Electrocardiographic Predictors of Response to Cardiac Resynchronization Therapy in Patients With Intraventricular Conduction Delay

Yoichi Takaya; Takashi Noda; Ikutaro Nakajima; Yuko Yamada; Koji Miyamoto; Hideo Okamura; Kazuhiro Satomi; Takeshi Aiba; Kengo F. Kusano; Hideaki Kanzaki; Toshihisa Anzai; Masaharu Ishihara; Satoshi Yasuda; Hisao Ogawa; Shiro Kamakura; Wataru Shimizu

doi:10.1253/circj.CJ-12-1569

Arrhythmia/Electrophysiology

Electrocardiographic Predictors of Response to Cardiac Resynchronization Therapy in Patients With Intraventricular Conduction Delay

Yoichi Takaya, Takashi Noda, Ikutaro Nakajima, Yuko Yamada, Koji Miyamoto, Hideo Okamura, Kazuhiro Satomi, Takeshi Aiba, Kengo F. Kusano, Hideaki Kanzaki, Toshihisa Anzai, Masaharu Ishihara, Satoshi Yasuda, Hisao Ogawa, Shiro Kamakura, Wataru Shimizu

Author information

Yoichi Takaya
Divisions of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center
Takashi Noda
Divisions of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center
Ikutaro Nakajima
Divisions of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center
Yuko Yamada
Divisions of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center
Koji Miyamoto
Divisions of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center
Hideo Okamura
Divisions of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center
Kazuhiro Satomi
Divisions of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center
Takeshi Aiba
Divisions of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center
Kengo F. Kusano
Divisions of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center
Hideaki Kanzaki
Heart Failure, National Cerebral and Cardiovascular Center
Toshihisa Anzai
Heart Failure, National Cerebral and Cardiovascular Center
Masaharu Ishihara
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
Satoshi Yasuda
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
Hisao Ogawa
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
Shiro Kamakura
Divisions of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center
Wataru Shimizu
Divisions of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center
Department of Cardiovascular Medicine, Nippon Medical School

Keywords: Cardiac resynchronization therapy, Electrocardiogram, Heart failure, Intraventricular conduction delay, Responder

JOURNAL FREE ACCESS

2014 Volume 78 Issue 1 Pages 71-77

DOI https://doi.org/10.1253/circj.CJ-12-1569

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Abstract

Background: Little is known about predictors of response to cardiac resynchronization therapy (CRT) in patients with intraventricular conduction delay (IVCD). The purpose of this study was to investigate the benefits of CRT and significant variables on surface electrocardiogram (ECG) to predict response to CRT in those patients. Methods and Results: Among the cohort of 152 CRT patients, 40 patients with IVCD were evaluated. Sixteen patients (40%) were responders. At baseline, responders had a wider QRS duration (158±18 vs. 144±18ms, P=0.02) and a higher frequency of left axis deviation (LADEV; 75% vs. 29%, P=0.004) compared with non-responders. After CRT, greater shortening of QRS duration (ΔQRS; 26±24 vs. 7±24ms, P=0.02), axis shift from LADEV to right axis deviation (RADEV; 69% vs. 13%, P<0.001), and both rightward forces in lead I and anterior forces in V1 (56% vs. 13%, P=0.003) were found more frequently in responders. Multivariable logistic regression analysis showed that LADEV at baseline, or ΔQRS and axis shift from LADEV to RADEV after CRT were independent predictors of response to CRT. Conclusions: Patients with IVCD may not respond to CRT, but LADEV at baseline and reversal of ventricular activation after CRT on surface ECG could be important to predict response to CRT. (Circ J 2014; 78: 71–77)

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