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Concomitant changes in ventricular depolarization and repolarization and long‐term outcomes of biventricular pacing
Author(s) -
Polcwiartek Christoffer,
Friedman Daniel J.,
Emerek Kasper,
Graff Claus,
Sørensen Peter L.,
Kisslo Joseph,
Loring Zak,
Hansen Steen M.,
Kragholm Kristian,
Tayal Bhupendar,
Jensen Svend E.,
Søgaard Peter,
TorpPedersen Christian,
Atwater Brett D.
Publication year - 2020
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.14065
Subject(s) - medicine , qrs complex , cardiology , repolarization , concomitant , hazard ratio , cardiac resynchronization therapy , electrocardiography , confidence interval , heart failure , ejection fraction , electrophysiology
Abstract Background Biventricular (BiV) pacing increases transmural repolarization heterogeneity due to epicardial to endocardial conduction from the left ventricular (LV) lead. However, limited evidence is available on concomitant changes in ventricular depolarization and repolarization and long‐term outcomes of BiV pacing. Therefore, we investigated associations of BiV pacing‐induced concomitant changes in ventricular depolarization and repolarization with mortality (i.e., LV assist device, heart transplantation, or all‐cause mortality) and sustained ventricular arrhythmia endpoints. Methods Consecutive BiV‐defibrillator recipients with digital preimplantation and postimplantation electrocardiograms recorded between 2006 and 2015 at Duke University Medical Center were included. We calculated changes in QRS duration and corrected JT (JTc) interval and split them by median values. For simplicity, these variables were named QRS decreased (≤ −12 ms), QRS increased (> –12 ms), JTc decreased (≤22 ms), and JTc increased (> 22 ms) and subsequently used to construct four mutually exclusive groups. Results We included 528 patients (median age, 68 years; male, 69%). No correlation between changes in QRS duration and JTc interval was observed ( P = .295). Compared to QRS decreased /JTc increased , increased risk of the composite mortality endpoint was associated with QRS decreased /JTc decreased (hazard ratio [HR] = 1.62; 95% confidence interval [CI] = 1.09‐2.43), QRS increased /JTc decreased (HR = 1.86; 95% CI = 1.27‐2.71), and QRS increased /JTc increased (HR = 2.25; 95% CI = 1.52‐3.35). No QRS/JTc group was associated with excess sustained ventricular arrhythmia risk ( P = .400). Conclusion Among BiV‐defibrillator recipients, QRS decreased /JTc increased was associated with the most favorable long‐term survival free of LV assist device, heart transplantation, and sustained ventricular arrhythmias. Our findings suggest that improved electrical resynchronization may be achieved by assessing concomitant changes in ventricular depolarization and repolarization.