Lead one ratio in left bundle branch block predicts poor cardiac resynchronization therapy response

Zak Loring, Daniel J. Friedman, Kasper Emerek, Claus Graff, Peter L. Sørensen, Steen M. Hansen, Bjorn Wieslander, Martin Ugander, Peter Søgaard, Brett D. Atwater

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

1 Citationer (Scopus)
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Background: A low electrocardiogram (ECG) lead one ratio (LOR) of the maximum positive/negative QRS amplitudes is associated with lower left ventricular ejection fraction (LVEF) and worse outcomes in left bundle branch block (LBBB); however, the impact of LOR on cardiac resynchronization therapy (CRT) outcomes is unknown. We compared clinical outcomes and echocardiographic changes after CRT implantation by LOR. Methods: Consecutive CRT-defibrillator recipients with LBBB implanted between 2006 and 2015 at Duke University Medical Center were included (N = 496). Time to heart transplant, left ventricular assist device (LVAD) implantation, or death was compared among patients with LOR <12 vs ≥12 using Cox-proportional hazard models. Changes in LVEF and LV volumes after CRT were compared by LOR. Results: Baseline ECG LOR <12 was associated with an adjusted hazard ratio (HR) of 1.69 (95% CI: 1.12-2.40, P =.01) for heart transplant, LVAD, or death. Patients with LOR <12 had less reduction of LV end diastolic volume (ΔLVEDV −4 ± 21 vs −13 ± 23%, P =.04) and LV end systolic volume (ΔLVESV −9 ± 27 vs −22 ± 26%, P =.03) after CRT. In patients with QRS duration (QRSd) ≥150 ms, LOR <12 was associated with an adjusted HR of 2.01 (95% CI 1.21-3.35, P =.008) for heart transplant, LVAD, or death, compared with LOR ≥12. Conclusions: Baseline ECG LOR <12 portends worse outcomes after CRT implantation in patients with LBBB, specifically among those with QRSd ≥150 ms. This ECG ratio may identify patients with a class I indication for CRT implantation at high risk for poor postimplantation outcomes.

TidsskriftPacing and Clinical Electrophysiology
Udgave nummer5
Sider (fra-til)503-510
Antal sider8
StatusUdgivet - 1 maj 2020


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  • Kardiel Resynkronisering

    Graff, C.

    01/03/2016 → …

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