Maximizing QRS duration reduction in contemporary cardiac resynchronization therapy is feasible and shorter QRS duration is associated with better clinical outcome
(2023) In Journal of Interventional Cardiac Electrophysiology 66(8). p.1799-1806- Abstract
- Background
We aimed to evaluate if optimization by maximizing QRS duration (QRSd) reduction is feasible in an all-comer cardiac resynchronization therapy (CRT) population, and if reduced, QRSd is associated with a better clinical outcome.
Methods
Patients with LBBB receiving CRT implants during the period 2015–2020 were retrospectively evaluated. Implants from 2015–2017 were designated as controls. Starting from 2018, an active 12-lead electrogram-based optimization of QRSd reduction was implemented (intervention group). QRSd reduction was evaluated in a structured way at various device AV and VV settings, aiming to maximize the reduction. The primary endpoint was a composite of heart failure hospitalization or death from... (More) - Background
We aimed to evaluate if optimization by maximizing QRS duration (QRSd) reduction is feasible in an all-comer cardiac resynchronization therapy (CRT) population, and if reduced, QRSd is associated with a better clinical outcome.
Methods
Patients with LBBB receiving CRT implants during the period 2015–2020 were retrospectively evaluated. Implants from 2015–2017 were designated as controls. Starting from 2018, an active 12-lead electrogram-based optimization of QRSd reduction was implemented (intervention group). QRSd reduction was evaluated in a structured way at various device AV and VV settings, aiming to maximize the reduction. The primary endpoint was a composite of heart failure hospitalization or death from any cause.
Results
A total of 254 patients were followed for up to 6 years (median 2.9 [1.8–4.1]), during which 82 patients (32%) reached the primary endpoint; 53 deaths (21%) and 58 (23%) heart failure hospitalizations. Median QRS duration pre-implant was 162 ms [150–174] and post-implant 146ms [132–160]. Mean reduction in QRS duration was progressively larger for each year during the intervention period, ranging from − 9.5ms in the control group to − 24 in the year 2020 (p = 0.005). QRS reduction > 14 ms (median value) was associated with a lower risk of death or heart failure hospitalization (adjusted HR 0.54 [0.29–0.98] (p = 0.04).
Conclusions
Implementing a general strategy of CRT device optimization by aiming for shorter QRS duration is feasible in a structured clinical setting and results in larger reductions in QRS duration post-implant. In patients with a larger QRS reduction, compared to those with a smaller QRS reduction, there is an association with a better clinical outcome. (Less) - Abstract (Swedish)
- Abstract
Background We aimed to evaluate if optimization by maximizing QRS duration (QRSd) reduction is feasible in an all-comer
cardiac resynchronization therapy (CRT) population, and if reduced, QRSd is associated with a better clinical outcome.
Methods Patients with LBBB receiving CRT implants during the period 2015–2020 were retrospectively evaluated. Implants
from 2015–2017 were designated as controls. Starting from 2018, an active 12-lead electrogram-based optimization of QRSd
reduction was implemented (intervention group). QRSd reduction was evaluated in a structured way at various device AV
and VV settings, aiming to maximize the reduction. The primary endpoint was a composite of heart failure... (More) - Abstract
Background We aimed to evaluate if optimization by maximizing QRS duration (QRSd) reduction is feasible in an all-comer
cardiac resynchronization therapy (CRT) population, and if reduced, QRSd is associated with a better clinical outcome.
Methods Patients with LBBB receiving CRT implants during the period 2015–2020 were retrospectively evaluated. Implants
from 2015–2017 were designated as controls. Starting from 2018, an active 12-lead electrogram-based optimization of QRSd
reduction was implemented (intervention group). QRSd reduction was evaluated in a structured way at various device AV
and VV settings, aiming to maximize the reduction. The primary endpoint was a composite of heart failure hospitalization
or death from any cause.
Results A total of 254 patients were followed for up to 6 years (median 2.9 [1.8–4.1]), during which 82 patients (32%) reached
the primary endpoint; 53 deaths (21%) and 58 (23%) heart failure hospitalizations. Median QRS duration pre-implant was
162 ms [150–174] and post-implant 146ms [132–160]. Mean reduction in QRS duration was progressively larger for each
year during the intervention period, ranging from − 9.5ms in the control group to − 24 in the year 2020 (p = 0.005). QRS
reduction > 14 ms (median value) was associated with a lower risk of death or heart failure hospitalization (adjusted HR
0.54 [0.29–0.98] (p = 0.04).
Conclusions Implementing a general strategy of CRT device optimization by aiming for shorter QRS duration is feasible
in a structured clinical setting and results in larger reductions in QRS duration post-implant. In patients with a larger QRS
reduction, compared to those with a smaller QRS reduction, there is an association with a better clinical outcome. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/3a84d090-2649-4d25-a5f0-762f4eb50996
- author
- Borgquist, Rasmus
LU
; Marinko, Sofia LU ; Platonov, Pyotr LU ; Wang, Lingwei LU
; Chaudhry, Uzma LU ; Brandt, Johan LU and Mortsell, David LU
- organization
- publishing date
- 2023-11
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Journal of Interventional Cardiac Electrophysiology
- volume
- 66
- issue
- 8
- pages
- 8 pages
- publisher
- Springer
- external identifiers
-
- scopus:85146057599
- pmid:36629961
- ISSN
- 1572-8595
- DOI
- 10.1007/s10840-022-01463-y
- language
- English
- LU publication?
- yes
- id
- 3a84d090-2649-4d25-a5f0-762f4eb50996
- date added to LUP
- 2023-01-12 21:14:14
- date last changed
- 2024-01-10 15:36:07
@article{3a84d090-2649-4d25-a5f0-762f4eb50996, abstract = {{Background<br/>We aimed to evaluate if optimization by maximizing QRS duration (QRSd) reduction is feasible in an all-comer cardiac resynchronization therapy (CRT) population, and if reduced, QRSd is associated with a better clinical outcome.<br/><br/>Methods<br/>Patients with LBBB receiving CRT implants during the period 2015–2020 were retrospectively evaluated. Implants from 2015–2017 were designated as controls. Starting from 2018, an active 12-lead electrogram-based optimization of QRSd reduction was implemented (intervention group). QRSd reduction was evaluated in a structured way at various device AV and VV settings, aiming to maximize the reduction. The primary endpoint was a composite of heart failure hospitalization or death from any cause.<br/><br/>Results<br/>A total of 254 patients were followed for up to 6 years (median 2.9 [1.8–4.1]), during which 82 patients (32%) reached the primary endpoint; 53 deaths (21%) and 58 (23%) heart failure hospitalizations. Median QRS duration pre-implant was 162 ms [150–174] and post-implant 146ms [132–160]. Mean reduction in QRS duration was progressively larger for each year during the intervention period, ranging from − 9.5ms in the control group to − 24 in the year 2020 (p = 0.005). QRS reduction > 14 ms (median value) was associated with a lower risk of death or heart failure hospitalization (adjusted HR 0.54 [0.29–0.98] (p = 0.04).<br/><br/>Conclusions<br/>Implementing a general strategy of CRT device optimization by aiming for shorter QRS duration is feasible in a structured clinical setting and results in larger reductions in QRS duration post-implant. In patients with a larger QRS reduction, compared to those with a smaller QRS reduction, there is an association with a better clinical outcome.}}, author = {{Borgquist, Rasmus and Marinko, Sofia and Platonov, Pyotr and Wang, Lingwei and Chaudhry, Uzma and Brandt, Johan and Mortsell, David}}, issn = {{1572-8595}}, language = {{eng}}, number = {{8}}, pages = {{1799--1806}}, publisher = {{Springer}}, series = {{Journal of Interventional Cardiac Electrophysiology}}, title = {{Maximizing QRS duration reduction in contemporary cardiac resynchronization therapy is feasible and shorter QRS duration is associated with better clinical outcome}}, url = {{http://dx.doi.org/10.1007/s10840-022-01463-y}}, doi = {{10.1007/s10840-022-01463-y}}, volume = {{66}}, year = {{2023}}, }