Work

P998Paced QRS duration predicts the optimal LV endocardial pacing site; results from a multi-centre registry

Year: 2017

Type: article

Abstract: Funding Acknowledgements: Dr Betts is supported by the Oxford Biomedical Research Centre Background: Biventricular endocardial (BIV ENDO) pacing may give superior acute hemodynamic response (AHR) over standard CRT. The optimal site for left ventricular endocardial (LV ENDO) endo stimulation varies between patients. We assessed the correlation between the paced QRS duration and AHR with LV endocardial pacing to predict the optimal LV ENDO site. Objective: We evaluating the relationship between the change in paced QRS duration (QRSd) and change in AHR at differing LV ENDO pacing locations during BIV ENDO pacing. Methods: LV endo acute pacing studies from five international centres were included: Johns Hopkins- USA, Bordeaux- France, Leiden- The Netherlands, Oxford- United Kingdom and King’s College London- United Kingdom. A modified 9 segment version of the AHA 17 segment circumferential polar plot was used. Results: 75 patients had data correlating change in QRS duration to AHR at varying LV endocardial pacing locations, incorporating 574 LV ENDO positions. The paced QRSd was significantly shorter at the optimal location than in the least favourable location (166.2ms vs 205.8ms, p<0.01). Endocardial pacing in a position which resulted in a narrower paced QRSd correlated with greater improvements in AHR, although this trend failed to achieve statistical significance (p=0.109), see Figure 1. Conclusions: Paced QRS duration is significantly shorter at the optimal hemodynamic site of LV endocardial pacing compared to the worst hemodynamic site. The lack of a strong correlation between AHR and QRS suggests that paced QRS duration alone may not always predict favourable hemodynamic sites for LV endocardial pacing. Abstract P998 Figure. Change in QRSd vs change in AHR

Source: EP Europace

DOI: 10.1093/ehjci/eux151.179