Reliability of QRS duration and morphology on surface electrocardiogram to identify ventricular dyssynchrony in patients with idiopathic dilated cardiomyopathy

doi:10.1016/S0002-9149(03)00644-1

The American Journal of Cardiology

Volume 92, Issue 3, 1 August 2003, Pages 341-344

https://doi.org/10.1016/S0002-9149(03)00644-1 Get rights and content

Abstract

Using Fourier phase analysis of equilibrium radionuclide angiography in both ventricles, inter- and intraventricular delays were correlated with QRS morphology and duration in 103 patients with idiopathic dilated cardiomyopathy. We found that left bundle branch block on the left axis may reflect a high intra-left ventricular dyssynchrony. A precise evaluation of the dyssynchrony appears useful because a high proportion of patients with incomplete bundle branch block, left anterior hemiblock, or “normal” QRS exhibit a marked intra-LV dyssynchrony and may respond to cardiac resynchronization therapy.

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This reflects the poor predictive capability of current approaches to identify potential responders to CRT. The QRS duration (QRS ≥150 ms), widely used in clinical trials as a basic component of the inclusion criteria for CRT, does not provide an indication of the degree of mechanical dyssynchrony (Fauchier et al., 2003). Indeed, patients with long QRS duration may not exhibit mechanical dyssynchrony and those with short QRS complexes may present with significant dyssynchrony in contraction (Auricchio et al., 1999; Fauchier et al., 2002; Pitzalis et al., 2002).
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Another study measuring QRS duration electronically with software found a weak correlation between QRS duration and delay between opposing myocardial walls by tissue synchronization imaging.12 Fauchier et al27 examined QRS duration using the caliper method and ventricular dyssynchrony by equilibrium radionuclide-gated blood pool angiography and revealed that QRS duration was significantly correlated with interventricular and intraventricular dyssynchrony, with a correlation coefficient of around 0.55. Similar results were reported by Haghjoo et al10 using TDI.
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Reliability of QRS duration and morphology on surface electrocardiogram to identify ventricular dyssynchrony in patients with idiopathic dilated cardiomyopathy

Abstract

J Am Coll Cardiol

J Am Coll Cardiol

Int J Cardiol

Am J Cardiol

J Am Coll Cardiol