TY - JOUR

T1 - Precision of automated QRS duration measurement in patients treated with cardiac resynchronization therapy

AU - Lund-Andersen, Casper

AU - Petersen, Helen H.

AU - Jøns, Christian

AU - Philbert, Berit T.

AU - Tfelt-Hansen, Jacob

AU - Skovgaard, Lene T.

AU - Svendsen, Jesper H.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - PURPOSE: Shortening of the QRS duration (QRSd) is often used to guide device optimization and reprogramming in patients with cardiac resynchronization therapy (CRT). Detecting the small changes expected during reprogramming requires that the QRSd can be measured with high precision, but this has never been studied in patients with CRT. In this study, we wanted to assess the precision of automated QRSd measurement in patients treated with CRT using two commonly available electrocardiographs.METHODS: Patients treated with CRT were recruited during routine follow-up in our pacemaker clinic. In all participants, a number of immediate successive ECGs were recorded with the GE MAC 5500 (Mac55) and the GE MAC 1600 (Mac16). Data were analyzed with a linear mixed model.RESULTS: A total of 785 12-lead ECGs were recorded in 36 patients with an average of 11.2 and 10.6 ECGs per patient with the Mac55 and Mac16, respectively. The Mac55 measured the QRSd longer by 10.3 milliseconds (ms) (95% CI 7.1-13.5 ms, p < 0.001) and with significantly smaller standard deviation for repeated measurements (6.3 vs. 10.4 ms, p < 0.001). Limits of agreement were ± 17.5 and ± 28.8 ms for the Mac55 and Mac16, respectively.CONCLUSIONS: Automated measurement of QRSd in patients with CRT shows low precision with limits of agreement of ± 17.5 and ± 28.8 ms for repeated measurements in two commercially available electrocardiographs. Device programming solely by QRSd changes should be done with caution, and clinical effects should be demonstrated in future trials. Device programming based on QRSd changes should be done with caution until the ability of this measure to predict clinical outcome can be demonstrated in prospective study.

AB - PURPOSE: Shortening of the QRS duration (QRSd) is often used to guide device optimization and reprogramming in patients with cardiac resynchronization therapy (CRT). Detecting the small changes expected during reprogramming requires that the QRSd can be measured with high precision, but this has never been studied in patients with CRT. In this study, we wanted to assess the precision of automated QRSd measurement in patients treated with CRT using two commonly available electrocardiographs.METHODS: Patients treated with CRT were recruited during routine follow-up in our pacemaker clinic. In all participants, a number of immediate successive ECGs were recorded with the GE MAC 5500 (Mac55) and the GE MAC 1600 (Mac16). Data were analyzed with a linear mixed model.RESULTS: A total of 785 12-lead ECGs were recorded in 36 patients with an average of 11.2 and 10.6 ECGs per patient with the Mac55 and Mac16, respectively. The Mac55 measured the QRSd longer by 10.3 milliseconds (ms) (95% CI 7.1-13.5 ms, p < 0.001) and with significantly smaller standard deviation for repeated measurements (6.3 vs. 10.4 ms, p < 0.001). Limits of agreement were ± 17.5 and ± 28.8 ms for the Mac55 and Mac16, respectively.CONCLUSIONS: Automated measurement of QRSd in patients with CRT shows low precision with limits of agreement of ± 17.5 and ± 28.8 ms for repeated measurements in two commercially available electrocardiographs. Device programming solely by QRSd changes should be done with caution, and clinical effects should be demonstrated in future trials. Device programming based on QRSd changes should be done with caution until the ability of this measure to predict clinical outcome can be demonstrated in prospective study.

KW - Cardiac resynchronization therapy

KW - ECG

KW - Heart failure

KW - Optimization

KW - Precision

KW - QRS

KW - Precision Medicine/methods

KW - Severity of Illness Index

KW - Heart Failure/diagnostic imaging

KW - Prospective Studies

KW - Humans

KW - Middle Aged

KW - Male

KW - Pattern Recognition, Automated/methods

KW - Cardiac Resynchronization Therapy/methods

KW - Electrocardiography/methods

KW - Sensitivity and Specificity

KW - Female

KW - Aged

KW - Cohort Studies

UR - http://www.scopus.com/inward/record.url?scp=85045028575&partnerID=8YFLogxK

U2 - 10.1007/s10840-018-0334-2

DO - 10.1007/s10840-018-0334-2

M3 - Journal article

C2 - 29508111

AN - SCOPUS:85045028575

VL - 52

SP - 103

EP - 110

JO - Journal of Interventional Cardiac Electrophysiology

JF - Journal of Interventional Cardiac Electrophysiology

SN - 1383-875X

IS - 1

ER -