Electrocardiographic Parameters as Predictors of Response to Cardiac Resynchronization Therapy

Authors

  • Lidija Poposka University Clinic of Cardiology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje
  • Vladimir Boskov University Clinic of Cardiology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje
  • Dejan Risteski University Clinic of Cardiology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje
  • Jane Taleski University Clinic of Cardiology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje
  • Filip Janusevski University Clinic of Cardiology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje
  • Elizabeta Srbinovska University Clinic of Cardiology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje
  • Ljubica Georgievska-Ismail University Clinic of Cardiology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje

DOI:

https://doi.org/10.3889/oamjms.2018.092

Keywords:

Cardiac resynchronization therapy, Responders, non-responders, non-LBBB, Electrocardiography parameters

Abstract

INTRODUCTION: Although strict selection criteria are used to select patients for cardiac resynchronisation therapy, up to 30% of patients do not have a positive clinical response.

PATIENTS: A total of 102 consecutive patients who had biventricular pacemaker/defibrillator (CRT-P or CRT-D) implanted were enrolled in this prospective observational study.

RESULTS: During the average follow-up period of 24.3 months 5 patients died and 17 (16.7%) patients were hospitalised with the symptoms of heart failure; 75 (73.5%) patients were responders based on the previously defined criteria. Responders in the group of LBBB patients kept the significant difference in a computed variable (S1 + R6) - (S6 + R1) and R6/S6 ratio. Responders in non-LBBB patients kept the significant difference only in the height of R waves in V6. The R6/S6 ratio tended to be higher, but it did not reach a statistical significance.

CONCLUSION: None of the tested ECG parameters stands out as an independent predictor of response to cardiac resynchronisation therapy, but some of them were different in responder-compared to the non-responder group. The amplitude of R wave in V6, higher R/S ratio in V6 and higher computed variable (S1 + R6) - (S6 + R1) may predict the likelihood of response to CRT therapy in both LBBB-patients and non-LBBB patients.

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References

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P; Authors/Task Force Members. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016; 37(27):2129-200. https://doi.org/10.1093/eurheartj/ehw128 PMid:27206819

Cleland JG, Abraham WT, Linde C, et al. An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure. Eur Heart J. 2013; 34:3547–3556. https://doi.org/10.1093/eurheartj/eht290 PMid:23900696 PMCid:PMC3855551

2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. The Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J. 2013; 34:2281–2329. https://doi.org/10.1093/eurheartj/eht150 PMid:23801822

Auricchio A, Prinzen FW. Non-responders to cardiac resynchronization therapy: the magnitude of the problem and the issues. Circ J. 2011; 75:521–527. https://doi.org/10.1253/circj.CJ-10-1268 PMid:21325727

Linde C, Abraham WT, Gold MR et al. REVERSE (REsynchronizationreVErses Remodeling in Systolic left vEntricular dysfunction) Study Group. Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms. J Am Coll Cardiol. 2008; 52:1834–1843. https://doi.org/10.1016/j.jacc.2008.08.027 PMid:19038680

Daubert C, Behar N, Martins RP et al. Avoiding non-responders to cardiac resynchronization therapy: a practical guide. Eur Heart J. 2017; 38:1463–1472. PMid:27371720

Cleland JG, Freemantle N, Ghio S et al. Predicting the long-term effects of cardiac resynchronization therapy on mortality from baseline variables and the early response a report from the CARE-HF (Cardiac Resynchronization in Heart Failure) Trial. J Am CollCardiol. 2008; 52:438–445. https://doi.org/10.1016/j.jacc.2008.04.036 PMid:18672164

Goldenberg I, Moss AJ, Hall WJ et al. MADIT-CRT Executive Committee. Predictors of response to cardiac resynchronization therapy in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT). Circulation 2011; 124:1527–1536. https://doi.org/10.1161/CIRCULATIONAHA.110.014324 PMid:21900084

Surawicz B, Childers R, Deal BJ, Gettes LS. AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the ElectrocardiogramPart III: Intraventricular Conduction Disturbances A Scientific Statement From the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society Endorsed by the International Society for Computerized Electrocardiology. Journal of the American College of Cardiology. 2009; 53(11):976-81. https://doi.org/10.1016/j.jacc.2008.12.013 PMid:19281930

Auricchio A, Stellbrink C, Block M et al. Effect of pacing chamber and atrioventricular delay on acute systolic function of paced patients with congestive heart failure: The Pacing Therapies for Congestive Heart Failure Study Group: The Guidant Congestive Heart Failure Research Group. Circulation. 1999; 99:2993 – 3001. https://doi.org/10.1161/01.CIR.99.23.2993 PMid:10368116

Auricchio A, Stellbrink C, Sack S et al. Long-term clinical effect of hemodynamically optimized cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay. J Am CollCardiol. 2002; 39:2026 – 2033. https://doi.org/10.1016/S0735-1097(02)01895-8

Moss AJ, Hall WJ, Cannom DS et al. (MADIT-CRT Trial Investigators) Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med. 2009;361(14):1329-38. https://doi.org/10.1056/NEJMoa0906431 PMid:19723701

Sweeney MO, Van Bommel RJ, Schalij MJ et al. Analysis of ventricular activation using surface electrocardiography to predict left ventricular reverse remodeling during cardiac resynchronization therapy. Circulation. 2010; 121:626 –634. https://doi.org/10.1161/CIRCULATIONAHA.109.894774 PMid:20100970

Tang ASL, Wells GA, Taljic M, et al. for the Resyncrhonization-Defibrillation for Ambulatory Heart Failure Trial (RAFT) investigators. Cardiac resynchronization therapy for mild-to-moderate heart failure. N Engl J Med. 2010; 363:2385–2395. https://doi.org/10.1056/NEJMoa1009540 PMid:21073365

Seo Y, Ito H, Nakatani S et al. The J-CRT investigators. The role of echocardiography in predicting responders to cardiac resynchronization therapy: Results from the Japan Cardiac Resynchronization therapy registry Trial (J-CRT). Circ J. 2011; 75(5):1156-63. https://doi.org/10.1253/circj.CJ-10-0861 PMid:21383516

Angelo A, Joost L, Frits WP. Does Cardiac Resynchronization Therapy Benefit Patients With Right Bundle Branch Block. Circ Arrhythm Electrophysiol. 2014; 7:532-542. https://doi.org/10.1161/CIRCEP.113.000628 PMid:24951571

Strauss DG, Selvester RH, Wagner GS. Defining left bundle branch block in the era of cardiac resynchronization therapy. Am J Cardiol. 2011; 107:927. https://doi.org/10.1016/j.amjcard.2010.11.010 PMid:21376930

Rickard J, Bassiouny M, Cronin EM, et al. Predictors of response to cardiac resynchronization therapy in patients with a non-left bundle branch block morphology. Am J Cardiol. 2011; 108:1576. https://doi.org/10.1016/j.amjcard.2011.07.017 PMid:21890086

Aranda JM, Conti JB, Johnson JW, et al. Cardiac resynchronization therapy in patients with heart failure and conduction abnormalities other than left bundle branch-block: Analysis of the Multicenter InSync Randomized Clinical Evaluation (MIRACLE). Clin Cardiol. 2004; 27:678 – 682. https://doi.org/10.1002/clc.4960271204 PMid:15628109

Takaya Y, Noda T, Nakajima I, et al. Electrocardiographic Predictors of Response to Cardiac Resynchronization Therapy in Patients With Intraventricular Conduction Delay. Circulation Journal. 2014; 78, January 2014. https://doi.org/10.1253/circj.CJ-12-1569

Bristow MR, Saxon LA, Boehmer J, et al; Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators. Cardiac resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004; 350:2140 – 2150. https://doi.org/10.1056/NEJMoa032423 PMid:15152059

Cleland JG, Daubert JC, Erdmann E, et al; Cardiac Resynchronization-Heart Failure (CARE-HF) Study Investigators. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005; 352:1539 – 1549. https://doi.org/10.1056/NEJMoa050496 PMid:15753115

Hsing JM, Selzman KA, Leclercq C, et al. Paced left ventricular QRS width and ECG parameters predict outcomes after cardiac resynchronization therapy: PROSPECT-ECG substudy. Circ Arrhythm Electrophysiol. 2011; 4: 851 – 857. https://doi.org/10.1161/CIRCEP.111.962605 PMid:21956038

Lecoq G, Leclercq C, Leray E, et al. Clinical and electrocardiographic predictors of a positive response to cardiac resynchronization therapy in advanced heart failure. Eur Heart J. 2005; 26:1094 – 1100. https://doi.org/10.1093/eurheartj/ehi146 PMid:15728648

Published

2018-02-09

How to Cite

1.
Poposka L, Boskov V, Risteski D, Taleski J, Janusevski F, Srbinovska E, Georgievska-Ismail L. Electrocardiographic Parameters as Predictors of Response to Cardiac Resynchronization Therapy. Open Access Maced J Med Sci [Internet]. 2018 Feb. 9 [cited 2024 Apr. 26];6(2):297-302. Available from: https://oamjms.eu/index.php/mjms/article/view/oamjms.2018.092

Issue

Section

B - Clinical Sciences