Advanced search
1 file | 523.19 KB Add to list

Relation between electrical and mechanical dyssynchrony in patients with left bundle branch block : an electro- and vectorcardiographic study

Author
Organization
Abstract
Background: Current guidelines select patients for cardiac resynchronization therapy (CRT) mainly on electrocardiographic parameters like QRS duration and left bundle branch block (LBBB). However, among those LBBB patients, heterogeneity in mechanical dyssynchrony occurs and might be a reason for nonresponse to CRT. This study assesses the relation between electrocardiographic characteristics and presence of mechanical dyssynchrony among LBBB patients. Methods: The study included patients with true LBBB (including mid-QRS notching) on standard 12-lead electrocardiograms. Left bundle branch block-induced mechanical dyssynchrony was assessed by the presence of septal flash on two-dimensional echocardiography. Previously reported electro- and vectorcardiographic dyssynchrony markers were analyzed: global QRS duration (QRSD(LBBB)), left ventricular activation time (QRSD(LVAT)), time to intrinsicoid deflection (QRSD(ID)), and vectorcardiographic QRS areas in the 3D vector loop (QRSA(3D)). Results: The study enrolled 545 LBBB patients. Septal flash (SF) is present in 52% of patients presenting with true LBBB. Patients with SF are more frequent female, have less ischemic heart disease and smaller left ventricular dimensions. In multivariate analysis longer QRSD(LBBB), QRSD(LVAT) and larger QRSA(3D) were independently associated with SF. Of all parameters, QRSA(3D) has the best accuracy to predict SF, although overall accuracy remains moderate (59% sensitivity, 58% specificity). The predictive value of QRSA(3D) remained constant in both sexes, irrespective of ischemic heart disease, ejection fraction and even when categorizing for QRSD(LBBB). Conclusion: In LBBB patients, large QRS areas correlate better with mechanical dyssynchrony compared to wide QRSD intervals. However, the overall accuracy to predict mechanical dyssynchrony by electrocardiographic dyssynchrony markers, even when using complex vectorcardiographic parameters, remains low.
Keywords
cardiac resynchronization therapy, dyssynchrony, electrocardiography, vectorcardiography and left bundle branch block, CARDIAC RESYNCHRONIZATION THERAPY, HEART-FAILURE, QRS DURATION, SEPTAL FLASH, VENTRICULAR ACTIVATION, TASK-FORCE, ASSOCIATION, CARDIOLOGY, SOCIETY, CRT

Downloads

  • (...).pdf
    • full text
    • |
    • UGent only
    • |
    • PDF
    • |
    • 523.19 KB

Citation

Please use this url to cite or link to this publication:

MLA
De Pooter, Jan et al. “Relation Between Electrical and Mechanical Dyssynchrony in Patients with Left Bundle Branch Block : an Electro- and Vectorcardiographic Study.” ANNALS OF NONINVASIVE ELECTROCARDIOLOGY 23.4 (2018): n. pag. Print.
APA
De Pooter, Jan, El Haddad, M., Kamoen, V., Kallupurackal, T. T., Stroobandt, R., De Buyzere, M., & Timmermans, F. (2018). Relation between electrical and mechanical dyssynchrony in patients with left bundle branch block : an electro- and vectorcardiographic study. ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, 23(4).
Chicago author-date
De Pooter, Jan, Milad El Haddad, Victor Kamoen, Thomas Tibin Kallupurackal, Roland Stroobandt, Marc De Buyzere, and Frank Timmermans. 2018. “Relation Between Electrical and Mechanical Dyssynchrony in Patients with Left Bundle Branch Block : an Electro- and Vectorcardiographic Study.” Annals of Noninvasive Electrocardiology 23 (4).
Chicago author-date (all authors)
De Pooter, Jan, Milad El Haddad, Victor Kamoen, Thomas Tibin Kallupurackal, Roland Stroobandt, Marc De Buyzere, and Frank Timmermans. 2018. “Relation Between Electrical and Mechanical Dyssynchrony in Patients with Left Bundle Branch Block : an Electro- and Vectorcardiographic Study.” Annals of Noninvasive Electrocardiology 23 (4).
Vancouver
1.
De Pooter J, El Haddad M, Kamoen V, Kallupurackal TT, Stroobandt R, De Buyzere M, et al. Relation between electrical and mechanical dyssynchrony in patients with left bundle branch block : an electro- and vectorcardiographic study. ANNALS OF NONINVASIVE ELECTROCARDIOLOGY. 2018;23(4).
IEEE
[1]
J. De Pooter et al., “Relation between electrical and mechanical dyssynchrony in patients with left bundle branch block : an electro- and vectorcardiographic study,” ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, vol. 23, no. 4, 2018.
@article{8545018,
  abstract     = {Background: Current guidelines select patients for cardiac resynchronization therapy (CRT) mainly on electrocardiographic parameters like QRS duration and left bundle branch block (LBBB). However, among those LBBB patients, heterogeneity in mechanical dyssynchrony occurs and might be a reason for nonresponse to CRT. This study assesses the relation between electrocardiographic characteristics and presence of mechanical dyssynchrony among LBBB patients. 
Methods: The study included patients with true LBBB (including mid-QRS notching) on standard 12-lead electrocardiograms. Left bundle branch block-induced mechanical dyssynchrony was assessed by the presence of septal flash on two-dimensional echocardiography. Previously reported electro- and vectorcardiographic dyssynchrony markers were analyzed: global QRS duration (QRSD(LBBB)), left ventricular activation time (QRSD(LVAT)), time to intrinsicoid deflection (QRSD(ID)), and vectorcardiographic QRS areas in the 3D vector loop (QRSA(3D)). 
Results: The study enrolled 545 LBBB patients. Septal flash (SF) is present in 52% of patients presenting with true LBBB. Patients with SF are more frequent female, have less ischemic heart disease and smaller left ventricular dimensions. In multivariate analysis longer QRSD(LBBB), QRSD(LVAT) and larger QRSA(3D) were independently associated with SF. Of all parameters, QRSA(3D) has the best accuracy to predict SF, although overall accuracy remains moderate (59% sensitivity, 58% specificity). The predictive value of QRSA(3D) remained constant in both sexes, irrespective of ischemic heart disease, ejection fraction and even when categorizing for QRSD(LBBB). 
Conclusion: In LBBB patients, large QRS areas correlate better with mechanical dyssynchrony compared to wide QRSD intervals. However, the overall accuracy to predict mechanical dyssynchrony by electrocardiographic dyssynchrony markers, even when using complex vectorcardiographic parameters, remains low.},
  articleno    = {e12525},
  author       = {De Pooter, Jan and El Haddad, Milad and Kamoen, Victor and Kallupurackal, Thomas Tibin and Stroobandt, Roland and De Buyzere, Marc and Timmermans, Frank},
  issn         = {1082-720X},
  journal      = {ANNALS OF NONINVASIVE ELECTROCARDIOLOGY},
  keywords     = {cardiac resynchronization therapy,dyssynchrony,electrocardiography,vectorcardiography and left bundle branch block,CARDIAC RESYNCHRONIZATION THERAPY,HEART-FAILURE,QRS DURATION,SEPTAL FLASH,VENTRICULAR ACTIVATION,TASK-FORCE,ASSOCIATION,CARDIOLOGY,SOCIETY,CRT},
  language     = {eng},
  number       = {4},
  pages        = {9},
  title        = {Relation between electrical and mechanical dyssynchrony in patients with left bundle branch block : an electro- and vectorcardiographic study},
  url          = {http://dx.doi.org/10.1111/anec.12525},
  volume       = {23},
  year         = {2018},
}

Altmetric
View in Altmetric
Web of Science
Times cited: