Association of QRS Notch Resolution During LV-Only Fusion Pacing With Early Left Ventricular Reverse Remodeling After Cardiac Resynchronization Therapy

IF 1.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia Pub Date : 2026-08-09 DOI:10.1002/joa3.70443

Junji Morita, Yuhei Kasai, Yumetsugu Munakata, Takayuki Kitai, Kei Murakami, Kazunari Mitsuishi, Daisuke Hachinohe, Yusuke Kondo

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引用次数: 0

Abstract

Background

Cardiac resynchronization therapy (CRT) improves outcomes in patients with heart failure and left bundle branch block (LBBB); however, many patients remain non-responders. Identifying effective electrical resynchronization early remains an important clinical need.

Objective

To investigate the association between resolution of V5–V6 R-wave notching/slurring during left ventricular-only pacing (LV-only pacing), combined with an LV-only pacing percentage ≥ 50% at 1 month, and early left ventricular reverse remodeling in patients with complete LBBB (CLBBB) undergoing CRT.

Methods

We retrospectively studied 49 patients with CLBBB who underwent CRT. Patients with resolution of V5–V6 R-wave notching/slurring during LV-only pacing at implantation and an LV-only pacing percentage ≥ 50% at 1 month were classified as the R-Notch Resolution group; all others were classified as the Non–R-Notch Resolution group. The primary endpoint was left ventricular reverse remodeling at 1 month, defined as a ≥ 15% reduction in left ventricular end-systolic volume (LVESV) from baseline. Logistic regression analysis was performed to identify associated factors.

Results

Fifteen patients were classified into the R-Notch Resolution group and 34 into the Non–R-Notch Resolution group. One-month left ventricular reverse remodeling occurred more frequently in the R-Notch Resolution group (80.0% vs. 47.1%). In multivariable logistic regression analysis, R-Notch Resolution group status remained independently associated with 1-month left ventricular reverse remodeling.

Conclusion

Resolution of V5–V6 R-wave notching/slurring during LV-only pacing, combined with an LV-only pacing percentage ≥ 50% at 1 month, was independently associated with early left ventricular reverse remodeling after CRT.

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心脏再同步化治疗后早期左心室反向重构与纯lv融合起搏期间QRS缺口分辨率的关系

背景：心脏再同步化治疗（CRT）改善心力衰竭和左束支传导阻滞（LBBB）患者的预后；然而，许多患者仍然无反应。早期识别有效的电再同步仍然是重要的临床需要。目的：探讨完全性LBBB （CLBBB）患者在接受CRT治疗时，仅左室起搏（LV-only起搏）时V5-V6 r波切陷/模糊的消退，以及1个月时LV-only起搏百分比≥50%与早期左室反向重构的关系。方法：对49例行CRT治疗的CLBBB患者进行回顾性研究。在植入时LV-only起搏期间V5-V6 r波缺口/模糊消退，且1个月时LV-only起搏百分比≥50%的患者被归类为R-Notch消退组；其余均被归类为非r - notch分辨率组。主要终点是1个月时左心室反向重构，定义为左心室收缩末期体积（LVESV）较基线减少≥15%。进行Logistic回归分析以确定相关因素。结果：15例患者分为R-Notch消退组，34例患者分为非R-Notch消退组。1个月左心室反向重构在R-Notch分辨率组发生的频率更高（80.0%比47.1%）。在多变量logistic回归分析中，R-Notch分辨率组状态与1个月左心室逆转重构保持独立相关。结论：单心室起搏期间V5-V6 r波切迹/模糊的消退，以及1个月时单心室起搏百分比≥50%，与CRT后早期左室反向重构独立相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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