Prediction of optimal cardiac resynchronization by vectors extracted from electrograms in dyssynchronous canine hearts
Key result
In canine hearts with LBBB, EGMV-QRSarea predicted optimal CRT-device settings better than QRS duration (AUC 0.89 vs 0.76; P<0.01).
Why the study?
Does EGMV-QRSarea improve the prediction of optimal acute hemodynamic response to CRT compared to QRS duration in a canine model of LBBB?
Population
13 dogs with left bundle branch block (LBBB), of which 5 also had myocardial infarction (MI)
Comparison
Prediction of optimal CRT-device settings using… vs Prediction using QRS duration
Design
Preclinical, 100 randomized AV- and VV-settings
Follow-up
acute
Authors
Discussion
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Implication
Draft 2:* Offers a promising electrogram-based metric for CRT optimization that should not.
Structured PICO
Does EGMV-QRSarea improve the prediction of optimal acute hemodynamic response to CRT compared to QRS duration in a canine model of LBBB?
P
Population
13 dogs with left bundle branch block (LBBB), including 5 with myocardial infarction, undergoing biventricular pacing with randomized AV and VV settings.
E
Exposure
Prediction of optimal CRT-device settings using QRS area derived from electrogram-based vectors (EGMV-QRSarea) during biventricular pacing with 100 randomized AV- and VV-settings
C
Comparator
Prediction using QRS duration
O
Outcome
Acute hemodynamic CRT response (defined as an acute increase in LV dP/dtmax ≥ 90% of the highest achieved value)surrogate
Main Result
Effect estimate: AUC 0.89 vs 0.76 (95% CI 0.86-0.93)
Absolute Event Rate: 0.89% vs 0.76%
p-value: p=<0.01
In a canine model, electrogram-based vector QRS area accurately predicts acute hemodynamic response to CRT, outperforming standard QRS duration.
Cite This Study
Engels et al. (2017) studied Left bundle branch block (LBBB) with or without myocardial infarction (n=13). EGMV-QRSarea vs. QRS duration was evaluated on Prediction of optimal CRT-device settings (acute increase in LV dP/dtmax ≥ 90% of the highest achieved value) (AUC 0.89 vs 0.76, 95% CI 0.86-0.93, p=<0.01). In canine hearts with LBBB, EGMV-QRSarea predicted optimal CRT-device settings better than QRS duration (AUC 0.89 vs 0.76; P<0.01).