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EJIMA Kouichirou
Department School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine Position Endowed Associate Professor |
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| Article types | Original article |
| Language | English |
| Peer review | Peer reviewed |
| Title | Time interval from left ventricular stimulation to QRS onset is a novel predictor of nonresponse to cardiac resynchronization therapy. |
| Journal | Formal name：Heart rhythm Abbreviation：Heart Rhythm ISSN code：1547-5271/1556-3871 |
| Domestic / Foregin | Foregin |
| Publisher | Elsevier B.V. |
| Volume, Issue, Page | 16(3),pp.395-402 |
| Author and coauthor | YAGISHITA Daigo†, SHODA Morio*, YAGISHITA Yoshimi, EJIMA Koichiro, HAGIWARA Nobuhisa |
| Publication date | 2019/03 |
| Summary | BACKGROUND:
Left ventricular (LV) lead placement at the late activation site (LAS) has been proposed as an optimal LV pacing site (ie, Q-LV interval). However, LAS may be relevant to local electrical conduction, measured as an interval from LV pacing stimulation to QRS onset (S-QRS interval). OBJECTIVE: The purpose of this study was to evaluate the prognostic value of S-QRS for reverse remodeling and the impact of S-QRS on pacing QRS configuration in patients undergoing cardiac resynchronization therapy (CRT). METHODS: Sixty consecutive heart failure patients with a wide QRS complex underwent CRT. A site with Q-LV ≥95 ms was targeted for LV lead placement. A responder was defined as one with >15% reduction in LV end-systolic volume 6 months after CRT. RESULTS: LV lead placement with Q-LV ≥95 ms was achieved in 52 of 60 patients (86.7%). Thirty-two of 52 patients (61.5%) were responders. S-QRS was significantly shorter in responders than nonresponders (P <.01), whereas Q-LV was not significantly different. A cutoff value of 37 ms for S-QRS had sensitivity and specificity of 81% and 90%, respectively. Shorter S-QRS (<37 ms) showed significantly narrower LV pacing QRS width and biventricular pacing QRS width compared to longer S-QRS. After multivariate analysis, PQ interval (odds ratio 0.97; P = .01) and long S-QRS ≥ 37ms (odds ratio 0.014; P <.01) were independent predictors of response to CRT. CONCLUSION: In addition to a sufficient Q-LV, S-QRS can be a useful indicator of optimal LV lead position to achieve reverse remodeling. S-QRS contributes to the pacing QRS configuration associated with CRT response. |
| DOI | 10.1016/j.hrthm.2018.08.035 |
| PMID | 30193853 |