The Effect of Diuresis on the Paced QRS Complexes in Pacing-Dependent Patients with Heart Failure

Background: Augmentation of the amplitude of QRS complexes with diuretic therapy for patients with congestive heart failure has been well documented. However, the effect of diuresis on the paced QRS complexes in pacing-dependent patients with heart failure is scarce. Objective: To investigate the effect of diuresis on the paced QRS complexes in pacing-dependent patients with heart failure. Method: Thrity-two consecutive pacing-dependent patients with heart failure were enrolled in this study. Before and after diuresis, the sums of paced QRS amplitude of leads I+II (Sigma pQRS(I+II)), six limb leads (Sigma pQRS(6L)), leads V-1-V-3 (Sigma pQRS(V1-V3)), leads V-4-V-6 (Sigma pQRS(V4-V6)), leads V-1-V-6 (Sigma pQRS(V1-V6)), and lead aVR (pQRS(aVR)), paced QRS duration (pQRS(d)), paced QT intervals (pQT) and the body weight of each patient were measured, then the % changes (Delta%) in paced electrocardiogram (ECG) variables and the Delta% in body weight were evaluated. Results: Compared with before diuresis, paced ECG variables significantly increased and body weight significantly decreased after diuresis, Delta% in paced QRS amplitude(s) in all ECG variables (Sigma pQRS(I+II), Sigma pQRS(6L), Sigma pQRS(V1-V3,) Sigma pQRS(V4-V6), Sigma pQRS(V1-V6), and pQRS(aVR)) correlated well with Delta% in body weight (r = 0.416, r = 0.849, r = 0.901, r = 0.371, r = 0.837, r = 0.619, and P = 0.018, P < 0.001, P < 0.001, P = 0.037, P < 0.001, P < 0.001), while there was no correlation between Delta% in pQRS(d) and pQT and Delta% in body weight. Conclusions: The changes in amplitude of paced QRS complexes may be useful for the monitoring of therapy of pacing-dependent patients with heart failure.