Increases in Repolarization Heterogeneity Predict Left Ventricular Systolic Dysfunction and Response to Cardiac Resynchronization Therapy in Patients with Left Bundle Branch Block

This study aimed to investigate the association between T ‐wave morphology and impaired left ventricular ejection fraction (LVEF) in patients with complete left bundle branch block (cLBBB), and the predictive value of T‐wave morphology for response to cardiac resynchronization therapy (CRT).Methods and ResultsWe enrolled 189 patients with cLBBB on electrocardiogram performed between January 2007 and December 2011 who underwent standard echocardiography. Repolarization parameters, including the QRS ‐to‐T angle (TCRT), T‐wave morphology dispersion (TMD), T‐wave loop area (PL), and T‐wave residuum (TWR), were reconstructed from digital standard 12‐lead electrocardiograms by T‐wave morphology analysis. CRT response was defined as ≥15% reduction in left ventricular end‐systolic v olume at 12 months after CRT implantation. The clinical outcome endpoint was a composite of heart failure hospitalization, heart transplantation, or death during follow up (mean, 5.8 years). On logistic regression, a higher heart rate, longer QRS duration, increased TMD, and larger TWR were all inde pendently associated with LVEF
Source: Journal of Cardiovascular Electrophysiology - Category: Cardiology Authors: Tags: ORIGINAL ARTICLES Source Type: research

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Conclusions: IAB is associated with new-onset AF and death in CRT recipients and may be helpful in the risk stratification in the context of heart failure management. Abnormal PTFV1 did not demonstrate any prognostic value.Cardiology
Source: Cardiology - Category: Cardiology Source Type: research
CONCLUSION: In our first Asian-Pacific real-world data, automated dynamic CRT optimization showed comparable efficacy to conventional methods regarding clinical outcomes and electromechanical remodeling. PMID: 31293111 [PubMed - in process]
Source: J Korean Med Sci - Category: General Medicine Authors: Tags: J Korean Med Sci Source Type: research
linical Cardiology; and Council on Cardiovascular and Stroke Nursing Abstract Left ventricular assist devices (LVADs) are an increasingly used strategy for the management of patients with advanced heart failure with reduced ejection fraction. Although these devices effectively improve survival, atrial and ventricular arrhythmias are common, predispose these patients to additional risk, and complicate patient management. However, there is no consensus on best practices for the medical management of these arrhythmias or on the optimal timing for procedural interventions in patients with refractory arrhythmias. Altho...
Source: Circulation - Category: Cardiology Authors: Tags: Circulation Source Type: research
ConclusionsThis study suggests that rescue CRT may be considered a viable therapeutic option in inotrope-dependent patients with HF. In these patients, rescue CRT may allow them to be weaned from inotropic therapy, improve their quality of life, and decrease the rate of mortality; furthermore, rescue CRT may serve as a possible bridge to cardiac transplantation or left ventricular assist device therapy.Graphical abstract
Source: JACC: Heart Failure - Category: Cardiology Source Type: research
AbstractAimsA dilated/end-stage phase of hypertrophic cardiomyopathy (HCM) is rare but well-recognized. The role for cardiac resynchronization therapy (CRT) in this subset of patients remains unexplored. We aimed to clarify the impact of bi-ventricular pacing CRT in dilated/end-stage HCM.Methods and resultsThe Mayo Clinic HCM database was interrogated to identify patients with ejection fraction (EF)  
Source: Europace - Category: Cardiology Source Type: research
Aims There is increasing evidence that left bundle branch block (LBBB) morphology on the electrocardiogram is a positive predictor for response to cardiac resynchronization therapy (CRT). We previously demonstrated that the vectorcardiography (VCG)-derived T-wave area predicts echocardiographic CRT response in LBBB patients. In the present study, we investigate whether the T-wave area also predicts long-term clinical outcome to CRT. Methods and results This is a retrospective study consisting of 335 CRT recipients. Primary endpoint were the composite of heart failure (HF) hospitalization, heart transplantation, left ventr...
Source: Europace - Category: Cardiology Authors: Tags: Electrocardiology and risk stratification Source Type: research
Background— Response to cardiac resynchronization therapy is most favorable in patients with heart failure with QRS duration ≥150 ms and left bundle branch block and less predictable in those with QRS width 120 to 149 ms or non–left bundle branch block. Methods and Results— We studied 205 patients with heart failure referred for cardiac resynchronization therapy with QRS ≥120 ms and ejection fraction ≤35%. We tested the hypothesis that contractile function using speckle-tracking echocardiographic global circumferential strain (GCS) from 2 short-axis views and global longitudinal strain (GLS) fro...
Source: Circulation: Cardiovascular Imaging - Category: Radiology Authors: Tags: Heart Failure, Echocardiography, Pacemaker Ventricular Structure and Function Source Type: research
Background— Left ventricular (LV) mechanical discoordination, often referred to as dyssynchrony, is often observed in patients with heart failure regardless of QRS duration. We hypothesized that different myocardial substrates for LV mechanical discoordination exist from (1) electromechanical activation delay, (2) regional differences in contractility, or (3) regional scar and that we could differentiate electromechanical substrates responsive to cardiac resynchronization therapy (CRT) from unresponsive non–electrical substrates. Methods and Results— First, we used computer simulations to characterize me...
Source: Circulation: Cardiovascular Imaging - Category: Radiology Authors: Tags: Other heart failure, Pacemaker, Echocardiography Ventricular Structure and Function Source Type: research
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.
Source: Pacing and Clinical Electrophysiology : PACE - Category: Cardiology Authors: Tags: ORIGINAL Source Type: research
ConclusionsThe 12‐lead ECG post‐implantation predicts clinical outcomes of biventricular 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.This article is protected by copyright. All rights reserved.
Source: Pacing and Clinical Electrophysiology : PACE - Category: Cardiology Authors: Tags: Original Source Type: research
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