The Association between Electrocardiographic Characteristics and Clinical Outcome in Cardiac Resynchronization Therapy

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Background: Cardiac resynchronization therapy (CRT) is a useful treatment for heart failure with mechanical dyssynchrony. However, about 30% of patients receiving CRT do not have a clinical improvement. Recently, it was reported that cardiac synchronization could be estimated by biventricular paced QRS morphology in electrocardiogram (ECG). Aims: We investigated the predictive value of ECG pattern on clinical outcome in CRT patients. Methods and Results: Study population consisted of 59 patients treated with CRT from 2005 to 2010 in our hospital. We recorded 12-leads ECG before and after implantation of devices and followed up for 2.1±1.1 years. No electrocardiographic parameters were associated with all-cause mortality and cardiac events. However, in patients with dominant R wave in lead V1 after CRT, left ventricular dimension and brain natriuretic peptide (BNP) were significantly decreased (60.1±10.9 vs 53.7±10.7 mm, p=0.02, 743±479 vs 384±290 pg/ml, p<0.001, respectively). On the other hand, in patients with QRS duration over 130 ms before CRT, only BNP was significantly decreased (618±387 vs 387±263 pg/ml, p=0.037). Conclusion: Some parameters of 12-leads ECG before and after CRT were good prognosis makers for cardiac function. Especially, V1R dominant after CRT was reported to be frequently seen after adjustment of VV delay, hence it might be a good maker for cardiac response of CRT.