Prediction of response to cardiac resynchronization therapy using electrocardiographic criteria: A systematic review.

BACKGROUND

Cardiac resynchronization therapy (CRT) is an established therapeutic option for heart failure, but despite careful selection around 30% of the patients still do not respond to this therapy. The standard electrocardiogram (ECG) is a practical and inexpensive tool to assess potential responders to CRT but with conflicting evidence regarding the value of different ECG parameters. As such, we conducted a systematic review of real-world studies to assess the value of pre-implantation standard ECG parameters in predicting response to CRT.

METHODS

We searched on PubMed, Scopus, and Web of Knowledge online databases to identify analytic studies and synthesized results through evidence tables.

RESULTS

Sixty-two eligible articles were included in this review. Traditional predictors of response were QRS duration ≥150 ms and the presence of left bundle branch block morphology. Contemporary ECG parameters, such as the presence of QRS notching or fragmentation, the S wave assessment, the time to intrinsicoid deflection (ID) in lateral leads, and a lead one ratio ≥12 also showed great potential in assessing response to CRT.

CONCLUSIONS

This review highlights the promising capability of the standard ECG in predicting response to CRT, particularly when using more contemporary predictors, while emphasizing the necessity for further research to validate the prognostic value of these predictors.