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Gündüz R, Usalp S. Predictive value of frontal QRS-T angle after cardiac resynchronization therapy. J Electrocardiol 2021; 68:24-29. [PMID: 34280808 DOI: 10.1016/j.jelectrocard.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE It is practical and useful to detect patients who benefit from cardiac resynchronization therapy (CRT) by electrocardiographic (ECG) methods. In this study, the predictive role of the frontal QRS-T angle and other ECG parameters was evaluated in CRT responder patients. METHOD Seventy-seven consecutive patients with left ventricular ejection fraction (LVEF) ≤ 35%, New York Heart Association (NYHA) classes II-III, ambulatory class IV and normal sinus rhythm, who had complete left bundle branch block and were treated with CRT were included in this study. Patients were classified as "CRT responders" and "CRT non responders" according to their LVEF improvement. The frontal QRS-T angle was calculated as the absolute value of the difference between the QRS and T wave axes [frontal QRS-T angle = (QRS axis-T axis)]. RESULTS The mean age of the patients was 64.5 ± 9.1 years, and the average follow-up was 28 (12-47) months. The post-implantation LVEF was higher in the patients CRT responders group (p < 0.001). Post-implantation frontal QRS-T angle (p = 0.003), QRS duration (p = 0.008) and cQT interval (p = 0.012) values were much shorter in the CRT responder group. Multivariable regression analyses showed that the frontal QRS-T angle and age were independent risk factors for CRT response (p = 0.009). The results of the receiver operating characteristic curve analyses (ROC) showed that the predictive optimal cut-off value of CRT response for the frontal QRS-T angle was <135 degrees (AUC: 0.69, 95% CI 0.575-0.814, p = 0.004). CONCLUSION The narrowed frontal QRS-T angle (<135 degrees), QRS duration and cQT interval were associated with CRT response in heart failure patients. The frontal QRS-T angle can be an independent predictor of CRT response.
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Affiliation(s)
- Ramazan Gündüz
- Department of Cardiology, Manisa City Hospital, Manisa 45040, Turkey
| | - Songül Usalp
- Department of Cardiology, Sancaktepe Sehit Profesor Ilhan Varank Education and Research Hospital, Istanbul, Turkey.
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Yuyun MF, Erqou SA, Peralta AO, Hoffmeister PS, Yarmohammadi H, Echouffo Tcheugui JB, Martin DT, Joseph J, Singh JP. Risk of ventricular arrhythmia in cardiac resynchronization therapy responders and super-responders: a systematic review and meta-analysis. Europace 2021; 23:1262-1274. [PMID: 33496319 DOI: 10.1093/europace/euaa414] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/18/2020] [Indexed: 12/22/2022] Open
Abstract
AIMS Response to cardiac resynchronization therapy (CRT) is associated with improved survival, and reduction in heart failure hospitalization, and ventricular arrhythmia (VA) risk. However, the impact of CRT super-response [CRT-SR, increase in left ventricular ejection fraction (LVEF) to ≥ 50%] on VA remains unclear. METHODS AND RESULTS We undertook a meta-analysis aimed at determining the impact of CRT response and CRT-SR on risk of VA and all-cause mortality. Systematic search of PubMed, EMBASE, and Cochrane databases, identifying all relevant English articles published until 31 December 2019. A total of 34 studies (7605 patients for VA and 5874 patients for all-cause mortality) were retained for the meta-analysis. The pooled cumulative incidence of appropriate implantable cardioverter-defibrillator therapy for VA was significantly lower at 13.0% (4.5% per annum) in CRT-responders, vs. 29.0% (annualized rate of 10.0%) in CRT non-responders, relative risk (RR) 0.47 [95% confidence interval (CI) 0.39-0.56, P < 0.0001]; all-cause mortality 3.5% vs. 9.1% per annum, RR of 0.38 (95% CI 0.30-0.49, P < 0.0001). The pooled incidence of VA was significantly lower in CRT-SR compared with CRT non-super-responders (non-responders + responders) at 0.9% vs. 3.8% per annum, respectively, RR 0.22 (95% CI 0.12-0.40, P < 0.0001); as well as all-cause mortality at 2.0% vs. 4.3%, respectively, RR 0.47 (95% CI 0.33-0.66, P < 0.0001). CONCLUSIONS Cardiac resynchronization therapy super-responders have low absolute risk of VA and all-cause mortality. However, there remains a non-trivial residual absolute risk of these adverse outcomes in CRT responders. These findings suggest that among CRT responders, there may be a continued clinical benefit of defibrillators.
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Affiliation(s)
- Matthew F Yuyun
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Sebhat A Erqou
- Department of Medicine, Brown University, Providence, RI, USA.,Division of Cardiology, Providence VA Medical Center, Providence, RI, USA
| | - Adelqui O Peralta
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Peter S Hoffmeister
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Hirad Yarmohammadi
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | | | - David T Martin
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jacob Joseph
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jagmeet P Singh
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, USA
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Postol AS, Neminushchi NM, Ivanchenko AV, Lyashenko VV, Mishanin SA, Vygovsky АB, Schneider YA. Analysis of arrhythmic episodes in patients with implanted cardioverter defibrillators and a high risk of sudden cardiac death. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2019. [DOI: 10.15829/1728-8800-2019-5-38-46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Postol AS, Neminushchi NM, Ivanchenko AV, Lyashenko VV, Mishanin SA, Vygovsky АB, Schneider YA. Analysis of arrhythmic episodes in patients with implanted cardioverter defibrillators and a high risk of sudden cardiac death. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2019. [DOI: 10.15829/38-46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Liosis S, Lyan E, Abdin A, Brüggemann B, Lange SA, Vogler J, Heeger CH, Yalin K, Tilz RR, Eitel C. Biventricular Pacing Going Along with Acute Hemodynamic Response in a Patient with Huge Anterior Wall Aneurysm - Importance of Pacing Viable Myocardium. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:810-815. [PMID: 31177265 PMCID: PMC6581013 DOI: 10.12659/ajcr.914480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Patient: Female, 85 Final Diagnosis: Ischemic cardiomyopathy with electrical storm Symptoms: Dyspnea Medication: — Clinical Procedure: Ablation of ventricular tachycardia Specialty: Cardiology
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Affiliation(s)
- Spyridon Liosis
- Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany
| | - Evgeny Lyan
- Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany
| | - Amr Abdin
- Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany
| | - Ben Brüggemann
- Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany
| | - Stefan A Lange
- Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany
| | - Julia Vogler
- Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany
| | - Christian H Heeger
- Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany
| | - Kivanc Yalin
- Department of Cardiology, Usak University, Faculty of Medicine, Usak, Turkey
| | - Roland R Tilz
- Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany
| | - Charlotte Eitel
- Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany
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Liang Y, Wang Q, Zhang M, Wang J, Chen H, Yu Z, Gong X, Su Y, Ge J. Cessation of pacing in super‐responders of cardiac resynchronization therapy: A randomized controlled trial. J Cardiovasc Electrophysiol 2018; 29:1548-1555. [PMID: 30106214 DOI: 10.1111/jce.13711] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Yixiu Liang
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghai China
| | - Qingqing Wang
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghai China
| | - Mingliang Zhang
- Department of CardiologyCentral Hospital of Tai’an Shandong China
| | - Jingfeng Wang
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghai China
| | - Haiyan Chen
- Department of EchocardiographyShanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan UniversityShanghai China
| | - Ziqing Yu
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghai China
| | - Xue Gong
- Department of CardiologyDeltahealth HospitalShanghai China
| | - Yangang Su
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghai China
| | - Junbo Ge
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghai China
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