Twelve‐Lead ECG Optimization of Cardiac Resynchronization Therapy in Patients With and Without Delayed Enhancement on Cardiac Magnetic Resonance Imaging

Autor: Kevin V. Burns, Imran S. Syed, Ryan M. Gage, Alan J. Bank, Akbar H. Khan, Ambareesh Bajpai, Amanda L. Blanchard, Jeffrey M. Gillberg, Subham Ghosh, Antonia E. Curtin
Rok vydání: 2018
Předmět:
Male
medicine.medical_specialty
medicine.medical_treatment
cardiac magnetic resonance imaging
Magnetic Resonance Imaging (MRI)
body surface mapping
Cardiac resynchronization therapy
cardiac resynchronization therapy
Delayed enhancement
030204 cardiovascular system & hematology
Electrocardiography
03 medical and health sciences
0302 clinical medicine
Cardiac magnetic resonance imaging
Internal medicine
medicine
Humans
In patient
030212 general & internal medicine
Adverse effect
Lead (electronics)
Original Research
Aged
Heart Failure
Electrocardiology (ECG)
medicine.diagnostic_test
business.industry
Heart
Magnetic resonance imaging
medicine.disease
Magnetic Resonance Imaging
Electrophysiology
Pacemaker
Treatment Outcome
Echocardiography
Heart failure
cardiovascular system
outcome
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Zdroj: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
ISSN: 2047-9980
DOI: 10.1161/jaha.118.009559
Popis: Background Delayed enhancement ( DE ) on magnetic resonance imaging is associated with ventricular arrhythmias, adverse events, and worse left ventricular mechanics. We investigated the impact of DE on cardiac resynchronization therapy ( CRT ) outcomes and the effect of CRT optimization. Methods and Results We studied 130 patients with ejection fraction ( EF ) ≤40% and QRS ≥120 ms, contrast cardiac magnetic resonance imaging, and both pre‐ and 1‐year post‐ CRT echocardiograms. Sixty‐three (48%) patients did not have routine optimization of CRT . The remaining patients were optimized for wavefront fusion by 12‐lead ECG . The primary end point in this study was change in EF following CRT . To investigate the association between electrical dyssynchrony and EF outcomes, the standard deviation of activation times from body‐surface mapping was calculated during native conduction and selected device settings in 52 of the optimized patients. Patients had no DE (n=45), midwall septal stripe (n=30), or scar (n=55). Patients without DE had better ∆ EF (13±10 versus 4±10 units; P EF in midwall stripe (2±9 versus 12±12 units; P =0.01) and scar (0±7 versus 5±10; P =0.04) groups, but not in the no‐ DE group. Patients without DE had greater native standard deviation of activation times ( P =0.03) and greater ∆standard deviation of activation times with standard programming ( P =0.01). Device optimization reduced standard deviation of activation times only in patients with DE ( P Conclusions DE on magnetic resonance imaging is associated with worse EF outcomes following CRT . Device optimization is associated with improved EF and reduced electrical dyssynchrony in patients with DE .
Databáze: OpenAIRE
Externí odkaz: