Heart Failure -> Cardiac Resynchronization Therapy: -> Indications D-PO03 - Poster Session III (ID 48) Poster

D-PO03-071 - Novel Electrocardiographic Dyssynchrony Criteria Predict Outcomes In Non-Left Bundle Branch Block Patients With Cardiac Resynchronization Therapy (ID 306)


Background: There are limited data assessing whether ECG criteria for estimating dyssynchrony may be used to identify CRT responders in the non-LBBB population.
Objective: To assess the utility of novel ECG dyssynchrony criteria in predicting outcomes in non-LBBB patients receiving CRT
Methods: Our cohort consisted of 269 CRT-D patients with non-LBBB from MADIT-CRT. Left ventricular (LV) intraventricular dyssynchrony (intraD) was estimated by the absolute time difference between the intrinsicoid deflections (IDs) in leads aVL and aVF divided by QRS duration (QRSd): [aVLID - aVFID]/QRSd (%), with >25% defining presence of intraD. Interventricular dyssynchrony (interD) was estimated as follows: [V5ID - V1ID]/QRSd (%), with >25% defining presence of interD. We assessed associations between the presence of intraD or interD and heart failure or death (HF/death) and death alone, including in patients with QRS≥150 ms.
Results: There were 118 (43.8%) patients with intraD, while 171 (63.6%) had interD. Those with intraD had similar risk of HF/death (Fig. 1A; HR=0.80, p=0.276), but lower risk of death (HR=0.53, p=0.031), vs. those without intraD. Patients with and without interD had similar risk of HF/death (HR=1.10, p=0.657) and death (HR=1.27, p=0.447). In the prolonged QRS subgroup, patients with intraD had lower risk of both HF/death (Fig. 1B, HR=0.49, p=0.043) and death (HR=0.36, p=0.039), vs. those without intraD. No differences in HF or death were found by the presence of interD in the prolonged QRS subgroup.
Conclusion: In non-LBBB patients, ECG-derived LV intraventricular dyssynchrony identified CRT patients with lower risk of HF or death in the wide QRS subgroup.