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Europace Advance Access published online on November 14, 2009
Europace, doi:10.1093/europace/eup364
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

CLINICAL RESEARCH

Electrocardiographic patterns and long-term clinical outcome in cardiac resynchronization therapy

Mads B. Kronborg*, Jens C. Nielsen and Peter T. Mortensen

Department of Cardiology, Aarhus University Hospital, Skejby, Bendstrupgaardsvej 100, DK-8200 Aarhus N, Denmark

Aims: The present study aims to identify the predictive value of electrocardiographic (ECG) patterns on long-term clinical and echocardiographic outcome in patients treated with cardiac resynchronization therapy (CRT).

Methods and results: Clinical information including a standard 12-lead ECG was collected from patient files in consecutive patients treated with CRT from 1997 to 2007. Symptomatic response was defined as improvement in New York Heart Association class (≥1) and echocardiographic response as improvement in left ventricular ejection fraction of ≥5% absolute. We included 659 patients [median age 66 years, 526 (80%) male]. There was a higher all-cause and cardiac mortality in patients with left bundle branch block (LBBB), prolonged PR interval, right-axis deviation combined with LBBB in the pre-implant ECG, and no QRS reduction after CRT. Patients with right bundle branch block and patients with an intermediate QRS duration (150–200 ms) had a higher chance of symptomatic improvement, and patients with normal PR interval and normal axis in LBBB had a higher chance of echocardiographic improvement.

Conclusion: Cardiac resynchronization therapy does not change the predictive value of ECG patterns in heart failure patients with bundle branch block, where LBBB, a prolonged PR, and an abnormal axis in LBBB are signs of a more severe degree of myocardial disease, and therefore a worse outcome. Lack of electrical resynchronization defined as an unchanged or prolonged QRS duration is associated with higher all-cause and cardiac mortality in patients treated with CRT.

Key Words: Cardiac resynchronization therapy, Biventricular pacing, Electrocardiogram, Bundle branch block, Heart failure, Mortality

* Corresponding author. Tel: +45 89 49 62 34, Fax: +45 89 49 60 02, Email: mads.brix.kronborg{at}ki.au.dk

Manuscript submitted 19 August 2009. Accepted after revision 21 October 2009.


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