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Maximizing QRS duration reduction in contemporary cardiac resynchronization therapy is feasible and shorter QRS duration is associated with better clinical outcome

Borgquist, Rasmus LU orcid ; Marinko, Sofia LU ; Platonov, Pyotr LU ; Wang, Lingwei LU orcid ; Chaudhry, Uzma LU ; Brandt, Johan LU and Mortsell, David LU orcid (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)
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author
; ; ; ; ; and
organization
publishing date
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 &gt; 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}},
}