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2015, Number 2

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CorSalud 2015; 7 (2)

QRS dispersion as an index of dyssynchrony in left bundle branch block and of synchrony after cardiac resynchronization therapy: A variable of successful response

Chávez GE, Alonso HA, Carmona PR, Pérez CD, Ramos RRR, Gómez PW, Moreno-Martínez FL

Language: Spanish
References: 51
Page: 106-116
PDF size: 569.29 Kb.


ABSTRACT

Introduction: Left bundle branch block is an important marker of poor prognosis in patients with heart failure. Resynchronization therapy can improve the function of the left ventricle in these cases.
Objective: To describe electrocardiographic variables associated with a better response to cardiac resynchronization.
Method: A total of 19 patients, 7 women and 12 men, with left bundle branch block and ejection fraction ≤ 35% were studied. An electrocardiogram was performed before and after resynchronization therapy, with QRS measurement in the twelve leads and calculation of its dispersion. Maximum QRS voltages were also measured. An echocardiogram was performed before and after the procedure.
Results: The ejection fraction increased from 29.8±4.7 to 41.2±10.7 % (p=0.000). The linear correlation between ejection fraction and QRS dispersion at six months of follow-up was significant (r=0.34 and p=0.02). Women showed a greater QRS dispersion (48.0±24.0 ms vs. 37.14±13.8 ms; p=0.04). QRS voltages were predominantly negative in aVR (-0.52±0.58 vs. 0.28±0.42 mVolt; p=0.032) and positive in V5 (0.71±1.12 vs. -0.15±1.20 mVolt; p=0.023) for responders in relation to non-responders.
Conclusions: QRS dispersion, increased in the electrocardiogram with left bundle branch block and decreased after resynchronization, showed a significant correlation with the ejection fraction. QRS narrowing after resynchronization was significant for responders. The predominantly positive voltages in aVR and negative in V5 could adequately predict which patients will not respond adequately to cardiac resynchronization therapy.


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