Abstract
Background: Different electrocardiogram (ECG) findings are known to be independent predictors of clinical response to cardiac resynchronization therapy (CRT). It remains unknown how these findings influence very long-term prognosis. Methods and Results: A total of 102 consecutive patients (75 males, mean age 65 ± 10 years) referred to our center for CRT implantation had previously been included in this prospective observational study. The same patient group was now re-evaluated for death from all causes over a prolonged median follow-up of 10.3 years (interquartile range 9.4–12.5 years). During follow-up, 55 patients died, and 82% of the clinical non-responders (n = 23) and 44% of the responders (n = 79) were deceased. We screened for univariate associations and found QRS width during biventricular (BIV) pacing (p = 0.02), left ventricular (LV) pacing (p < 0.01), Δ LV paced–right ventricular (RV) paced (p = 0.03), age (p = 0.03), New York Heart Association (NYHA) class (p < 0.01), CHA2DS2-Vasc score (p < 0.01), glomerular filtration rate (p < 0.01), coronary artery disease (p < 0.01), non-ischemic cardiomyopathy (NICM) (p = 0.01), arterial hypertension (p < 0.01), NT-proBNP (p < 0.01), and clinical response to CRT (p < 0.01) to be significantly associated with mortality. In the multivariate analysis, NICM, the lower NYHA class, and smaller QRS width during BIV pacing were independent predictors of better outcomes. Conclusion: Our data show that QRS width duration during biventricular pacing, an ECG parameter easily obtainable during LV lead placement, is an independent predictor of mortality in a long-term follow-up. Our data add further evidence that NICM and lower NYHA class are independent predictors for better outcome after CRT implantation.
Highlights
Heart failure (HF) remains a leading cause of mortality in the western world [1].Advances in pharmacological and device therapy have played a key role in improving survival and quality of life in patients with HF and reduced ejection fraction (HFrEF).Cardiac resynchronization therapy (CRT), which was first introduced over 30 years ago, has advanced to be a cornerstone of HFrEF therapy
The basis for the presented analysis is the previously described cohort [4]: A total of 102 consecutive patients referred to our center for cardiac resynchronization therapy (CRT) implantation were initially enrolled, and 14 patients were lost to follow-up at some point
Two patients presented with a right bundle branch block (RBBB) masking left bundle branch block (LBBB)
Summary
Advances in pharmacological and device therapy have played a key role in improving survival and quality of life in patients with HF and reduced ejection fraction (HFrEF). Cardiac resynchronization therapy (CRT), which was first introduced over 30 years ago, has advanced to be a cornerstone of HFrEF therapy. A multitude of studies were able to demonstrate a positive effect of CRT therapy on mortality, quality of life, and left ventricular ejection fraction (LVEF) in patients with left bundle branch block (LBBB) [2,3]. Different electrocardiogram (ECG) findings are known to be independent predictors of clinical response to cardiac resynchronization therapy (CRT). It remains unknown how these findings influence very long-term prognosis.
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