Left ventricular lead electrical delay predicts response to cardiac resynchronization therapy

Jagmeet P. Singh, Dali Fan, E. Kevin Heist, Chrisfouad R. Alabiad, Cynthia C. Taub, Vivek Reddy, Moussa Mansour, Michael H. Picard, Jeremy N. Ruskin, Theofanie Mela

Research output: Contribution to journalArticle

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Abstract

Background: Intracardiac electrograms can be used to guide left ventricular (LV) lead placement during implantation of cardiac resynchronization therapy (CRT) devices. Although attempts often are made to ensure that the LV lead is positioned at a site of maximal electrical delay, information on whether this is useful in predicting the acute hemodynamic response and long-term clinical outcome to CRT is limited. Objectives: The purpose of this study was to assess the ability of intracardiac (electrogram) measurements made during LV lead placement in patients undergoing CRT for predicting acute hemodynamic response and long-term clinical outcome to CRT. Methods: Seventy-one subjects with standard indications for CRT underwent electrogram measurements and echocardiograms performed in the acute phase of this study. The LV lead electrical delay was measured intraoperatively from the onset of the surface ECG QRS complex to the onset of the sensed electrogram on the LV lead, as a percentage of the baseline QRS interval. Echocardiographic assessment of the hemodynamic response to CRT was measured as an intra-individual percentage change in dP/dt over baseline (ΔdP/dt, derived from the mitral regurgitation Doppler profile) with CRT on and off. dP/dt was measurable in 48 subjects, and acute responders to CRT were defined as those with ΔdP/dt ≥25%. Long-term response was measured as a combined endpoint of hospitalization for heart failure and/or all cause mortality at 12 months. Time to the primary endpoint was estimated by the Kaplan-Meier method, with comparisons made using the log rank test. Results: LV lead electrical delay correlated weakly with ΔdP/dt of the combined group (n = 48, r = 0.311, P = .029) but was strongly correlated with ΔdP/dt in the nonischemic subgroup (n = 20, r = 0.48, P = .027). LV lead electrical delay (%) was significantly longer in acute responders (69.6 ± 23.9 vs 31.95 ± 11.57, P = .002) among patients with nonischemic cardiomyopathy. A reduced LV lead electrical delay (<50% of the QRS duration) was associated with worse clinical outcome within the entire cohort (hazard ratio: 2.7, 95% confidence interval: 1.17-6.68, P = .032) as well as when stratified into ischemic and nonischemic subgroups. Conclusion: Measuring LV lead electrical delay is useful during CRT device implantation because it may help predict hemodynamic response and long-term clinical outcome.

Original languageEnglish (US)
Pages (from-to)1285-1292
Number of pages8
JournalHeart Rhythm
Volume3
Issue number11
DOIs
StatePublished - Nov 2006
Externally publishedYes

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Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy Devices
Hemodynamics
Cardiac Electrophysiologic Techniques
Mitral Valve Insufficiency
Cardiomyopathies
Electrocardiography
Hospitalization
Heart Failure
Confidence Intervals
Mortality

Keywords

  • Cardiac resynchronization therapy
  • Electrograms
  • Heart failure
  • Hemodynamics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Left ventricular lead electrical delay predicts response to cardiac resynchronization therapy. / Singh, Jagmeet P.; Fan, Dali; Heist, E. Kevin; Alabiad, Chrisfouad R.; Taub, Cynthia C.; Reddy, Vivek; Mansour, Moussa; Picard, Michael H.; Ruskin, Jeremy N.; Mela, Theofanie.

In: Heart Rhythm, Vol. 3, No. 11, 11.2006, p. 1285-1292.

Research output: Contribution to journalArticle

Singh, JP, Fan, D, Heist, EK, Alabiad, CR, Taub, CC, Reddy, V, Mansour, M, Picard, MH, Ruskin, JN & Mela, T 2006, 'Left ventricular lead electrical delay predicts response to cardiac resynchronization therapy', Heart Rhythm, vol. 3, no. 11, pp. 1285-1292. https://doi.org/10.1016/j.hrthm.2006.07.034
Singh, Jagmeet P. ; Fan, Dali ; Heist, E. Kevin ; Alabiad, Chrisfouad R. ; Taub, Cynthia C. ; Reddy, Vivek ; Mansour, Moussa ; Picard, Michael H. ; Ruskin, Jeremy N. ; Mela, Theofanie. / Left ventricular lead electrical delay predicts response to cardiac resynchronization therapy. In: Heart Rhythm. 2006 ; Vol. 3, No. 11. pp. 1285-1292.
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T1 - Left ventricular lead electrical delay predicts response to cardiac resynchronization therapy

AU - Singh, Jagmeet P.

AU - Fan, Dali

AU - Heist, E. Kevin

AU - Alabiad, Chrisfouad R.

AU - Taub, Cynthia C.

AU - Reddy, Vivek

AU - Mansour, Moussa

AU - Picard, Michael H.

AU - Ruskin, Jeremy N.

AU - Mela, Theofanie

PY - 2006/11

Y1 - 2006/11

N2 - Background: Intracardiac electrograms can be used to guide left ventricular (LV) lead placement during implantation of cardiac resynchronization therapy (CRT) devices. Although attempts often are made to ensure that the LV lead is positioned at a site of maximal electrical delay, information on whether this is useful in predicting the acute hemodynamic response and long-term clinical outcome to CRT is limited. Objectives: The purpose of this study was to assess the ability of intracardiac (electrogram) measurements made during LV lead placement in patients undergoing CRT for predicting acute hemodynamic response and long-term clinical outcome to CRT. Methods: Seventy-one subjects with standard indications for CRT underwent electrogram measurements and echocardiograms performed in the acute phase of this study. The LV lead electrical delay was measured intraoperatively from the onset of the surface ECG QRS complex to the onset of the sensed electrogram on the LV lead, as a percentage of the baseline QRS interval. Echocardiographic assessment of the hemodynamic response to CRT was measured as an intra-individual percentage change in dP/dt over baseline (ΔdP/dt, derived from the mitral regurgitation Doppler profile) with CRT on and off. dP/dt was measurable in 48 subjects, and acute responders to CRT were defined as those with ΔdP/dt ≥25%. Long-term response was measured as a combined endpoint of hospitalization for heart failure and/or all cause mortality at 12 months. Time to the primary endpoint was estimated by the Kaplan-Meier method, with comparisons made using the log rank test. Results: LV lead electrical delay correlated weakly with ΔdP/dt of the combined group (n = 48, r = 0.311, P = .029) but was strongly correlated with ΔdP/dt in the nonischemic subgroup (n = 20, r = 0.48, P = .027). LV lead electrical delay (%) was significantly longer in acute responders (69.6 ± 23.9 vs 31.95 ± 11.57, P = .002) among patients with nonischemic cardiomyopathy. A reduced LV lead electrical delay (<50% of the QRS duration) was associated with worse clinical outcome within the entire cohort (hazard ratio: 2.7, 95% confidence interval: 1.17-6.68, P = .032) as well as when stratified into ischemic and nonischemic subgroups. Conclusion: Measuring LV lead electrical delay is useful during CRT device implantation because it may help predict hemodynamic response and long-term clinical outcome.

AB - Background: Intracardiac electrograms can be used to guide left ventricular (LV) lead placement during implantation of cardiac resynchronization therapy (CRT) devices. Although attempts often are made to ensure that the LV lead is positioned at a site of maximal electrical delay, information on whether this is useful in predicting the acute hemodynamic response and long-term clinical outcome to CRT is limited. Objectives: The purpose of this study was to assess the ability of intracardiac (electrogram) measurements made during LV lead placement in patients undergoing CRT for predicting acute hemodynamic response and long-term clinical outcome to CRT. Methods: Seventy-one subjects with standard indications for CRT underwent electrogram measurements and echocardiograms performed in the acute phase of this study. The LV lead electrical delay was measured intraoperatively from the onset of the surface ECG QRS complex to the onset of the sensed electrogram on the LV lead, as a percentage of the baseline QRS interval. Echocardiographic assessment of the hemodynamic response to CRT was measured as an intra-individual percentage change in dP/dt over baseline (ΔdP/dt, derived from the mitral regurgitation Doppler profile) with CRT on and off. dP/dt was measurable in 48 subjects, and acute responders to CRT were defined as those with ΔdP/dt ≥25%. Long-term response was measured as a combined endpoint of hospitalization for heart failure and/or all cause mortality at 12 months. Time to the primary endpoint was estimated by the Kaplan-Meier method, with comparisons made using the log rank test. Results: LV lead electrical delay correlated weakly with ΔdP/dt of the combined group (n = 48, r = 0.311, P = .029) but was strongly correlated with ΔdP/dt in the nonischemic subgroup (n = 20, r = 0.48, P = .027). LV lead electrical delay (%) was significantly longer in acute responders (69.6 ± 23.9 vs 31.95 ± 11.57, P = .002) among patients with nonischemic cardiomyopathy. A reduced LV lead electrical delay (<50% of the QRS duration) was associated with worse clinical outcome within the entire cohort (hazard ratio: 2.7, 95% confidence interval: 1.17-6.68, P = .032) as well as when stratified into ischemic and nonischemic subgroups. Conclusion: Measuring LV lead electrical delay is useful during CRT device implantation because it may help predict hemodynamic response and long-term clinical outcome.

KW - Cardiac resynchronization therapy

KW - Electrograms

KW - Heart failure

KW - Hemodynamics

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