What does this research mean for the field?

Interventricular pacing interval optimization based on QRS width yields a higher rate of echocardiographic reverse remodeling response than tissue Doppler imaging optimization in cardiac resynchronization therapy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 2, 2011Journal of Cardiovascular Electrophysiology

Electrocardiographic versus Echocardiographic Optimization of the Interventricular Pacing Delay in Patients Undergoing Cardiac Resynchronization Therapy

Q: What is the clinical evidence from this study?

Study design: RCT. Population: severe heart failure and left bundle-branch block (n=156). Intervention: Electrocardiographic (ECG) optimization of the VV interval vs. Echocardiographic (ECHO) optimization of the VV interval. Primary outcome: Echocardiographic responders (neither death nor heart transplantation and a LV end-systolic volume reduction >10%) (p=0.023).

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Key result

ECG-based VV optimization yields ~36% more echocardiographic responders than tissue Doppler imaging.

P=0.023
n=156

Why the study?

Echocardiographic optimization of the VV interval may improve CRT response but is time-consuming and not routinely performed, necessitating comparison with electrocardiographic optimization.

Does electrocardiographic optimization of the VV interval improve echocardiographic response compared to echocardiographic optimization in patients with severe heart failure and LBBB undergoing CRT?

Population

156 consecutive CRT patients with severe heart failure and left bundle-branch block

Comparison

VV interval optimization by echocardiography (TDI) vs electrocardiography (QRS width)

Design

Randomized controlled trial with random assignment to ECHO or ECG optimization

Follow-up

6 months

Authors

DTDavid TamboreroKarolinska University Hospital BVBárbara VidalHospital General Universitario Gregorio Marañón JTJosé Marı́a TolosanaElectrophysiology

Discussion

Member takes

Overview

TDI VV optimization showed no clear CRT benefit over QRS criteria; leaves open whether routine echocardiographic tuning improves outcomes in broader populations.

Study Design

Type

RCT (n=156)

Randomization

randomly assigned

Structured PICO

Does electrocardiographic optimization of the VV interval improve echocardiographic response compared to echocardiographic optimization in patients with severe heart failure and LBBB undergoing CRT?

Population

156 patients with severe heart failure and left bundle-branch block undergoing cardiac resynchronization therapy, followed for 6 months.

Intervention

Interventricular pacing (VV) interval optimization based on electrocardiography (ECG) to achieve the narrowest QRS measured from the earliest deflection.

Comparator

Interventricular pacing (VV) interval optimization based on echocardiography (ECHO) to produce the best left ventricular intraventricular synchrony according to tissue Doppler imaging (TDI) displacement curves.

Outcome

Echocardiographic response (defined as neither death nor heart transplantation and a LV end-systolic volume reduction >10%) at 6-month follow-up.composite

Main Result

Absolute Event Rate: 67.9% vs 50%

p-value: p=0.023

ECG-based optimization of the VV interval using QRS width is a simpler and more effective method for achieving left ventricular reverse remodeling in CRT patients compared to time-consuming echocardiographic TDI optimization.

Cite This Study

Tamborero et al. (2011) conducted an RCT in severe heart failure and left bundle-branch block (n=156). Electrocardiographic (ECG) optimization of the VV interval vs. Echocardiographic (ECHO) optimization of the VV interval was evaluated on Echocardiographic responders (neither death nor heart transplantation and a LV end-systolic volume reduction >10%) (p=0.023). Electrocardiographic optimization of the VV interval based on QRS width yielded more echocardiographic responders than tissue Doppler imaging (67.9% vs 50.0%; P=0.023).

synapsesocial.com/papers/6aaca0ea696769727593cee9 https://doi.org/10.1111/j.1540-8167.2011.02085.x

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June 2, 2011Journal of Cardiovascular Electrophysiology

Electrocardiographic versus Echocardiographic Optimization of the Interventricular Pacing Delay in Patients Undergoing Cardiac Resynchronization Therapy

View Full Paper

Ask AI

Bookmark

Key result

ECG-based VV optimization yields ~36% more echocardiographic responders than tissue Doppler imaging.

P=0.023
n=156

Why the study?

Echocardiographic optimization of the VV interval may improve CRT response but is time-consuming and not routinely performed, necessitating comparison with electrocardiographic optimization.

Does electrocardiographic optimization of the VV interval improve echocardiographic response compared to echocardiographic optimization in patients with severe heart failure and LBBB undergoing CRT?

Population

156 consecutive CRT patients with severe heart failure and left bundle-branch block

Comparison

VV interval optimization by echocardiography (TDI) vs electrocardiography (QRS width)

Design

Randomized controlled trial with random assignment to ECHO or ECG optimization

Follow-up

6 months

Authors

DTDavid TamboreroKarolinska University Hospital BVBárbara VidalHospital General Universitario Gregorio Marañón JTJosé Marı́a TolosanaElectrophysiology

Discussion

Member takes

Overview

TDI VV optimization showed no clear CRT benefit over QRS criteria; leaves open whether routine echocardiographic tuning improves outcomes in broader populations.

Study Design

Type

RCT (n=156)

Randomization

randomly assigned

Structured PICO

Does electrocardiographic optimization of the VV interval improve echocardiographic response compared to echocardiographic optimization in patients with severe heart failure and LBBB undergoing CRT?

Population

156 patients with severe heart failure and left bundle-branch block undergoing cardiac resynchronization therapy, followed for 6 months.

Intervention

Interventricular pacing (VV) interval optimization based on electrocardiography (ECG) to achieve the narrowest QRS measured from the earliest deflection.

Comparator

Outcome

Echocardiographic response (defined as neither death nor heart transplantation and a LV end-systolic volume reduction >10%) at 6-month follow-up.composite

Main Result

Absolute Event Rate: 67.9% vs 50%

p-value: p=0.023

Cite This Study

synapsesocial.com/papers/6aaca0ea696769727593cee9 https://doi.org/10.1111/j.1540-8167.2011.02085.x

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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