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Electrical remodelling post cardiac resynchronization therapy in patients with ischemic and non-ischemic heart

Chukwudiebube N Ajaero1, Anand Ganesan2, John D Horowitz3

  • 1The Queen Elizabeth Hospital, 28 Woodville road, Woodville South 5011, South Australia, Australia.

Journal of Electrocardiology
|January 8, 2019
PubMed

Insights

Cardiac resynchronization therapy (CRT) improves heart failure by reducing electrical abnormalities, particularly in non-ischemic patients. These electrical changes correlate with functional and symptomatic benefits.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Cardiac resynchronization therapy (CRT) benefits in heart failure are often attributed to mechanical improvements.
  • The role of electrical remodeling in CRT efficacy remains less understood.

Purpose of the Study:

  • To evaluate the impact of electrical remodeling on CRT outcomes in heart failure patients.
  • To compare the effects of CRT on electrical remodeling between ischemic and non-ischemic etiologies.

Main Methods:

  • Prospective recruitment of 33 heart failure patients (17 ischemic, 16 non-ischemic) indicated for CRT.
  • Measurement of functional parameters (VO2max, QOL score) and electrical remodeling markers (iQRSD, LVp-RVegm) at baseline and 6 months post-CRT.

Main Results:

  • Reduction in LVp-RVegm correlated with improved VO2max; reduced iQRSD correlated with improved QOL.
  • Electrical remodeling changes (LVp-RVegm, iQRSD) were more pronounced in non-ischemic cardiomyopathy (NICM) than ischemic cardiomyopathy (ICM) patients.
  • Non-ischemic etiology was a significant determinant of reduced iQRSD on multivariate analysis.

Conclusions:

  • CRT can induce beneficial electrical remodeling, specifically reduced LVp-RVegm and iQRSD.
  • These electrical improvements are more significant in NICM patients compared to ICM patients.
  • The degree of electrical remodeling is associated with functional and symptomatic improvements in CRT efficacy.
Abstract

Keywords:
Cardiac resynchronization therapyCardiopulmonary exercise testingElectrical remodellingIntracardiac conduction timeIntracardiac electrocardiogramIntrinsic QRS duration

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