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Abstract
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.
Original language | English |
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Journal | Pacing and Clinical Electrophysiology |
Volume | 43 |
Issue number | 5 |
Pages (from-to) | 503-510 |
Number of pages | 8 |
ISSN | 0147-8389 |
DOIs | |
Publication status | Published - 1 May 2020 |
Bibliographical note
© 2020 Wiley Periodicals, Inc.Keywords
- cardiac resynchronization therapy
- clinical outcomes
- echocardiography
- electrocardiography
- left bundle branch block
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