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Background <p>PR-interval reflects atrioventricular timing but does not well characterize adverse hemodynamics. Novel ECG parameters of conduction may identify benefit from non-dyssynchronous ventricular pacing to correct long atrioventricular conduction delays.</p> Objective <p>Evaluating novel ECG parameters to identify risk of heart failure (HF)/death and benefit vs harm by CRT-D in MADIT-CRT non-LBBB patients.</p> Methods <p>We analyzed intervals from ECGs in 535 non-LBBB patients enrolled in MADIT-CRT, using ImageJ. Onset of atrial activation, P wave zero crossing in V1, latest P offset, earliest QRS onset, and time to the first R peak in V1 and V6 were determined. Endpoints included HF or death. Associations between novel conduction measures and clinical outcomes in ICD patients (<i>n</i> = 209), and CRT-D (<i>n</i> = 326) vs. ICD benefit, were assessed using Kaplan–Meier and multivariable Cox regression analyses.</p> Results <p>We identified the delay from P zero crossing to the first R peak in V1 (P0PV1) at quintile 5 as the strongest risk predictor in ICD patients (<i>n</i> = 159, 30%), over PR-interval, for all endpoints (<i>p</i> &lt; 0.001), with a more than threefold risk increase. In this group, CRT-D was associated with a 66% lower risk of HF/Death (95% CI: 0.22–0.68, <i>p</i> = 0.001) vs. an ICD. However, in patients with a P0PV1 &lt; 201&#xa0;ms, CRT-D vs. an ICD was associated with a 64% increased risk of HF/death (95% CI: 1.12–2.55, <i>p</i> = 0.012), with significant bidirectional interaction (<i>p</i>-value &lt; 0.001).</p> Conclusions <p>We propose a novel variable, P0PV1, to identify risk and benefit vs. harm from CRT-D in HF patients with non-LBBB. Prospective studies are warranted to confirm our findings.</p> Graphical Abstract <p></p>

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A novel measure of AV-conduction predicts clinical outcomes and benefit from CRT-D in non-LBBB patients with wide QRS and a low left ventricular ejection fraction

  • 期刊论文

  • 发表日期：

    2025年8月20日

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  • Anika Sophie Beierle,
  • Wojciech Zareba,
  • Richard E. Auge,
  • Spencer Z. Rosero,
  • Scott McNitt,
  • Fabian Knebel,
  • Martin A. Stockburger,
  • Valentina Kutyifa

摘要

Background

PR-interval reflects atrioventricular timing but does not well characterize adverse hemodynamics. Novel ECG parameters of conduction may identify benefit from non-dyssynchronous ventricular pacing to correct long atrioventricular conduction delays.

Objective

Evaluating novel ECG parameters to identify risk of heart failure (HF)/death and benefit vs harm by CRT-D in MADIT-CRT non-LBBB patients.

Methods

We analyzed intervals from ECGs in 535 non-LBBB patients enrolled in MADIT-CRT, using ImageJ. Onset of atrial activation, P wave zero crossing in V1, latest P offset, earliest QRS onset, and time to the first R peak in V1 and V6 were determined. Endpoints included HF or death. Associations between novel conduction measures and clinical outcomes in ICD patients (n = 209), and CRT-D (n = 326) vs. ICD benefit, were assessed using Kaplan–Meier and multivariable Cox regression analyses.

Results

We identified the delay from P zero crossing to the first R peak in V1 (P0PV1) at quintile 5 as the strongest risk predictor in ICD patients (n = 159, 30%), over PR-interval, for all endpoints (p < 0.001), with a more than threefold risk increase. In this group, CRT-D was associated with a 66% lower risk of HF/Death (95% CI: 0.22–0.68, p = 0.001) vs. an ICD. However, in patients with a P0PV1 < 201 ms, CRT-D vs. an ICD was associated with a 64% increased risk of HF/death (95% CI: 1.12–2.55, p = 0.012), with significant bidirectional interaction (p-value < 0.001).

Conclusions

We propose a novel variable, P0PV1, to identify risk and benefit vs. harm from CRT-D in HF patients with non-LBBB. Prospective studies are warranted to confirm our findings.

Graphical Abstract