Abstract
Introduction
Electrical transmission disorders have a deleterious effect on cardiac depolarization, resulting in a disorganized ventricular contraction that reduces global mechanical efficiency; this mechanical dyssynchrony can be corrected by cardiac resynchronization therapy. However, despite adjustments in the electrical criteria selection of QRS for the recognition of mechanical dyssynchrony, a significant proportion of patients do not currently respond to this therapy.
Purpose
To find if a new predictor of dyssynchrony, the electrocardiogram spatial variance, is a better marker of mechanical dyssynchrony than QRS duration.
Methods
Forty-seven electrocardiograms and 47 strain (2D speckle tracking) echocardiograms were prospectively collected simultaneously in consecutive, non-selected patients; the left ventricular mechanical dispersion was measured in all the cases. The electrocardiographic analysis of variance was made with a digital superposition of the electrocardiographic leads and generates different indexes of variance of both QRS complex and repolarization phase.
Results
ROC analysis probed that the best area under the curve (AUC) value correlated with left ventricular mechanical dispersion and was obtained combining several spatial variance markers (considering depolarization and repolarization spatial variance together; AUC = 0.97); the same analysis using the QRS duration versus mechanical dispersion showed a significantly lower AUC value (AUC = 0.64).
Conclusion
Spatial variance combining depolarization and repolarization markers is a superior predictor of left ventricular mechanical dispersion than QRS duration.
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The protocol was approved by the Ethics Committee of Hospital de Diagnóstico Escalón, San Salvador, El Salvador.
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Bonomini, M.P., Villarroel-Abrego, H. & Garillo, R. Spatial variance in the 12-lead ECG and mechanical dyssynchrony. J Interv Card Electrophysiol 62, 479–485 (2021). https://doi.org/10.1007/s10840-021-00999-9
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DOI: https://doi.org/10.1007/s10840-021-00999-9