The Showa University Journal of Medical Sciences
Online ISSN : 2185-0968
Print ISSN : 0915-6380
ISSN-L : 0915-6380
Original
Usefulness of Intracardiac Local Ventricular Electrogram to Predict Responders in Patients Undergoing Cardiac Resynchronization Therapy
Yoshimasa ONUMA, Mitsuharu KAWAMURA, Kosuke YOSHIKAWA, Toshihiko GOKAN, Ko OGAWA, Yuya NAKAMURA, Akinori OCHI, Koichiro INOKUCHI, Yumi MUNETSUGU, Tatsuya ONUKI, Hiroyuki ITO, Norikazu WATANABE, Youichi KOBAYASHI
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Keywords: cardiac resynchronization therapy, ventricular tachycardia, intracardiac electrocardiogram, heart failure
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2017 Volume 29 Issue 2 Pages 131-139

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Abstract

Cardiac resynchronization therapy (CRT) is a well-established, efficient strategy for medically-refractory congestive heart failure (HF) with ventricular conduction disturbances. However, about 30% of patients who undergo CRT do not receive any benefit. Therefore, we investigated the usefulness of the QRS-left ventricle (LV) interval for predicting responders during CRT implantation. This study included 66 patients who underwent CRT implantation. The definition of responder was a ≥15% reduction in LV end-systolic volume or ≥20% increase in LV ejection fraction. The QRS-LV interval was measured from the beginning of the body surface electrocardiogram QRS complex to the LV potential recorded by LV leads. We analyzed the correlations between the QRS-LV intervals and CRT responders, admission for HF and mortality. The patients were 67±12 years old, and their mean LV ejection fraction was 26.3%±8.3%. During follow-up (27.2±19.9 months), 27 patients were admitted for HF (40.1%), and 17 died (25.7%); the median QRS-LV interval was 103±33 msec. Patients were divided into 2 groups: wide QRS-LV (>103 msec), and narrow QRS-LV (<103 msec). The wide QRS-LV group had a lower mortality rate than the narrow QRS-LV group (77% vs. 53%, P<0.05). In patients with dilated cardiomyopathy, the QRS-LV interval was significantly wider in responders, compared to non-responders (112±9.2 vs. 80.0±10 msec, P<0.05). The QRS-LV interval did not correlate with CRT responders or admission for HF. The mortality rate was lower in patients with wide QRS-LV intervals, compared to narrow QRS-LV intervals. Furthermore, a wide QRS-LV interval might be a predictor for CRT responders in patients with dilated cardiomyopathy.

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© 2017 The Showa University Society
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