Longer pre-implant left ventricular activation time was associated with a reduced risk of heart failure hospitalization or all-cause mortality in patients with LBBB (log-rank p = 0.046).
Cohort (n=415)
No
Is longer baseline left ventricular activation time associated with reduced heart failure hospitalization or all-cause mortality in patients receiving cardiac resynchronization therapy?
Longer baseline left ventricular activation time on a standard 12-lead ECG may help identify patients with LBBB who are more likely to have improved clinical outcomes from cardiac resynchronization therapy.
p-value: p=0.046
INTRODUCTION: Many patients do not benefit from cardiac resynchronization therapy (CRT) with current guideline parameters. The objective of this study was to examine the relationship between left ventricular activation time (LVAT) from the standard 12-lead surface electrocardiogram (ECG) and clinical outcome from CRT. METHODS: A retrospective study was performed on patients receiving CRT implants at a large-volume tertiary care center. Digital ECGs were collected pre- and post-implant. LVAT was defined as the time from QRS onset to maximum deflection in lead V6. The primary combined endpoint was heart failure hospitalization or all-cause mortality. RESULTS: The study group comprised 415 patients (median age Q1-Q3 of 72.8 years 65.1-78.7, 77.3% male, median baseline LVEF 27.5% 22-30, and 43.1% with ischemic heart failure etiology) who were followed for up to 7.6 years (median 2.8). LVAT was measured pre-implant (median 78 ms 66-98) and post-implant (median 88 ms 74-106). In Kaplan-Meier analysis, a longer pre-implant LVAT was associated with a reduced risk of reaching the primary endpoint in patients with LBBB (log-rank p = 0.046). Post-implant LVAT was not associated with clinical outcome. CONCLUSION: Our results show that a longer baseline LVAT is associated with a lower risk of heart failure hospitalization and all-cause mortality. This relationship was of borderline significance in multivariable analysis. Prospective trials would be useful to further explore the potential role of pre-implant LVAT in patient selection for CRT.
Marinko et al. (Wed,) conducted a cohort in Heart failure requiring cardiac resynchronization therapy (n=415). Longer baseline left ventricular activation time (LVAT) vs. Shorter baseline LVAT was evaluated on Heart failure hospitalization or all-cause mortality (p=0.046). Longer pre-implant left ventricular activation time was associated with a reduced risk of heart failure hospitalization or all-cause mortality in patients with LBBB (log-rank p = 0.046).