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QRS morphology and ventricular dyssynchrony in patients with chronic right ventricular pacing.

Abstract：

BACKGROUND:Mechanical dyssynchrony (MD) is associated with poor outcomes in many different populations. However, the predictors for the development of MD after chronic right ventricular (RV) pacing are not well known. METHODS:Pacing QRS morphology and MD using echocardiography was analyzed in 175 consecutive patients that have pacemaker implantation during a 7.6 year median follow-up. Predictive score for MD was constructed using QRS morphology variables and calculated by summing the points of the 4 variables: duration (≥150 ms, 1 point), transition (1 point), notching (2 points), and left-axis deviation (1 point), based on a multivariate-adjusted risk relationship with MD. RESULTS:Sixty-eight (38.9%) patients developed MD. Patients with MD had worsened left ventricular systolic function (ejection fraction from 64.6±10.6% to 59.1±10.4%, p<0.001) and heart failure symptoms (New York Heart Association functional class increase from 1.1±0.3 to 1.9±0.8, p<0.001). In an electrocardiographic analysis, QRS duration≥150 ms, the presence of precordial axis transition, notching, and left-axis deviation were strongly associated with MD. Predictive score for MD using QRS morphology parameters displayed an excellent graded relationship with MD (score 0: 3.4% vs. 1: 12.5% vs. 2: 22.6% vs. 3: 45.0% vs. 4: 57.9% vs. 5: 72.7%, linear p<0.001) (model performance c-static 0.78, 95% confidence interval 0.72-0.85, p<0.001). CONCLUSION:Patients with MD experienced a decline in left ventricular systolic function and an increase in heart failure symptoms after chronic RV pacing. A new scoring system using QRS morphology is considered a simple and efficient tool for predicting the development of MD after chronic RV pacing.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

Lee KH,Cho JG,Park HW,Yoon NS,Kim SS,Kim MR,Kim MC,Cho KH,Kim HK,Kim CH,Kim KH,Jun SJ,Kim WJ,Lee KJ,Jeong HC,Cho JY,Park KH,Sim Ds,Yoon HJ,Kim KH,Hong YJ,Kim JH,Ahn Y,Jeong MH,Park JC

doi

10.1016/j.ijcard.2014.08.131

subject

Has Abstract

pub_date

2014-10-20 00:00:00

pages

962-8

issue

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(14)01678-7

journal_volume

176

pub_type

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QRS morphology and ventricular dyssynchrony in patients with chronic right ventricular pacing.