Electrocardiographic parameters predict super-response in cardiac resynchronization therapy

•Some ECG parameters are associated with echocardiographic response after CRT.•Absolute post-implant QRS duration is related with super-response in CRT.•Acute relative shortening of QRS duration is good predictor of super-response.•Monitoring of ECG parameters during implantation could improve CRT outcomes.

BackgroundCardiac resynchronization therapy (CRT) is an established treatment for heart failure patients. However, determinants of response to CRT remain elusive. The aim of the study was to assess the value of ECG parameters to predict super-response in CRT patients.MethodsA 12-lead surface ECG was recorded at baseline and immediately after CRT-device implantation. Baseline ECG parameters (QRS duration, bundle branch morphology, axis, PR interval, QTc, intrinsicoid deflection) and post-implant paced QRS duration were analyzed; relative change in QRS duration was calculated. Decrease of left ventricular end-systolic volume ≥ 30% after 12 months was classified as super-response.ResultsIn group of 101 patients, 32 (31.7%) were super-responders. There were no significant differences in baseline ECG parameters between super-responders and other patients. Post-implant QRS duration was shorter in super-responders (148 ± 22 ms vs. 162 ± 28 ms; P = 0.010). Only in super-responders was significant QRS reduction observed after implantation. Relative QRS shortening was higher in super-responders (12.1% (6.8 to 22.2) vs. 1.7% (− 11.9 to 11.8); P = 0.005). In a multivariable analysis post-implant QRS duration and relative QRS shortening remained independent predictor of super-response.ConclusionAbsolute post-implant QRS duration and relative QRS shortening are the only ECG parameters associated with super-response in CRT. Further prospective studies on larger population are warranted to determine our findings.