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Reverse Electrical Remodeling by Cardiac Resynchronization Therapy: Prevalence and Clinical Impact

Authors

  • FREDERIC A. SEBAG M.D.,

    1. INSERM U642, Rennes, France
    2. Université de Rennes 1, LTSI, Rennes, France
    3. CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France
    4. INSERM 1099, CIC-IT 804, Rennes, France
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  • RAPHAEL P. MARTINS M.D.,

    1. INSERM U642, Rennes, France
    2. Université de Rennes 1, LTSI, Rennes, France
    3. CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France
    4. INSERM 1099, CIC-IT 804, Rennes, France
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  • PASCAL DEFAYE M.D., Ph.D.,

    1. Service de Cardiologie, Hopital A. Michallon, CHU Grenoble, France
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  • FRANÇOISE HIDDEN-LUCET M.D.,

    1. Institut de Cardiologie, Service de Rythmologie, CHU Pitié Salpetrière, Paris
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  • PHILIPPE MABO M.D., Ph.D.,

    1. INSERM U642, Rennes, France
    2. Université de Rennes 1, LTSI, Rennes, France
    3. CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France
    4. INSERM 1099, CIC-IT 804, Rennes, France
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  • JEAN-CLAUDE DAUBERT M.D.,

    1. INSERM U642, Rennes, France
    2. Université de Rennes 1, LTSI, Rennes, France
    3. CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France
    4. INSERM 1099, CIC-IT 804, Rennes, France
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  • CHRISTOPHE LECLERCQ M.D., Ph.D.

    1. INSERM U642, Rennes, France
    2. Université de Rennes 1, LTSI, Rennes, France
    3. CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France
    4. INSERM 1099, CIC-IT 804, Rennes, France
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  • Drs. Sebag and Martins share first authorship.

  • Drs. Sebag and Martins report research grants from St. Jude Medical and Sorin Group. Dr. Daubert reports research grants from Medtronic and Medtronic Bakken Research Center; he is a consultant for Medtronic and St. Jude Medical. Dr. Leclercq reports research grants from Medtronic, St. Jude Medical, Biotronik, Sorin, and Boston Scientific; he is a consultant for Sorin, Medtronic, and St. Jude Medical. Other authors: No disclosures.

Christophe Leclercq, M.D., Ph.D., Service de Cardiologie et Maladies Vasculaires, Centre Hospitalier Universitaire de Rennes, 2, rue Henri Le Guilloux Cedex 35003, Rennes, France. Fax: +33-2-99-28-25-18; E-mail: christophe.leclercq@chu-rennes.fr

Abstract

Intrinsic QRS Narrowing with CRTBackground: Cardiac resynchronization therapy (CRT) improves left ventricular ejection fraction (LVEF) in patients with congestive heart failure, LV systolic dysfunction, and a wide QRS complex. Previous reports suggest that CRT may also induce electrical remodeling but the impact on clinical outcome remains unknown.

Objective: We sought to determine (1) if chronic CRT induces a relevant shortening of the intrinsic QRS (iQRS), (2) whether changes in the native conduction system correlate with clinical or echocardiographic response to CRT, and (3) to identify predictors of iQRS width shortening.

Methods: We prospectively included 85 consecutive patients with left bundle-branch block who received a CRT device in 3 French centers. NYHA class, iQRS duration, LVEF, and left ventricular volumes were assessed before and 1 year after CRT implantation. Clinical and echocardiographic CRT responders were defined respectively as NYHA class improvement >1 class without heart failure hospitalization and an increase of LVEF by ≥10% and/or a decrease in LVESV by ≥15%. Electrocardiographic responders were defined as a decrease in iQRS duration by ≥20 ms.

Results: Baseline and 1-year follow-up mean iQRS durations were, respectively, 168.0 ± 19.7 ms and 149.6 ± 31.6 ms (P < 0.0001). Electrocardiographic response, observed in 43/85 patients (51%), was associated with a greater rate of clinical (P = 0.035) and echocardiographic (P = 0.023) response. Younger age, male gender, and longer baseline QRS width were independent predictors of electrocardiographic response.

Conclusion: CRT decreases iQRS duration. A reduction of at least 20 ms in iQRS duration is associated with better clinical and echocardiographic response. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1219–1227, November 2012)

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