The Postimplantation Electrocardiogram Predicts Clinical Response to Cardiac Resynchronization Therapy
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Coverstone, Edward
[1
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Sheehy, Justin
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Washington Univ, Sch Med, Dept Med, St Louis, MO 63110 USAWashington Univ, Sch Med, Dept Med, Div Cardiovasc, St Louis, MO 63110 USA
Sheehy, Justin
[2
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Kleiger, Robert E.
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Washington Univ, Sch Med, Dept Med, Div Cardiovasc, St Louis, MO 63110 USAWashington Univ, Sch Med, Dept Med, Div Cardiovasc, St Louis, MO 63110 USA
Kleiger, Robert E.
[1
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Smith, Timothy W.
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Washington Univ, Sch Med, Dept Med, Div Cardiovasc, St Louis, MO 63110 USAWashington Univ, Sch Med, Dept Med, Div Cardiovasc, St Louis, MO 63110 USA
Smith, Timothy W.
[1
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[1] Washington Univ, Sch Med, Dept Med, Div Cardiovasc, St Louis, MO 63110 USA
[2] Washington Univ, Sch Med, Dept Med, St Louis, MO 63110 USA
BackgroundBiventricular (BiV) pacing for cardiac resynchronization therapy (CRT) is intended to improve left ventricular function by coordinating systolic activity of the septum and free walls. Optimal resynchronization should be manifested by 12-lead electrocardiogram (ECG) patterns consistent with resynchronized activation, a tall (4 mm) R wave in V1, and predominant negative deflection in lead I (RV1SI). We investigated whether the presence or absence of RV1SI predicts heart failure outcomes within 1 year of CRT implant. MethodsTwo independent physicians reviewed the paced ECG of 213 patients post-CRT device implantation with disputes resolved by a third reviewer. The primary end points of all-cause death, unplanned hospitalization, left ventricular assist device implant, or transplant within a 1-year follow-up were blindly adjudicated according to standard definitions. Groups were compared via Kaplan-Meier estimates and Cox proportional hazards models to determine association with event-free survival. ResultsAmong CRT patients postimplantation, 56 (26.3%) exhibited the RV1SI pattern on ECG. Patients with the RV1SI pattern were significantly less likely to achieve the primary end point as compared to patients without the RV1SI pattern (33.9% vs 52.2%; Log Rank P = 0.022). This difference was driven by a significantly lower risk for unplanned hospitalization among patients with the RV1SI pattern (hazard ratio = 0.510; confidence interval [0.298, 0.876]). The predictive value remained after adjustment for potential confounders (P = 0.004). ConclusionsThe 12-lead ECG postimplantation predicts clinical outcomes of BiV pacing. Such prediction may be useful in predicting the need for alternative or advanced heart failure therapies. Further study into ECG patterns may help to prospectively guide CRT.
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Prince Sultan Mil Med City, PSCC, Adult Cardiol Dept, Riyadh 11427, Saudi ArabiaPrince Sultan Mil Med City, PSCC, Adult Cardiol Dept, Riyadh 11427, Saudi Arabia
Al Hebaishi, Yahya S.
Al Shehri, Halia Z.
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King Fahad Med City, Prince Salman Heart Ctr, Adult Cardiol Dept, Riyadh 11525, Saudi ArabiaPrince Sultan Mil Med City, PSCC, Adult Cardiol Dept, Riyadh 11427, Saudi Arabia
Al Shehri, Halia Z.
Al Moghairi, Abdulrahman M.
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Prince Sultan Mil Med City, PSCC, Adult Cardiol Dept, Riyadh 11427, Saudi ArabiaPrince Sultan Mil Med City, PSCC, Adult Cardiol Dept, Riyadh 11427, Saudi Arabia
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Atal Bihari Vajpayee Inst Med Sci & Dr Ram Manoha, Dept Cardiol, New Delhi, IndiaAtal Bihari Vajpayee Inst Med Sci & Dr Ram Manoha, Dept Cardiol, New Delhi, India
Raj, Ajay
Nath, Ranjit Kumar
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Atal Bihari Vajpayee Inst Med Sci & Dr Ram Manoha, Dept Cardiol, New Delhi, IndiaAtal Bihari Vajpayee Inst Med Sci & Dr Ram Manoha, Dept Cardiol, New Delhi, India
Nath, Ranjit Kumar
Pandit, Bhagya Narayan
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Atal Bihari Vajpayee Inst Med Sci & Dr Ram Manoha, Dept Cardiol, New Delhi, IndiaAtal Bihari Vajpayee Inst Med Sci & Dr Ram Manoha, Dept Cardiol, New Delhi, India
Pandit, Bhagya Narayan
Singh, Ajay Pratap
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Atal Bihari Vajpayee Inst Med Sci & Dr Ram Manoha, Dept Cardiol, New Delhi, IndiaAtal Bihari Vajpayee Inst Med Sci & Dr Ram Manoha, Dept Cardiol, New Delhi, India
Singh, Ajay Pratap
Pandit, Neeraj
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Atal Bihari Vajpayee Inst Med Sci & Dr Ram Manoha, Dept Cardiol, New Delhi, IndiaAtal Bihari Vajpayee Inst Med Sci & Dr Ram Manoha, Dept Cardiol, New Delhi, India
Pandit, Neeraj
Aggarwal, Puneet
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Atal Bihari Vajpayee Inst Med Sci & Dr Ram Manoha, Dept Cardiol, New Delhi, IndiaAtal Bihari Vajpayee Inst Med Sci & Dr Ram Manoha, Dept Cardiol, New Delhi, India