Journal
EUROPACE
Volume 12, Issue 2, Pages 216-222Publisher
OXFORD UNIV PRESS
DOI: 10.1093/europace/eup364
Keywords
Cardiac resynchronization therapy; Biventricular pacing; Electrocardiogram; Bundle branch block; Heart failure; Mortality
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Funding
- Danish Heart Foundation [07-4-B695-A1464-22378]
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The present study aims to identify the predictive value of electrocardiographic (ECG) patterns on long-term clinical and echocardiographic outcome in patients treated with cardiac resynchronization therapy (CRT). Clinical information including a standard 12-lead ECG was collected from patient files in consecutive patients treated with CRT from 1997 to 2007. Symptomatic response was defined as improvement in New York Heart Association class (>= 1) and echocardiographic response as improvement in left ventricular ejection fraction of >= 5% absolute. We included 659 patients [median age 66 years, 526 (80%) male]. There was a higher all-cause and cardiac mortality in patients with left bundle branch block (LBBB), prolonged PR interval, right-axis deviation combined with LBBB in the pre-implant ECG, and no QRS reduction after CRT. Patients with right bundle branch block and patients with an intermediate QRS duration (150-200 ms) had a higher chance of symptomatic improvement, and patients with normal PR interval and normal axis in LBBB had a higher chance of echocardiographic improvement. Cardiac resynchronization therapy does not change the predictive value of ECG patterns in heart failure patients with bundle branch block, where LBBB, a prolonged PR, and an abnormal axis in LBBB are signs of a more severe degree of myocardial disease, and therefore a worse outcome. Lack of electrical resynchronization defined as an unchanged or prolonged QRS duration is associated with higher all-cause and cardiac mortality in patients treated with CRT.
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