Key result
Mid-range paced QRS duration linked to ~72% fewer cardiac events versus longer QRS.
Why the study?
The effect of paced-QRS duration on long-term cardiac outcomes after pacemaker implantation was unclear.
Does a mid-range paced-QRS duration (≤149 ms) reduce cardiac events in patients undergoing pacemaker implantation compared to a long paced-QRS duration (>149 ms)?
Cohort (n=187)
Does a mid-range paced-QRS duration (≤149 ms) reduce cardiac events in patients undergoing pacemaker implantation compared to a long paced-QRS duration (>149 ms)?
A paced-QRS duration of ≤149 ms is an independent predictor of reduced cardiac events in patients undergoing right ventricular pacing, suggesting it as a potential procedural target.
Paced-QRS ≤149 ms may lower events; hypothesis-generating and needs prospective confirmation before practice change.
BACKGROUND: The effect of paced-QRS (p-QRS) duration on long-term outcomes is unclear, so we assessed the association between p-QRS duration and cardiac events. METHODS AND RESULTS: We enrolled 187 patients (103 males, mean age: 77±12 years) who underwent pacemaker implantation between 2018 and 2021. During the median follow-up period of 972 days (761-1,292 days), 18 patients experienced cardiac events (1 cardiac death, 17 heart failure hospitalizations). The p-QRS duration was longer in the cardiac event group than in the noncardiac event group (162±17 vs. 148±17 ms, P=0.005). Receiver operating characteristic curve analysis identified 149 ms as the optimal cutoff value for predicting cardiac events (area under the curve, 0.72). Kaplan-Meier analysis showed better outcomes for mid-range p-QRS duration (≤149 ms, n=89) compared with long p-QRS duration (>149 ms, n=98) (P=0.005). Multivariate Cox hazard analysis indicated a good outcome with mid-range p-QRS duration (hazard ratio: 0.28, 95% confidence interval: 0.06-0.88, P=0.029). CONCLUSIONS: A p-QRS duration of ≤149 ms was associated with a reduction in cardiac events. Therefore, it may serve as a target index of success in right ventricular pacing.
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Miyazaki et al. (2025) conducted a cohort in Pacemaker implantation (n=187). Mid-range paced-QRS duration (≤149 ms) vs. Long paced-QRS duration (>149 ms) was evaluated on Cardiac events (cardiac death or heart failure hospitalizations) (HR 0.28, 95% CI 0.06-0.88, p=0.029). Mid-range paced-QRS duration (≤149 ms) was associated with a significant reduction in cardiac events compared to long paced-QRS duration (HR 0.28; 95% CI 0.06-0.88; P=0.029).
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