Electrocardiographic versus echocardiographic optimization of the interventricular pacing delay in patients undergoing cardiac resynchronization therapy

J Cardiovasc Electrophysiol. 2011 Oct;22(10):1129-34. doi: 10.1111/j.1540-8167.2011.02085.x. Epub 2011 Jun 2.

Abstract

Introduction: Echocardiographic optimization of the VV interval may improve CRT response, but it is time-consuming and not routinely performed. The aim of this study was to compare the response to cardiac resynchronization therapy (CRT) when the interventricular pacing (VV) interval was optimized by tissue Doppler imaging (TDI) to CRT response when it was optimized following QRS width criteria.

Methods and results: The study included 156 consecutive CRT patients with severe heart failure and left bundle-branch block configuration. Atrioventricular interval was selected according to a pulsed Doppler assessment, and VV optimization was randomly assigned to echocardiography (ECHO group, n = 78) or electrocardiography (ECG group, n = 78). Optimal VV was defined for the ECHO group as producing the best LV intraventricular synchrony according to TDI displacement curves and for the ECG group as resulting in the narrowest QRS measured from the earliest deflection. At 6-month follow-up, percentage of echocardiographic responders (defined as neither death nor heart transplantation and a LV end-systolic volume reduction >10%) was higher in the ECG optimized group (50.0% vs 67.9%; P = 0.023), whereas clinical response (defined as neither death nor heart transplantation and >10% improvement in the 6-minute walking test) was similar in both groups (71.8% vs 73.1%; P = 0.858).

Conclusions: VV optimization based on QRS width obtained a higher percentage of responders in terms of LV reverse remodeling compared to the TDI method.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bundle-Branch Block / diagnostic imaging
  • Bundle-Branch Block / physiopathology
  • Bundle-Branch Block / therapy*
  • Cardiac Resynchronization Therapy*
  • Chi-Square Distribution
  • Echocardiography, Doppler, Pulsed*
  • Electrocardiography*
  • Exercise Test
  • Exercise Tolerance
  • Heart Failure / diagnostic imaging
  • Heart Failure / physiopathology
  • Heart Failure / therapy*
  • Humans
  • Logistic Models
  • Predictive Value of Tests
  • Prospective Studies
  • Recovery of Function
  • Spain
  • Time Factors
  • Treatment Outcome
  • Ventricular Function, Left
  • Ventricular Remodeling
  • Walking