UHF-ECG-derived ventricular dyssynchrony independently predicted response to CRT (OR 1.02 per ms; P=0.04) more accurately than conventional ECG parameters.
Cohort (n=114)
No
Does UHF-ECG-derived ventricular dyssynchrony better predict response to cardiac resynchronization therapy than conventional ECG parameters in heart failure patients?
UHF-ECG-derived ventricular dyssynchrony (e-DYS) is a superior predictor of response to biventricular pacing compared to conventional QRS duration and morphology.
Odds Ratio: 1.02
p-value: p=0.04
BACKGROUND: Biventricular pacing improves morbidity and mortality in heart failure patients with electrical dyssynchrony. Yet, approximately one-third fail to respond when selection is based on QRS duration and morphology. OBJECTIVES: This study sought to determine if ultra-high-frequency electrocardiography (UHF-ECG) assesses ventricular dyssynchrony and may better predict cardiac resynchronization therapy (CRT) response. METHODS: In this prospective single-center study, 114 patients with heart failure, sinus rhythm, nonright bundle branch block morphology, LVEF ≤35%, and QRS duration >130 milliseconds were enrolled and followed for 6 months. Ventricular electrical dyssynchrony (e-DYS) was derived from UHF-ECG as the interval between earliest and latest activation in any of V RESULTS: A total of 73 patients (64%) were responders. Responders more often had nonischemic cardiomyopathy, larger QRS area, longer QRS duration, and greater e-DYS. Optimal cutoffs for CRT response prediction were e-DYS >55 ms, QRS area >81 μVs, NDAT V8 >117 ms, and QRS duration >155 ms. In multivariable analysis, only e-DYS (OR: 1.02 per ms; P = 0.04) and nonischemic cardiomyopathy (OR: 2.8; P = 0.03) independently predicted response. In ischemic cardiomyopathy, e-DYS remained the sole independent predictor. Postimplant Δe-DYS (-37 ms) predicted response more accurately (AUC = 0.73, 95% CI: 0.63-0.83) than ΔQRS area or ΔQRS duration. CONCLUSIONS: UHF-ECG-derived ventricular dyssynchrony predicts response to CRT more accurately than conventional ECG parameters. Both baseline e-DYS and its postimplant reduction identify patients most likely to benefit from biventricular pacing.
Leinveber et al. (Mon,) conducted a cohort in Heart failure (n=114). UHF-ECG-derived ventricular electrical dyssynchrony (e-DYS) vs. Conventional ECG parameters (QRS duration and morphology) was evaluated on Cardiac resynchronization therapy (CRT) response (OR 1.02 per ms, p=0.04). UHF-ECG-derived ventricular dyssynchrony independently predicted response to CRT (OR 1.02 per ms; P=0.04) more accurately than conventional ECG parameters.