 3
Fig. 3
Kaplan-Meier curve showing survival free of heart failure hospitalization stratified for reduction of QRS duration during CRT (cutoff is the median value, a reduction of 14 ms)
Fig. 4
Fig. 4
Kaplan Meier curve showing survival free of heart failure hospitalization stratified for implant period (2015–2017 vs. 2020) and truncated to 2 years of follow-up
See this image and copyright information in PMC

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