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Journal of cardiovascular electrophysiology v.28 no.2, 2017년, pp.192 - 200   SCI SCIE
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Biventricular Paced QRS Area Predicts Acute Hemodynamic CRT Response Better Than QRS Duration or QRS Amplitudes

DE POOTER, JAN (Ghent University Hospital, Heart Center, Ghent, Belgium ) ; EL HADDAD, MILAD (Ghent University Hospital, Heart Center, Ghent, Belgium ) ; DE BUYZERE, MARC (Ghent University Hospital, Heart Center, Ghent, Belgium ) ; ARANDA, HERNANDEZ ALFONSO (Medtronic Plc, Bakken Research Center, Maastricht, The Netherlands ) ; CORNELUSSEN, RICHARD (Medtronic Plc, Bakken Research Center, Maastricht, The Netherlands ) ; STEGEMANN, BERTHOLD (Medtronic Plc, Bakken Research Center, Maastricht, The Netherlands ) ; RINALDI, CHRISTOPHER A. (Guy's and St Thomas' NHS Trust, London, UK ) ; STERLINSKI, MACIEJ (The Second Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland ) ; SOKAL, ADAM (Department of Cardiology, Congenital Heart Diseases and Electrotherapy Silesian Center of Heart Disease, Zabrze, Poland ) ; FRANCIS, DARREL P. (Faculty of Medici ) ; JORDAENS, LUC ; STROOBANDT, ROLAND X. ; VAN HEUVERSWYN, FREDERIC ; TIMMERMANS, FRANK ;
  • 초록  

    Paced QRS Area Predicts CRT Response Introduction Vectorcardiographic (VCG) QRS area of left bundle branch block (LBBB) predicts acute hemodynamic response in cardiac resynchronization therapy (CRT) patients. We hypothesized that changes in QRS area occurring with biventricular pacing (BV) might predict acute hemodynamic CRT response (AHR). Methods and Results VCGs of 624 BV paced electrocardiograms (25 LBBB patients with 35 different pacing configurations) were calculated according to Frank's orthogonal lead system. Maximum QRS vector amplitudes (X Ampl , Y Ampl , Z Ampl , and 3D Amp ) and QRS areas (X Area , Y Area , Z Area , and 3D Area ) in the orthogonal leads (X, Y, and Z) and in 3‐dimensional projection were measured. Volume of the 3D vector loop and global QRS duration (QRSD) on the surface electrocardiogram were assessed. Differences (Δ) in VCG parameters between BV paced and LBBB QRS complexes were calculated. An increase of 10% in dP/dt max was considered as AHR. LBBB conduction is characterized by a large Z Area (109 μVs, interquartile range [IQR]:75;135), significantly larger than X Area (22 μVs, IQR:10;57) and Y Area (44 μVs, IQR:32;62, P Ampl , Δ3D Ampl , Z Area, ΔZ Area , Δ3D Area , and ΔQRSD differentiate AHR response from nonresponse (P Area predicted best positive AHR (area under the curve = 0.813) and outperformed any other VCG parameter or QRSD measurement. Conclusion Of all VCG parameters, reduction in QRS area, calculated in Frank's Z lead, predicts acute hemodynamic response best. This method might be an easy, noninvasive tool to guide CRT implantation and optimization.


  • 주제어

    biventricular pacing .   cardiac resynchronization therapy .   QRS area .   vectorcardiography.  

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