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ECG predictors of outcome in non-left bundle branch block cardiac resynchronization therapy patients

Session Poster Session 4

Speaker Antonius Martinus Wilhelmus van Stipdonk

Congress : Heart Failure 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Cardiac Resynchronization Therapy
  • Session type : Poster Session
  • FP Number : P1989

Authors : A M W Van Stipdonk (Maastricht,NL), M Dural (Eskisehir,TR), FCWM Salden (Maastricht,NL), I A H Ter Horst (Utrecht,NL), H J G Crijns (Utrecht,NL), F W Prinzen (Maastricht,NL), M Meine (Utrecht,NL), A H Maass (Groningen,NL), K Vernooy (Maastricht,NL)

A M W Van Stipdonk1 , M Dural2 , FCWM Salden1 , I A H Ter Horst3 , H J G Crijns3 , F W Prinzen4 , M Meine3 , A H Maass5 , K Vernooy1 , 1Maastricht University Medical Centre (MUMC), Cardiology - Maastricht - Netherlands (The) , 2Eskisehir Osmangazi University, Cardiology - Eskisehir - Turkey , 3University Medical Center Utrecht, Cardiology - Utrecht - Netherlands (The) , 4Cardiovascular Research Institute Maastricht (CARIM), Physiology - Maastricht - Netherlands (The) , 5University Medical Center Groningen, Cardiology - Groningen - Netherlands (The) ,


Background: The effectiveness of cardiac resynchronization therapy (CRT) in patients without left bundle branch block (non-LBBB) QRS morphology is limited, compared to those with LBBB. Still, a substantial part of these patients can benefit from therapy and additional selection criteria are needed to identify these patients.

Purpose: To evaluate the association of additional baseline 12-lead ECG features; with clinical and echocardiographic outcomes in CRT-treated non-LBBB patients.

Methods: Pre-implantation 12-lead ECGs from 790 consecutive non-LBBB CRT patients from 3 implanting centres in the Netherlands, were evaluated for the presence of predefined ECG parameters. QRS morphology (right bundle branch block and intraventricular conduction delay), QRS duration (=/< 150ms), QRS area (=/< 109µVs), left ventricular activation time (=/< 125ms) and the presence of fragmented QRS. The association with the primary endpoint, the combination of left ventricular assist device implantation, cardiac transplantation and all-cause mortality, was evaluated.

Results:  There was a significantly lower occurrence of the primary endpoint in non-LBBB patients with QRS area =109µVs (p<0.001) and in those without PR prolongation (p<0.001), and without fQRS (p=0.004). (Figure 1)

Conclusion: A larger QRS area is positively associated to all-cause mortality, LVAD implantation and cardiac transplantation.  The presence of fragmented QRS is negatively associated with long term clinical outcome in non-LBBB patients. QRS duration, morphology and LVAT however were not associated to the occurrence of long term events in non-LBBB patients treated with CRT. These data may provide additional value for patient selection for CRT in non-LBBB patients and warrant prospective studies.

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