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      Narrowing filtered QRS duration on signal‐averaged electrocardiogram predicts outcomes in cardiac resynchronization therapy patients with nonischemic heart failure

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          Abstract

          Background

          To evaluate the impact of changes in the filtered QRS duration ( fQRS) on signal‐averaged electrocardiograms ( SAECGs) from pre‐ to postimplantation on the clinical outcomes in nonischemic heart failure ( HF) patients under cardiac resynchronization therapy ( CRT).

          Methods

          We studied 103 patients with nonischemic HF and sinus rhythm who underwent CRT implantation. SAECGs were obtained within 1 week before and 1 week after implantation and narrowing fQRS was defined as a decrease in fQRS from pre‐ to postimplantation. Echocardiography was performed before and 6 months after CRT implantation. The primary outcome was death from any cause. The secondary outcomes were hospitalization due to worsened HF and occurrence of ventricular tachyarrhythmias.

          Results

          Of the 103 CRT patients, 53 (51%) showed narrowing fQRS. Left ventricular end‐diastolic volume and end‐systolic volume were significantly reduced (both < .001), and the left ventricular ejection fraction was significantly increased ( < .001) after CRT in patients with narrowing fQRS, but not in patients with nonnarrowing fQRS. During a median follow‐up period of 33 months, patients with narrowing fQRS exhibited better survival than patients with nonnarrowing fQRS ( p = .007). A lower incidence of hospitalization due to worsened HF ( < .001) and a lower occurrence of ventricular tachyarrhythmias ( = .071) were obtained in patients with narrowing fQRS. After adjusting for confounding variables, narrowing fQRS was associated with a low risk of mortality ( HR 0.27, = .006).

          Conclusion

          Our results suggested that narrowing fQRS on SAECG after CRT implantation predicts LV reverse remodeling and long‐term outcomes in nonischemic HF patients.

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          Author and article information

          Contributors
          mshiga@hij.twmu.ac.jp
          Journal
          Ann Noninvasive Electrocardiol
          Ann Noninvasive Electrocardiol
          10.1111/(ISSN)1542-474X
          ANEC
          Annals of Noninvasive Electrocardiology : The Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc
          John Wiley and Sons Inc. (Hoboken )
          1082-720X
          1542-474X
          30 November 2017
          May 2018
          : 23
          : 3 ( doiID: 10.1111/anec.2018.23.issue-3 )
          : e12523
          Affiliations
          [ 1 ] Department of Cardiology Tokyo Women's Medical University Tokyo Japan
          [ 2 ] Clinical Research Division for Heart Rhythm Management Tokyo Women's Medical University Tokyo Japan
          Author notes
          [*] [* ] Correspondence

          Tsuyoshi Shiga, MD, Department of Cardiology, Tokyo Women's Medical University, Shinjuku‐ku, Tokyo, Japan.

          Email: mshiga@ 123456hij.twmu.ac.jp

          Author information
          http://orcid.org/0000-0003-0358-7196
          Article
          PMC6931640 PMC6931640 6931640 ANEC12523
          10.1111/anec.12523
          6931640
          29194868
          db3a39b9-1620-4811-970f-9d71b0242bbc
          © 2017 Wiley Periodicals, Inc.
          History
          : 12 August 2017
          : 17 October 2017
          Page count
          Figures: 3, Tables: 4, Pages: 9, Words: 6183
          Funding
          Funded by: Health and Labour Sciences Research
          Award ID: H25‐Junkankito (Seishuu‐Ippan‐018)
          Categories
          Original Article
          Original Articles
          Custom metadata
          2.0
          May 2018
          Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.3 mode:remove_FC converted:19.12.2019

          mortality,cardiac resynchronization therapy,signal‐averaged electrocardiogram,ventricular arrhythmias, QRS duration,heart failure

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