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High Left Ventricular Lead Sensing Delay Predicts QRS Narrowing and Good Response to Cardiac Resynchronization Therapy
Author(s) -
KAYPAKLI ONUR,
KOÇ MEVLÜT,
GÖZÜBÜYÜK GÖKHAN,
ŞAHİN DURMUŞ YILDIRAY
Publication year - 2016
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12963
Subject(s) - medicine , cardiac resynchronization therapy , cardiology , qrs complex , lead (geology) , heart failure , ejection fraction , geomorphology , geology
Background Cardiac resynchronization therapy (CRT) was shown to improve heart failure (HF) prognosis. But many patients do not benefit from CRT. Optimization of left ventricular (LV) lead position to the latest activated LV area is important to increase CRT response. We aimed to detect the relationship between LV lead sensing delay and echocardiographic and electrocardiographic response to CRT treatment. Methods We prospectively included 156 consecutive patients with HF diagnosis, QRS ≥ 120 ms, left bundle branch block, New York Heart Association II–IV, LV ejection fraction (LVEF) < 35%, and scheduled for CRT (100 male, 56 female; mean age 65.8 ± 10.06 years). Echocardiographic CRT response was defined as ≥15% reduction in LV end‐systolic volume (LVESV). LV lead sensing delay was calculated as the time interval from the onset of surface QRS wave to the onset of depolarization wave recorded from the LV lead by using the LV pacing lead as a bipolar electrode. Results LVESV reduction was associated with baseline QRS width (r = 0.292, P = 001), QRS narrowing (r = 0.332, P < 001), and LV lead sensing delay (r = 0.454, P < 001) in bivariate analysis. In logistic regression analysis, LV lead sensing delay was found to be the only independent parameter for predicting significant LVESV reduction (β = 0.423, P < 0.001). LV lead sensing delay was also found to be significantly associated with LVEF increase (r = 0.320, P < 0.001) and QRS narrowing (r = 0.345, P < 0.001). Conclusion LV lead sensing delay is the only independent predictor for significant reduction in LVESV and was found to be significantly associated with LVEF increase and QRS narrowing after CRT treatment. We suggest that LV lead sensing delay may be used as a marker to predict the favorable response to CRT.