Delayed intrinsicoid deflection onset in surface ECG lateral leads predicts left ventricular reverse remodeling after cardiac resynchronization therapy

Freddy Del-Carpio Munoz, Brian D. Powell, Yong-Mei Cha, Heather J. Wiste, Margaret May Redfield, Paul Andrew Friedman, Samuel J Asirvatham

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background Up to one-third of the patients who undergo cardiac resynchronization therapy (CRT) are not responders. Objective To demonstrate that delayed lateral left ventricular activation time determined through time to intrinsicoid deflection onset (ID) predicts response after CRT. Methods The ID in leads I, aVL, V1 and V2, and V5 and V 6 were measured in 135 patients who underwent CRT. A CRT response was defined as a decrease in left ventricular end-systolic volume (LVESV) exceeding 15% at 6 months. Results In patients with left bundle branch block or nonspecific intraventricular conduction delay, response was predicted by longer ID in lead I (odds ratio [OR] 3.23; 95% confidence interval (CI) 1.4-7.4; per 20-ms increase), in lead aVL (OR 3.0; 95% CI 1.2-7.3; per 20-ms increase), and in lead I minus lead V1 (OR 2.4; 95% CI 1.2-4.7) adjusting for baseline QRS duration and LVESV. Results were similar after adjusting for postimplant or change in QRS duration. The ID parameters were better predictors of response than QRS duration parameters. ID in lead I/QRS duration ratio (OR 3.1; 95% CI 1.6-5.9) also increased the odds of response after adjusting for baseline LVESV. Cutoff values for ID in leads - I, 110 ms; aVL, 130 ms; I minus V1, 90 ms - and ID in lead I/QRS duration ratio of 0.69 yielded a sensitivity and a specificity as high as 83% and 81%. Conclusions Measurement of ID on surface electrocardiography permits a preimplant, noninvasive means of determining left ventricle activation delay; is a good predictor of CRT response; and represents a promising alternative to QRS duration parameters.

Original languageEnglish (US)
Pages (from-to)979-987
Number of pages9
JournalHeart Rhythm
Volume10
Issue number7
DOIs
StatePublished - Jul 2013

Fingerprint

Cardiac Resynchronization Therapy
Ventricular Remodeling
Electrocardiography
Odds Ratio
Stroke Volume
Confidence Intervals
Bundle-Branch Block
Heart Ventricles
Lead
Sensitivity and Specificity

Keywords

  • Cardiac resynchronization therapy
  • Cardiac resynchronization therapy response
  • Delayed ventricular activation
  • Electrocardiogram
  • Intrinsicoid deflection onset
  • Left ventricular activation time

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

@article{8a7c84d8b22a4bc8af7c124151d82907,
title = "Delayed intrinsicoid deflection onset in surface ECG lateral leads predicts left ventricular reverse remodeling after cardiac resynchronization therapy",
abstract = "Background Up to one-third of the patients who undergo cardiac resynchronization therapy (CRT) are not responders. Objective To demonstrate that delayed lateral left ventricular activation time determined through time to intrinsicoid deflection onset (ID) predicts response after CRT. Methods The ID in leads I, aVL, V1 and V2, and V5 and V 6 were measured in 135 patients who underwent CRT. A CRT response was defined as a decrease in left ventricular end-systolic volume (LVESV) exceeding 15{\%} at 6 months. Results In patients with left bundle branch block or nonspecific intraventricular conduction delay, response was predicted by longer ID in lead I (odds ratio [OR] 3.23; 95{\%} confidence interval (CI) 1.4-7.4; per 20-ms increase), in lead aVL (OR 3.0; 95{\%} CI 1.2-7.3; per 20-ms increase), and in lead I minus lead V1 (OR 2.4; 95{\%} CI 1.2-4.7) adjusting for baseline QRS duration and LVESV. Results were similar after adjusting for postimplant or change in QRS duration. The ID parameters were better predictors of response than QRS duration parameters. ID in lead I/QRS duration ratio (OR 3.1; 95{\%} CI 1.6-5.9) also increased the odds of response after adjusting for baseline LVESV. Cutoff values for ID in leads - I, 110 ms; aVL, 130 ms; I minus V1, 90 ms - and ID in lead I/QRS duration ratio of 0.69 yielded a sensitivity and a specificity as high as 83{\%} and 81{\%}. Conclusions Measurement of ID on surface electrocardiography permits a preimplant, noninvasive means of determining left ventricle activation delay; is a good predictor of CRT response; and represents a promising alternative to QRS duration parameters.",
keywords = "Cardiac resynchronization therapy, Cardiac resynchronization therapy response, Delayed ventricular activation, Electrocardiogram, Intrinsicoid deflection onset, Left ventricular activation time",
author = "{Del-Carpio Munoz}, Freddy and Powell, {Brian D.} and Yong-Mei Cha and Wiste, {Heather J.} and Redfield, {Margaret May} and Friedman, {Paul Andrew} and Asirvatham, {Samuel J}",
year = "2013",
month = "7",
doi = "10.1016/j.hrthm.2013.03.045",
language = "English (US)",
volume = "10",
pages = "979--987",
journal = "Heart Rhythm",
issn = "1547-5271",
publisher = "Elsevier",
number = "7",

}

TY - JOUR

T1 - Delayed intrinsicoid deflection onset in surface ECG lateral leads predicts left ventricular reverse remodeling after cardiac resynchronization therapy

AU - Del-Carpio Munoz, Freddy

AU - Powell, Brian D.

AU - Cha, Yong-Mei

AU - Wiste, Heather J.

AU - Redfield, Margaret May

AU - Friedman, Paul Andrew

AU - Asirvatham, Samuel J

PY - 2013/7

Y1 - 2013/7

N2 - Background Up to one-third of the patients who undergo cardiac resynchronization therapy (CRT) are not responders. Objective To demonstrate that delayed lateral left ventricular activation time determined through time to intrinsicoid deflection onset (ID) predicts response after CRT. Methods The ID in leads I, aVL, V1 and V2, and V5 and V 6 were measured in 135 patients who underwent CRT. A CRT response was defined as a decrease in left ventricular end-systolic volume (LVESV) exceeding 15% at 6 months. Results In patients with left bundle branch block or nonspecific intraventricular conduction delay, response was predicted by longer ID in lead I (odds ratio [OR] 3.23; 95% confidence interval (CI) 1.4-7.4; per 20-ms increase), in lead aVL (OR 3.0; 95% CI 1.2-7.3; per 20-ms increase), and in lead I minus lead V1 (OR 2.4; 95% CI 1.2-4.7) adjusting for baseline QRS duration and LVESV. Results were similar after adjusting for postimplant or change in QRS duration. The ID parameters were better predictors of response than QRS duration parameters. ID in lead I/QRS duration ratio (OR 3.1; 95% CI 1.6-5.9) also increased the odds of response after adjusting for baseline LVESV. Cutoff values for ID in leads - I, 110 ms; aVL, 130 ms; I minus V1, 90 ms - and ID in lead I/QRS duration ratio of 0.69 yielded a sensitivity and a specificity as high as 83% and 81%. Conclusions Measurement of ID on surface electrocardiography permits a preimplant, noninvasive means of determining left ventricle activation delay; is a good predictor of CRT response; and represents a promising alternative to QRS duration parameters.

AB - Background Up to one-third of the patients who undergo cardiac resynchronization therapy (CRT) are not responders. Objective To demonstrate that delayed lateral left ventricular activation time determined through time to intrinsicoid deflection onset (ID) predicts response after CRT. Methods The ID in leads I, aVL, V1 and V2, and V5 and V 6 were measured in 135 patients who underwent CRT. A CRT response was defined as a decrease in left ventricular end-systolic volume (LVESV) exceeding 15% at 6 months. Results In patients with left bundle branch block or nonspecific intraventricular conduction delay, response was predicted by longer ID in lead I (odds ratio [OR] 3.23; 95% confidence interval (CI) 1.4-7.4; per 20-ms increase), in lead aVL (OR 3.0; 95% CI 1.2-7.3; per 20-ms increase), and in lead I minus lead V1 (OR 2.4; 95% CI 1.2-4.7) adjusting for baseline QRS duration and LVESV. Results were similar after adjusting for postimplant or change in QRS duration. The ID parameters were better predictors of response than QRS duration parameters. ID in lead I/QRS duration ratio (OR 3.1; 95% CI 1.6-5.9) also increased the odds of response after adjusting for baseline LVESV. Cutoff values for ID in leads - I, 110 ms; aVL, 130 ms; I minus V1, 90 ms - and ID in lead I/QRS duration ratio of 0.69 yielded a sensitivity and a specificity as high as 83% and 81%. Conclusions Measurement of ID on surface electrocardiography permits a preimplant, noninvasive means of determining left ventricle activation delay; is a good predictor of CRT response; and represents a promising alternative to QRS duration parameters.

KW - Cardiac resynchronization therapy

KW - Cardiac resynchronization therapy response

KW - Delayed ventricular activation

KW - Electrocardiogram

KW - Intrinsicoid deflection onset

KW - Left ventricular activation time

UR - http://www.scopus.com/inward/record.url?scp=84879482799&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84879482799&partnerID=8YFLogxK

U2 - 10.1016/j.hrthm.2013.03.045

DO - 10.1016/j.hrthm.2013.03.045

M3 - Article

C2 - 23542361

AN - SCOPUS:84879482799

VL - 10

SP - 979

EP - 987

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

IS - 7

ER -