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Related Experiment Video

Updated: May 3, 2026

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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QRS fusion complex analysis using wave interference to predict reverse remodeling during cardiac resynchronization

Michael O Sweeney1, Anne S Hellkamp1, Rutger J van Bommel2

  • 1Brigham and Women's Hospital, Boston, Massachusetts.

Heart Rhythm
|January 28, 2014
PubMed
Summary
This summary is machine-generated.

Simple electrocardiogram (ECG) analysis can predict left ventricular (LV) reverse remodeling in cardiac resynchronization therapy (CRT) patients. Specific QRS complex patterns and electrical asynchrony effectively identify patients likely to benefit from CRT.

Keywords:
Bundle branch blockCardiac resynchronization therapyHeart failurePacingWaves

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Imaging

Background:

  • Biventricular (BV) electrical wavefront fusion during cardiac resynchronization therapy (CRT) improves left ventricular (LV) function.
  • Changes in BV wave propagation are reflected in the QRS complex on the electrocardiogram (ECG).
  • A novel wave interference method was developed to characterize BV fusion and predict LV reverse remodeling.

Purpose of the Study:

  • To create a straightforward ECG-based method for predicting reverse remodeling in CRT patients.
  • To identify specific QRS complex features that correlate with positive remodeling outcomes.

Main Methods:

  • Analysis of QRS complexes in 375 patients with heart failure undergoing CRT, including those with left bundle branch block (LBBB).
  • Quantification of CRT-induced changes in ventricular activation (QRS fusion contour) and electrical asynchrony (QRS difference).
  • Assessment of LBBB substrate using LV activation time and QRS score for LV scar.

Main Results:

  • Two BV fusion patterns (QRS normalization in V1-V2 or new/increased R wave in V1-V2) predicted remodeling.
  • A QRS difference ≤ -25 ms and good substrate (low QRS score, LV activation time ≥110 ms) were significant predictors.
  • High remodeling rates (97%) were observed with optimal BV QRS fusion and reduced electrical asynchrony, versus 40% for poor substrate and absent BV fusion.

Conclusions:

  • Simple QRS complex attributes assessed before and after CRT are effective predictors of LV reverse remodeling.
  • This ECG-based approach offers a practical tool for patient selection and outcome prediction in CRT.