Association Between Resolution of Fragmented QRS and Response to Cardiac Resynchronization Therapy

Overview

Journal Ann Noninvasive Electrocardiol

Specialty Cardiology & Vascular Diseases

Date 2014 Jul 22

PMID 25039278

Citations 8

Authors

Umut Celikyurt

Kurtulus Karauzum

Tayfun Sahin

Aysen Agacdiken

Ahmet Vural

Dilek Ural

Affiliations

Soon will be listed here.

Abstract

Background: Cardiac resynchronization therapy (CRT) has been recommended for patients with symptomatic heart failure and a wide QRS. Fragmented QRS (fQRS) on a 12-lead electrocardiography (ECG) has been shown to predict cardiac events. We aimed to investigate the relationship between resolution of fQRS and response to CRT.

Methods: Sixty-seven consecutive patients (38 men, mean age 65 ± 11) with left bundle branch block and fQRS on ECG undergoing CRT were studied. The presence of fQRS was assessed using standardized criteria. Echocardiographic response to CRT was defined by a ≥15% reduction in left ventricular end-systolic volume (LVESV) and resolution of fQRS was defined as decrease in number of leads with fQRS on ECG at 6 months follow-up.

Results: Thirty-nine patients (58%) had response to CRT. LVESV significantly decreased from 150 ± 64 to 100 ± 48 in responders (P = 0.001). There was not any significant decrease in nonresponders (LVESV; from 157 ± 70 to 153 ± 66, P = 0.45). The number of leads with fQRS was decreased from 4.4 ± 1.8 to 1.7 ± 1.6 in responder patients (P < 0.001). The number of leads with fQRS was not significantly changed in nonresponders. (4.2 ± 2.2 vs. 5.1 ± 2.4, P = 0.06). In multivariate analysis, significant associates of response to CRT was evaluated adjusting for etiology of cardiomyopathy, baseline QRS width, left ventricular ejection fraction, number of leads with fQRS and resolution of fQRS. Resolution of fQRS was the only predictor of response to CRT (OR 0.018, 95% CI, 0.004-0.083, P < 0.001).

Conclusions: After adjusting for potential confounders, resolution of fQRS, is associated with response to CRT.

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References

Geng J, Wu B, Zheng L, Zhu J . Heart failure patients selection for cardiac resynchronization therapy. Eur J Intern Med. 2011; 22(1):32-8. DOI: 10.1016/j.ejim.2010.11.002. View

Schiller N, Shah P, Crawford M, DeMaria A, Devereux R, FEIGENBAUM H . Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989; 2(5):358-67. DOI: 10.1016/s0894-7317(89)80014-8. View

Sebag F, Martins R, Defaye P, Hidden-Lucet F, Mabo P, Daubert J . Reverse electrical remodeling by cardiac resynchronization therapy: prevalence and clinical impact. J Cardiovasc Electrophysiol. 2012; 23(11):1219-27. DOI: 10.1111/j.1540-8167.2012.02376.x. View

Bhatia V, Bhatia R, Dhindsa S, Virk A . Cardiac resynchronization therapy in heart failure: recent advances and new insights. Indian Pacing Electrophysiol J. 2006; 3(3):129-42. PMC: 1502045. View

Linde C, Abraham W, Gold M, St John Sutton M, Ghio S, Daubert C . Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms. J Am Coll Cardiol. 2008; 52(23):1834-1843. DOI: 10.1016/j.jacc.2008.08.027. View

Auger D, van Bommel R, Bertini M, Delgado V, Ng A, Ewe S . Prevalence and characteristics of patients with clinical improvement but not significant left ventricular reverse remodeling after cardiac resynchronization therapy. Am Heart J. 2010; 160(4):737-43. DOI: 10.1016/j.ahj.2010.07.016. View

Das M, Suradi H, Maskoun W, Michael M, Shen C, Peng J . Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis. Circ Arrhythm Electrophysiol. 2009; 1(4):258-68. DOI: 10.1161/CIRCEP.107.763284. View

Celikyurt U, Agacdiken A, Sahin T, Al N, Kozdag G, Vural A . Number of leads with fragmented QRS predicts response to cardiac resynchronization therapy. Clin Cardiol. 2012; 36(1):36-9. PMC: 6649405. DOI: 10.1002/clc.22061. View

Pei J, Li N, Gao Y, Wang Z, Li X, Zhang Y . The J wave and fragmented QRS complexes in inferior leads associated with sudden cardiac death in patients with chronic heart failure. Europace. 2012; 14(8):1180-7. DOI: 10.1093/europace/eur437. View

10.

Chatterjee S, Changawala N . Fragmented QRS complex: a novel marker of cardiovascular disease. Clin Cardiol. 2010; 33(2):68-71. PMC: 6653133. DOI: 10.1002/clc.20709. View

11.

Delnoy P, Ottervanger J, Luttikhuis H, Nicastia D, Elvan A, Ramdat Misier A . Sustained benefit of cardiac resynchronization therapy. J Cardiovasc Electrophysiol. 2007; 18(3):298-302. DOI: 10.1111/j.1540-8167.2006.00732.x. View

12.

Moss A, Hall W, Cannom D, Klein H, Brown M, Daubert J . Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med. 2009; 361(14):1329-38. DOI: 10.1056/NEJMoa0906431. View

13.

Basaran Y, Tigen K, Karaahmet T, Isiklar I, Cevik C, Gurel E . Fragmented QRS complexes are associated with cardiac fibrosis and significant intraventricular systolic dyssynchrony in nonischemic dilated cardiomyopathy patients with a narrow QRS interval. Echocardiography. 2010; 28(1):62-8. DOI: 10.1111/j.1540-8175.2010.01242.x. View

14.

Hsing J, Selzman K, Leclercq C, Pires L, McLaughlin M, McRae S . Paced left ventricular QRS width and ECG parameters predict outcomes after cardiac resynchronization therapy: PROSPECT-ECG substudy. Circ Arrhythm Electrophysiol. 2011; 4(6):851-7. DOI: 10.1161/CIRCEP.111.962605. View

15.

Korhonen P, Husa T, Konttila T, Tierala I, Makijarvi M, Vaananen H . Fragmented QRS in prediction of cardiac deaths and heart failure hospitalizations after myocardial infarction. Ann Noninvasive Electrocardiol. 2010; 15(2):130-7. PMC: 6932707. DOI: 10.1111/j.1542-474X.2010.00353.x. View

16.

Bleeker G, Schalij M, Nihoyannopoulos P, Steendijk P, Molhoek S, van Erven L . Left ventricular dyssynchrony predicts right ventricular remodeling after cardiac resynchronization therapy. J Am Coll Cardiol. 2005; 46(12):2264-9. DOI: 10.1016/j.jacc.2005.04.069. View

17.

Cleland J, Daubert J, Erdmann E, Freemantle N, Gras D, Kappenberger L . The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005; 352(15):1539-49. DOI: 10.1056/NEJMoa050496. View

18.

Rickard J, Popovic Z, Verhaert D, Sraow D, Baranowski B, Martin D . The QRS narrowing index predicts reverse left ventricular remodeling following cardiac resynchronization therapy. Pacing Clin Electrophysiol. 2011; 34(5):604-11. DOI: 10.1111/j.1540-8159.2010.03022.x. View

19.

Abraham T, Olsen N . QRS width and mechanical dyssynchrony for selection of patients for cardiac resynchronization therapy: one can't do without the other. JACC Cardiovasc Imaging. 2010; 3(2):141-3. DOI: 10.1016/j.jcmg.2009.12.005. View

20.

Breithardt O, Stellbrink C, Franke A, Balta O, Diem B, Bakker P . Acute effects of cardiac resynchronization therapy on left ventricular Doppler indices in patients with congestive heart failure. Am Heart J. 2002; 143(1):34-44. DOI: 10.1067/mhj.2002.119616. View