Value of Fragmented QRS in Predicting Prognosis of Patients after Cardiac Resynchronization Therapy

Huang SUN; Wei LUO; Mi-er MA; Hui-kai MU; Lei ZHONG; Xue-juan MA; Yun-zhu PENG; Rui-jie LI

doi:10.12259/j.issn.2095-610X.S20201111

Volume 41 Issue 11

Dec. 2020

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Huang SUN, Wei LUO, Mi-er MA, Hui-kai MU, Lei ZHONG, Xue-juan MA, Yun-zhu PENG, Rui-jie LI. Value of Fragmented QRS in Predicting Prognosis of Patients after Cardiac Resynchronization Therapy[J]. Journal of Kunming Medical University, 2020, 41(11): 38-43. doi: 10.12259/j.issn.2095-610X.S20201111

Citation:

Huang SUN, Wei LUO, Mi-er MA, Hui-kai MU, Lei ZHONG, Xue-juan MA, Yun-zhu PENG, Rui-jie LI. Value of Fragmented QRS in Predicting Prognosis of Patients after Cardiac Resynchronization Therapy[J]. Journal of Kunming Medical University, 2020, 41(11): 38-43. doi: 10.12259/j.issn.2095-610X.S20201111

Citation:

Huang SUN, Wei LUO, Mi-er MA, Hui-kai MU, Lei ZHONG, Xue-juan MA, Yun-zhu PENG, Rui-jie LI. Value of Fragmented QRS in Predicting Prognosis of Patients after Cardiac Resynchronization Therapy[J]. Journal of Kunming Medical University, 2020, 41(11): 38-43. doi: 10.12259/j.issn.2095-610X.S20201111

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Value of Fragmented QRS in Predicting Prognosis of Patients after Cardiac Resynchronization Therapy

doi: 10.12259/j.issn.2095-610X.S20201111

1.
Dept. of Cardiology，The 1st Affiliated Hospital of Kunming Medical University，Kunming Yunnan 650032
2.
Dept. of Echocardiography，Yan’an Hospital of Kunming，Kunming Yunnan 650051，China

Received Date: 2020-08-23
Publish Date: 2020-11-25

Abstract

Abstract

Objestive To investigate the association between characteristics of Fragmented QRS（fQRS）before and after CRT implantation and response to CRT. Methods Patients with heart failure planned for CRT were enrolled. The 12-lead ECGs before and after CRT were analyzed. The presence of fQRs was confirmed according to the definition in previous studies. Echocardiography imagines were obtained before and 6 months after the CRT implantation. Results The study included 108 patients（78 male, 72.2%）with a mean age of 56.5 ± 11.9 years. Totally 75 patients（69.4%）responded to CRT with significantly increased mean LVEF（from 30.71±1.92 to 50.61±2.57, P < 0.001）and decreased LVESV（from 195.26±78.79 to 156.55±84.44, P < 0.001）. After CRT implantation, the number of leads with fQRS remained unchanged in responders（6.25±2.68 vs. 6.03±2.54, P= 0.57 before and after CRT respectively）but increased in non-responders（6.18±2.20 vs.7.36±2.61, P = 0.013 before and after CRT respectively）. In the multivariate logistic analysis, a decreased number of leads with fQRS and shortened QRS duration immediately after CRT implantation was found to be a predictor of response to CRT. Conclusions In patients undergoing CRT, new fQRS as well as an increased number of leads with fQRS in 12-lead ECG immediately after CRT implantation predicts non-response to CRT and may help in the decision making in heart failure patients.
- Cardiac resynchronization therapy,
- Fragmented QRS,
- Non-response

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References(24)

References

[1]	Normand C, Linde C, Singh J, Dickstein K. Indications for Cardiac Resynchronization Therapy: A Comparison of the Major International Guidelines. JACC Heart Fail 2018; 6（4）: 308-316. doi: 10.1016/j.jchf.2018.01.022
[2]	Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology（ESC）. Developed with the special contribution of the Heart Failure Association（HFA）of the ESC. Eur J Heart Fail 2016; 18（8）: 891-975. doi: 10.1002/ejhf.592
[3]	Leclercq C, Burri H, Curnis A, et al. Cardiac resynchronization therapy non-responder to responder conversion rate in the more response to cardiac resynchronization therapy with MultiPoint Pacing（MORE-CRT MPP）study: results from Phase I. Eur Heart J 2019; 40（35）: 2979-2987. doi: 10.1093/eurheartj/ehz109
[4]	Sohaib SM, Chen Z, Whinnett ZI, et al. Meta-analysis of symptomatic response attributable to the pacing component of cardiac resynchronization therapy. Eur J Heart Fail 2013; 15（12）: 1419-1428. doi: 10.1093/eurjhf/hft139
[5]	Daubert C, Behar N, Martins RP, Mabo P, Leclercq C. Avoiding non-responders to cardiac resynchronization therapy: a practical guide. Eur Heart J 2017; 38（19）: 1463-1472.
[6]	Das MK, Suradi H, Maskoun W, et al. Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis. Circ Arrhythm Electrophysiol 2008; 1（4）: 258-68. doi: 10.1161/CIRCEP.107.763284
[7]	Das MK. Can fragmented QRS help in risk-stratifying patients with coronary artery disease and a relatively preserved ejection fraction? Heart Rhythm 2012; 9（6）: 936-937. doi: 10.1016/j.hrthm.2012.01.017
[8]	Chanavuth K, Pattara R, Poemlarp M, et al. Baseline fragmented QRS is associated with increased all-cause mortality in heart failure with reduced ejection fraction: A systematic review and meta-analysis[J]. Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc 2019; 24(2): e12597. doi: 10.1111/jce.13139
[9]	Igarashi M, Tada H, Yamasaki H, et al. Fragmented QRS Is a Novel Risk Factor for Ventricular Arrhythmic Events After Receiving Cardiac Resynchronization Therapy in Nonischemic Cardiomyopathy[J]. J Cardiovasc Electrophysiol 2017; 28(3): 327-335. doi: 10.1111/anec.12186
[10]	Chanavuth K, Pattara R, Poemlarp M, et al. Baseline fragmented QRS is associated with increased all-cause mortality in heart failure with reduced ejection fraction: A systematic review and meta-analysis. Annals of noninvasive electrocardiology: the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc 2019; 24（2）: e12597. doi: 10.1111/anec.12597
[11]	Das MK, El Masry H. Fragmented QRS and other depolarization abnormalities as a predictor of mortality and sudden cardiac death. Curr Opin Cardiol 2010; 25（1）: 59-64. doi: 10.1097/HCO.0b013e328333d35d
[12]	Chung ES, Leon AR, Tavazzi L, et al. Results of the Predictors of Response to CRT (PROSPECT) trial. Circulation 2008; 117(20): 2608-2616. doi: 10.1161/CIRCULATIONAHA.107.743120
[13]	A NS, A RC. Is CRT response rate all about patient selection? International journal of cardiology 2018; 270: 183-184. doi: 10.1016/j.ijcard.2018.06.079
[14]	Rickard J, Michtalik H, Sharma R, et al. Predictors of response to cardiac resynchronization therapy: A systematic review. Int J Cardiol 2016; 225: 345-352. doi: 10.1016/j.ijcard.2016.09.078
[15]	Lawin D, Stellbrink C. Change in indication for cardiac resynchronization therapy? Eur J Cardiothorac Surg 2019; 55（Suppl 1）: i11-i6.
[16]	Vernooy K, van Deursen CJ, Strik M, Prinzen FW. Strategies to improve cardiac resynchronization therapy. Nat Rev Cardiol 2014; 11（8）: 481-493. doi: 10.1038/nrcardio.2014.67
[17]	Chew DS, Wilton SB, Kavanagh K, et al. Fragmented QRS complexes after acute myocardial infarction are independently associated with unfavorable left ventricular remodeling. J Electrocardiol 2018; 51（4）: 607-612. doi: 10.1016/j.jelectrocard.2018.04.004
[18]	Amir A, Amir T, Zahra E. Diffuse fragmented QRS as an index of extensive myocardial scar. Indian pacing and electrophysiology journal 2010; 10（1）: 67-68.
[19]	Mohamed H, Lamaan A, Bilal S, Jo M, K DM. Fragmented QRS complexes on 12-lead ECG: a marker of cardiac sarcoidosis as detected by gadolinium cardiac magnetic resonance imaging. Annals of noninvasive electrocardiology: the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc 2009; 14（4）: 319-326. doi: 10.1111/j.1542-474X.2009.00320.x
[20]	Luc L, Alexandre C, Olivier C, et al. Relationship between fragmented QRS and no-reflow, infarct size, and peri-infarct zone assessed using cardiac magnetic resonance in patients with myocardial infarction. The Canadian journal of cardiology 2014; 30（2）: 204-210. doi: 10.1016/j.cjca.2013.11.026
[21]	Das MK, Maskoun W, Shen C, et al. Fragmented QRS on twelve-lead electrocardiogram predicts arrhythmic events in patients with ischemic and nonischemic cardiomyopathy. Heart Rhythm 2010; 7（1）: 74-80. doi: 10.1016/j.hrthm.2009.09.065
[22]	Diaz-Infante E, Mont L, Leal J, et al. Predictors of lack of response to resynchronization therapy. Am J Cardiol 2005; 95（12）: 1436-1440. doi: 10.1016/j.amjcard.2005.02.009
[23]	Rickard J, Zardkoohi O, Popovic Z, et al. QRS fragmentation is not associated with poor response to cardiac resynchronization therapy[J]. Ann Noninvasive Electrocardiol 2011; 16(2): 165-171. doi: 10.1111/j.1542-474X.2011.00424.x
[24]	Hu YR, Hua W, Yang SW, et al. Predictors of non-response to cardiac resynchronization therapy implantation in patients with class I indications: the markedly dilated left ventricular end-diastolic dimension and the presence of fragmented QRS. J Geriatr Cardiol 2019; 16（7）: 514-521.

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