Skip to main content
SpringerLink
Log in

Native QRS narrowing reflects electrical reversal and associates with anatomical reversal in cardiac resynchronization therapy

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Abbreviation of paced QRS duration has been taken as electrical resynchronization imposed by cardiac resynchronization therapy (CRT). However, little is known about alteration in native QRS duration and its correlation with therapeutic response as well as anatomical remodeling post-CRT.

Methods

Data of 74 consecutive patients with complete ECG records were reviewed. Response was defined as absolute improvement in LVEF by ≥10 % from baseline. Changes in native QRS duration (native ΔQRS) were analyzed to CRT response and to changes in echocardiography.

Results

Over median follow-up of 13 months, 47 patients had response to CRT and 30 subjects had abbreviation in native QRS duration. Native ΔQRS correlated positively with QRS duration pre- and post-CRT as well as with changes in echocardiography. Reversal of electrical remodeling as assessed by native QRS narrowing accompanied with greater improvements in LVEF (20 % ± 11 % vs 10% ± 10 %, p = 0.000) and LVEDD (14 ± 11 mm vs. 4 ± 10 mm, p = 0.000). Multivariate analysis indicated that native ΔQRS was the lone independent factor of ECG in association to response to CRT (OR1.049, 95%CI 1.015–1.085, p = 0.004): 83.3 % of patients with native QRS reduction were responders. Among the non-responders, 18.5 % had native QRS narrowing at follow-ups.

Conclusions

Native QRS narrowing associated with beneficial response and greater improvements in echocardiography. Abbreviation in native QRS duration could reflect electrical reversal imposed by CRT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Abraham, W. T., Fisher, W. G., Smith, A. L., Delurgio, D. B., Leon, A. R., Loh, E., et al. (2002). Cardiac resynchronization in chronic heart failure. New England Journal of Medicine, 346(24), 1845–1853.

    Article  PubMed  Google Scholar 

  2. Linde, C., Abraham, W. T., Gold, M. R., St John Sutton, M., Ghio, S., & Daubert, C. (2008). Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms. Journal of the American College of Cardiology, 52(23), 1834–1843.

    Article  PubMed  Google Scholar 

  3. Castellant, P., Fatemi, M., Orhan, E., Etienne, Y., & Blanc, J. J. (2009). Patients with non-ischaemic dilated cardiomyopathy and hyper-responders to cardiac resynchronization therapy: characteristics and long-term evolution. Europace, 11(3), 350–355.

    Article  PubMed  Google Scholar 

  4. Daubert, C., Gold, M. R., Abraham, W. T., Ghio, S., Hassager, C., Goode, G., et al. (2009). Prevention of disease progression by cardiac resynchronization therapy in patients with asymptomatic or mildly symptomatic left ventricular dysfunction: insights from the European cohort of the REVERSE (Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction) trial. Journal of the American College of Cardiology, 54(20), 1837–1846.

    Article  PubMed  Google Scholar 

  5. Rickard, J., Popovic, Z., Verhaert, D., Sraow, D., Baranowski, B., Martin, D. O., et al. (2011). The QRS narrowing index predicts reverse left ventricular remodeling following cardiac resynchronization therapy. Pacing and Clinical Electrophysiology, 34(5), 604–611.

    Article  PubMed  Google Scholar 

  6. Gervais, R., Leclercq, C., Shankar, A., Jacobs, S., Eiskjaer, H., Johannessen, A., et al. (2009). Surface electrocardiogram to predict outcome in candidates for cardiac resynchronization therapy: a sub-analysis of the CARE-HF trial. European Journal of Heart Failure, 11(7), 699–705.

    Article  PubMed  Google Scholar 

  7. Rickard, J., Jackson, G., Spragg, D. D., Cronin, E. M., Baranowski, B., Tang, W. H., et al. (2012). QRS prolongation induced by cardiac resynchronization therapy correlates with deterioration in left ventricular function. Heart Rhythm, 9(10), 1674–1678.

    Article  PubMed  Google Scholar 

  8. Iler, M. A., Hu, T., Ayyagari, S., Callahan, T. D., 4th, Civello, K. C., Thal, S. G., et al. (2008). Prognostic value of electrocardiographic measurements before and after cardiac resynchronization device implantation in patients with heart failure due to ischemic or nonischemic cardiomyopathy. American Journal of Cardiology, 101(3), 359–363.

    Article  PubMed  Google Scholar 

  9. Boriani, G., Biffi, M., Martignani, C., Ziacchi, M., Saporito, D., Grigioni, F., et al. (2006). Electrocardiographic remodeling during cardiac resynchronization therapy. International Journal of Cardiology, 108(2), 165–170.

    Article  PubMed  Google Scholar 

  10. Vogt, J., Krahnefeld, O., Lamp, B., Hansky, B., Kirkels, H., Minami, K., et al. (2000). Electrocardiographic remodeling in patients paced for heart failure. American Journal of Cardiology, 86(9A), 152K–156K.

    Article  PubMed  CAS  Google Scholar 

  11. Perrin, M. J., Green, M. S., Redpath, C. J., Nery, P. B., Keren, A., Beanlands, R. S., et al. (2012). Greater response to cardiac resynchronization therapy in patients with true complete left bundle branch block: a PREDICT substudy. Europace, 14(5), 690–695.

    Article  PubMed  Google Scholar 

  12. Serdoz, L. V., Daleffe, E., Merlo, M., Zecchin, M., Barbati, G., Pecora, D., et al. (2011). Predictors for restoration of normal left ventricular function in response to cardiac resynchronization therapy measured at time of implantation. American Journal of Cardiology, 108(1), 75–80.

    Article  PubMed  Google Scholar 

  13. Hsing, J. M., Selzman, K. A., Leclercq, C., Pires, L. A., McLaughlin, M. G., McRae, S. E., et al. (2011). Paced left ventricular QRS width and ECG parameters predict outcomes after cardiac resynchronization therapy: PROSPECT-ECG substudy. Circulation Arrhythmia and Electrophysiology, 4(6), 851–857.

    Article  PubMed  Google Scholar 

  14. Sahn, D. J., DeMaria, A., Kisslo, J., & Weyman, A. (1978). Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation Journal, 58, 1072.

    Article  CAS  Google Scholar 

  15. Gold, M. R., Thébault, C., Linde, C., Abraham, W. T., Gerritse, B., Ghio, S., et al. (2012). Effect of QRS duration and morphology on cardiac resynchronization therapy outcomes in mild heart failure: results from the Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) study. Circulation, 126(7), 822–829.

    Article  PubMed  Google Scholar 

  16. Stavrakis, S., Lazzara, R., & Thadani, U. (2012). The benefit of cardiac resynchronization therapy and QRS duration: a meta-analysis. Journal of Cardiovascular Electrophysiology, 23(2), 163–168.

    Article  PubMed  Google Scholar 

  17. Birnie, D. H., Ha, A., Higginson, L., Sidhu, K., Green, M., Philippon, F., et al. (2013). Impact of QRS morphology and duration on outcomes following cardiac resynchronization therapy: results from the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT). Circulation. Heart Failure, 6(6), 1190–1198.

    Article  PubMed  Google Scholar 

  18. Yeim, S., Bordachar, P., Reuter, S., Laborderie, J., O'Neill, M. D., Lafitte, S., et al. (2007). Predictors of a positive response to biventricular pacing in patients with severe heart failure and ventricular conduction delay. Pacing and Clinical Electrophysiology, 30(8), 970–975.

    Article  PubMed  Google Scholar 

  19. Lecoq, G., Leclercq, C., Leray, E., Crocq, C., Alonso, C., de Place, C., et al. (2005). Clinical and electrocardiographic predictors of a positive response to cardiac resynchronization therapy in advanced heart failure. European Heart Journal, 26(11), 1094–1100.

    Article  PubMed  Google Scholar 

  20. Rickard, J., Cheng, A., Spragg, D., Cantillon, D., Chung, M. K., Tang, W. H., et al. (2013). QRS narrowing is associated with reverse remodeling in patients with chronic right ventricular pacing upgraded to cardiac resynchronization therapy. Heart Rhythm, 10(1), 55–60.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Alonso, C., Leclercq, C., Victor, F., Mansour, H., de Place, C., Pavin, D., et al. (1999). Electrocardiographic predictive factors of long-term clinical improvement with multisite biventricular pacing in advanced heart failure. American Journal of Cardiology, 84(12), 1417–1421.

    Article  PubMed  CAS  Google Scholar 

  22. Dizon, J., Horn, E., Neglia, J., Medina, N., & Garan, H. (2004). Loss of left bundle branch block following biventricular pacing therapy for heart failure: evidence for electrical remodeling? Journal of Interventional Cardiac Electrophysiology, 10(1), 47–50.

    Article  PubMed  Google Scholar 

  23. Yu, C. M., Chan, Y. S., Zhang, Q., Yip, G. W., Chan, C. K., Kum, L. C., et al. (2006). Benefits of cardiac resynchronization therapy for heart failure patients with narrow QRS complexes and coexisting systolic asynchrony by echocardiography. Journal of the American College of Cardiology, 48(11), 2251–2257.

    Article  PubMed  Google Scholar 

  24. Varma, N. (2009). Cardiac resynchronization therapy and the electrical substrate in heart failure: what does the QRS conceal? Heart Rhythm, 6(7), 1059–1062.

    Article  PubMed  Google Scholar 

Download references

Disclosure

There is no financial disclosure to report.

Conflict of interest

There is no conflict of interest related to this manuscript.

Author information

Authors and Affiliations

  1. Centre of Arrhythmia Diagnosis and Treatment, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, 100037, Beijing, China

    Xin-wei Yang, Wei Hua, Jing Wang, Zhi-min Liu, Li-gang Ding, Ke-ping Chen & Shu Zhang

Authors
  1. Xin-wei Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wei Hua
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jing Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhi-min Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Li-gang Ding
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ke-ping Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shu Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wei Hua.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yang, Xw., Hua, W., Wang, J. et al. Native QRS narrowing reflects electrical reversal and associates with anatomical reversal in cardiac resynchronization therapy. J Interv Card Electrophysiol 41, 161–168 (2014). https://doi.org/10.1007/s10840-014-9936-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-014-9936-5

Keywords

Search

Navigation