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Updated: Aug 12, 2026
Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Association of QRS Notch Resolution During LV-Only Fusion Pacing With Early Left Ventricular Reverse Remodeling After
Junji Morita1, Yuhei Kasai1, Yumetsugu Munakata2
1Department of Cardiology Sapporo Cardiovascular Clinic Sapporo Hokkaido Japan.
Background:
Cardiac resynchronization therapy (CRT) improves outcomes in patients with heart failure and left bundle branch block (LBBB); however, many patients remain non-responders. Identifying effective electrical resynchronization early remains an important clinical need.
Objective:
To investigate the association between resolution of V5-V6 R-wave notching/slurring during left ventricular-only pacing (LV-only pacing), combined with an LV-only pacing percentage ≥ 50% at 1 month, and early left ventricular reverse remodeling in patients with complete LBBB (CLBBB) undergoing CRT.
Methods:
We retrospectively studied 49 patients with CLBBB who underwent CRT. Patients with resolution of V5-V6 R-wave notching/slurring during LV-only pacing at implantation and an LV-only pacing percentage ≥ 50% at 1 month were classified as the R-Notch Resolution group; all others were classified as the Non-R-Notch Resolution group. The primary endpoint was left ventricular reverse remodeling at 1 month, defined as a ≥ 15% reduction in left ventricular end-systolic volume (LVESV) from baseline. Logistic regression analysis was performed to identify associated factors.
Results:
Fifteen patients were classified into the R-Notch Resolution group and 34 into the Non-R-Notch Resolution group. One-month left ventricular reverse remodeling occurred more frequently in the R-Notch Resolution group (80.0% vs. 47.1%). In multivariable logistic regression analysis, R-Notch Resolution group status remained independently associated with 1-month left ventricular reverse remodeling.
Conclusion:
Resolution of V5-V6 R-wave notching/slurring during LV-only pacing, combined with an LV-only pacing percentage ≥ 50% at 1 month, was independently associated with early left ventricular reverse remodeling after CRT.
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