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Cardiovascular disease (CVD) continues to be the primary cause of mortality and morbidity globally with middle-aged women presenting with additional and possibly, overlooked risk factors.1 Despite several awareness programmes, there remain several gaps in the political education and representation needs of this group, which includes those from low socioeconomic status (SES) and culturally diverse backgrounds. These […]

100/Vectorcardiographic direction of ventricular activation as a predictor of long-term outcomes after cardiac resynchronisation therapy

O Okafor (Presenting Author) - Aston University, Birmingham, UK; PM van Dam - University Medical Centre, Utrecht, The Netherlands; A Zegard - Aston University, Birmingham, UK; B Stegemann - Aston University, Birmingham, UK; T Qiu - Queen Elizabeth Hospital, Birmingham, UK; H Marshall - Queen Elizabeth Hospital, Birmingham, UK; F Leyva - Aston University, Birmingham, UK
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Published Online: Oct 3rd 2008 European Journal of Arrhythmia & Electrophysiology. 2019;5(Suppl. 1):abstr100
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Article

Background: Predicting clinical outcomes after cardiac resynchronisation therapy (CRT) remains a challenge. Although QRS duration is crucial as an indication for CRT, it is a poor predictor of clinical outcomes.
Objectives: To determine whether the direction of ventricular activation, measured using the ratio of the temporospatial isochrone to QRS duration (TSIQRSd) on vectorcardiography (VCG) predicts clinical outcomes
after CRT.
Methods: In this retrospective study, TSIQRSd, QRS area, QRS duration (QRSd) and QRS morphology (LBBB), derived from pre-implantation ECGs, were assessed in relation to the primary endpoint of cardiac mortality
after CRT.
Results: In patients (n=720, age 72.8 ± 11.8 years, 71.3% male) undergoing CRT over 7.7 years (median follow-up period of 3.7 [interquartile range 2.3–5.1] years), TSIQRSd <92% predicted cardiac mortality (adjusted hazard
ratio [aHR]: 2.21, 95% CI 1.54–3.17; p<0.001), independent of known confounders. When considered together with QRSd, LBBB and QRS area, TSIQRSd <92% was the only predictor of cardiac mortality (aHR: 2.22, 95% CI 1.55–3.18; c-statistics: 0.59, 0.57, 0.63 and 0.68, respectively). A TSIQRSd < 92% predicted cardiac mortality in the strata of QRSd (< or ≥150 ms) and QRS morphology (LBBB or non-LBBB) (all p<0.0001). Both TSIQRSd <92% and a QRS area <102 ms also predicted total mortality or heart failure hospitalisation, and total mortality or major adverse cardiac events (all p<0.001)
Conclusions: Vectorcardiographic TSIQRSd is superior to QRS area, QRSd and QRS morphology in predicting cardiac mortality after CRT. These findings support the use of pre-implantation VCG in predicting clinical outcomes after CRT.

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