Abstract
BackgroundMechanical dyssynchrony (MD) is associated with poor outcomes in many different populations. However, the predictors for the development of MD after chronic right ventricular (RV) pacing are not well known. MethodsPacing QRS morphology and MD using echocardiography was analyzed in 175 consecutive patients that have pacemaker implantation during a 7.6year median follow-up. Predictive score for MD was constructed using QRS morphology variables and calculated by summing the points of the 4 variables: duration (≥150ms, 1 point), transition (1 point), notching (2 points), and left-axis deviation (1 point), based on a multivariate-adjusted risk relationship with MD. ResultsSixty-eight (38.9%) patients developed MD. Patients with MD had worsened left ventricular systolic function (ejection fraction from 64.6±10.6% to 59.1±10.4%, p<0.001) and heart failure symptoms (New York Heart Association functional class increase from 1.1±0.3 to 1.9±0.8, p<0.001). In an electrocardiographic analysis, QRS duration ≥150ms, the presence of precordial axis transition, notching, and left-axis deviation were strongly associated with MD. Predictive score for MD using QRS morphology parameters displayed an excellent graded relationship with MD (score 0: 3.4% vs. 1: 12.5% vs. 2: 22.6% vs. 3: 45.0% vs. 4: 57.9% vs. 5: 72.7%, linear p<0.001) (model performance c-static 0.78, 95% confidence interval 0.72–0.85, p<0.001). ConclusionPatients with MD experienced a decline in left ventricular systolic function and an increase in heart failure symptoms after chronic RV pacing. A new scoring system using QRS morphology is considered a simple and efficient tool for predicting the development of MD after chronic RV pacing.
Published Version
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