Lead one ratio in left bundle branch block predicts poor cardiac resynchronization therapy response.

Journal Article (Journal Article)

BACKGROUND: A low electrocardiogram (ECG) lead one ratio (LOR) of the maximum positive/negative QRS amplitudes is associated with lower left ventricular ejection fraction (LVEF) and worse outcomes in left bundle branch block (LBBB); however, the impact of LOR on cardiac resynchronization therapy (CRT) outcomes is unknown. We compared clinical outcomes and echocardiographic changes after CRT implantation by LOR. METHODS: Consecutive CRT-defibrillator recipients with LBBB implanted between 2006 and 2015 at Duke University Medical Center were included (N = 496). Time to heart transplant, left ventricular assist device (LVAD) implantation, or death was compared among patients with LOR <12 vs ≥12 using Cox-proportional hazard models. Changes in LVEF and LV volumes after CRT were compared by LOR. RESULTS: Baseline ECG LOR <12 was associated with an adjusted hazard ratio (HR) of 1.69 (95% CI: 1.12-2.40, P = .01) for heart transplant, LVAD, or death. Patients with LOR <12 had less reduction of LV end diastolic volume (ΔLVEDV -4 ± 21 vs -13 ± 23%, P = .04) and LV end systolic volume (ΔLVESV -9 ± 27 vs -22 ± 26%, P = .03) after CRT. In patients with QRS duration (QRSd) ≥150 ms, LOR <12 was associated with an adjusted HR of 2.01 (95% CI 1.21-3.35, P = .008) for heart transplant, LVAD, or death, compared with LOR ≥12. CONCLUSIONS: Baseline ECG LOR <12 portends worse outcomes after CRT implantation in patients with LBBB, specifically among those with QRSd ≥150 ms. This ECG ratio may identify patients with a class I indication for CRT implantation at high risk for poor postimplantation outcomes.

Full Text

Duke Authors

Cited Authors

  • Loring, Z; Friedman, DJ; Emerek, K; Graff, C; Sørensen, PL; Hansen, SM; Wieslander, B; Ugander, M; Søgaard, P; Atwater, BD

Published Date

  • May 2020

Published In

Volume / Issue

  • 43 / 5

Start / End Page

  • 503 - 510

PubMed ID

  • 32285950

Pubmed Central ID

  • PMC7324940

Electronic International Standard Serial Number (EISSN)

  • 1540-8159

Digital Object Identifier (DOI)

  • 10.1111/pace.13916


  • eng

Conference Location

  • United States