Incidence, predictors, and impact on outcome of increased left ventricular latency in patients undergoing cardiac resynchronization therapy
- 108 Downloads
Latency during left ventricle (LV) pacing has been suggested as a potential cause of ineffectual biventricular pacing. We assessed the incidence, predictors, and impact on outcome of increased LV latency in 274 patients undergoing cardiac resynchronization therapy (CRT).
On implantation, the latency interval was defined as the shortest stimulus-to-QRS onset interval in any lead of the 12-lead ECG. A stimulus-to-QRS onset interval ≥ 40 ms was used to define the presence of increased LV latency.
Increased LV latency was observed in 55 patients (20%). On multivariate analysis, only ischemic etiology proved to be a predictor of increased LV latency. On 12-month echocardiographic evaluation, 68% patients showed a ≥ 15% decrease in LV end systolic volume (74% patients with increased LV latency, 67% patients without increased LV latency (p = 0.58). The presence of increased LV latency was not associated with a different clinical response to CRT.
Increased LV latency occurred in almost 20% of patients undergoing CRT and was more frequent in patients with ischemic heart disease. The presence of increased LV latency does not seem to have an impact on echocardiographic or clinical response to CRT.
KeywordsCardiac resynchronization therapy Latency Ventricular pacing Ischemic heart disease with left ventricular pacing Outcome
Compliance with ethical standards
The Institutional Review Board of each participating center approved the protocol, and each patient provided written informed consent before enrollment.
Conflict of interest
Roberto Ospizio, Greta Merlotti, and Maurizio Malacrida are employees of Boston Scientific, Inc. No other conflicts of interest exist.
- 1.Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, et al. American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA Guideline for the Management of Heart Failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;128(16):e240–327. https://doi.org/10.1161/CIR.0b013e31829e8776.CrossRefPubMedGoogle Scholar
- 2.Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J. 2013;34:2281–329.CrossRefPubMedGoogle Scholar
- 3.Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, et al. Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004;350(21):2140–50. https://doi.org/10.1056/NEJMoa032423.CrossRefPubMedGoogle Scholar
- 6.Daubert C, Behar N, Martins RP, Mabo P, Leclercq C. Avoiding non-responders to cardiac resynchronization therapy: a practical guide. Eur Heart J. 2016:ehw270. https://doi.org/10.1093/eurheartj/ehw270.
- 8.Herweg B, Ali R, Ilercil A, Madramootoo C, Cutro R, Weston MW, et al. Site-specific differences in latency intervals during biventricular pacing: impact on paced QRS morphology and echo-optimized V-V interval. Pacing Clin Electrophysiol. 2010;33(11):1382–91. https://doi.org/10.1111/j.1540-8159.2010.02882.x.CrossRefPubMedGoogle Scholar
- 9.Dickstein K, Vardas PE, Auricchio A, Daubert JC, Linde C, McMurray J, et al. 2010 Focused Update of ESC Guidelines on device therapy in heart failure: an update of the 2008 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure and the 2007 ESC guidelines for cardiac and resynchronization therapy. Developed with the special contribution of the Heart Failure Association and the European Heart Rhythm Association. Eur Heart J. 2010;31:2677–87.CrossRefPubMedGoogle Scholar
- 11.Surawicz B, Childers R, Deal BJ, Gettes LS, Bailey JJ, Gorgels A, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III:intraventricular conduction disturbances: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol. 2009;53(11):976–81. https://doi.org/10.1016/j.jacc.2008.12.013.CrossRefPubMedGoogle Scholar