Open AccessTwelve‐Lead ECG Optimization of Cardiac Resynchronization Therapy in Patients With and Without Delayed Enhancement on Cardiac Magnetic Resonance Imaging
Author(s) -
Gage Ryan M.,
Khan Akbar H.,
Syed Imran S.,
Bajpai Ambareesh,
Burns Kevin V.,
Curtin Antonia E.,
Blanchard Amanda L.,
Gillberg Jeffrey M.,
Ghosh Subham,
Bank Alan J.
Publication year - 2018
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.118.009559
Subject(s) - medicine , cardiac resynchronization therapy , magnetic resonance imaging , ejection fraction , cardiology , cardiac magnetic resonance imaging , lead (geology) , qrs complex , heart failure , standard deviation , nuclear medicine , radiology , statistics , mathematics , geomorphology , geology
Background Delayed enhancement ( DE ) on magnetic resonance imaging is associated with ventricular arrhythmias, adverse events, and worse left ventricular mechanics. We investigated the impact of DE on cardiac resynchronization therapy ( CRT ) outcomes and the effect of CRT optimization. Methods and Results We studied 130 patients with ejection fraction ( EF ) ≤40% and QRS ≥120 ms, contrast cardiac magnetic resonance imaging, and both pre‐ and 1‐year post‐ CRT echocardiograms. Sixty‐three (48%) patients did not have routine optimization of CRT . The remaining patients were optimized for wavefront fusion by 12‐lead ECG . The primary end point in this study was change in EF following CRT . To investigate the association between electrical dyssynchrony and EF outcomes, the standard deviation of activation times from body‐surface mapping was calculated during native conduction and selected device settings in 52 of the optimized patients. Patients had no DE (n=45), midwall septal stripe (n=30), or scar (n=55). Patients without DE had better ∆ EF (13±10 versus 4±10 units; P <0.01). Optimized patients had greater ∆ EF in midwall stripe (2±9 versus 12±12 units; P =0.01) and scar (0±7 versus 5±10; P =0.04) groups, but not in the no‐ DE group. Patients without DE had greater native standard deviation of activation times ( P =0.03) and greater ∆standard deviation of activation times with standard programming ( P =0.01). Device optimization reduced standard deviation of activation times only in patients with DE ( P <0.01). Conclusions DE on magnetic resonance imaging is associated with worse EF outcomes following CRT . Device optimization is associated with improved EF and reduced electrical dyssynchrony in patients with DE .