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

Published Online: October 3rd 2008 European Journal of Arrhythmia & Electrophysiology. 2019;5(Suppl. 1):abstr100
Authors: 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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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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European Journal of Arrhythmia & Electrophysiology. 2021;7(Suppl. 1):abstr43

Introduction: Cardiac tamponade is a high morbidity complication of transseptal puncture (TSP). We examined the incidence and predictors of TSP-related cardiac tamponade (TRCT) for all patients undergoing left atrial ablation at our centre from 2016-2020. Methods: Patient and procedural variables were extracted retrospectively. Cases of cardiac tamponade were scrutinised to adjudicate TSP culpability. Adjusted multivariate […]

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