title: Paced QRS duration as a predictor for clinical heart failure events during right ventricular apical pacing in patients with idiopathic complete atrioventricular block: results from an observational cohort study (PREDICT-HF).
abstract: OBJECTIVE
  The aim of this study was to investigate the predictive ability of paced QRS duration (pQRSd) for heart failure events among patients receiving right ventricular apical pacing (RVAP).
  
  
  RESULTS
  A total of 194 patients with complete atrioventricular block receiving pacemaker treatment were enrolled and stratified to group 1, pQRSd < 160 ms, n = 53; group 2, 160 ≤ pQRSd < 190 ms, n = 97; and group 3, pQRSd ≥ 190 ms, n = 44. Study outcomes were heart failure events, changes in pQRSd, and changes in left ventricular ejection fraction (LVEF). During the 3-year follow-up, the incidence of heart failure events was 9.4, 27.8, and 56.8% in groups 1, 2, and 3, respectively (P < 0.001). Among the patients without heart failure events, the pQRSd at 3 years remained longer than that at baseline (162.1 ± 22.6 vs. 160.9 ± 22.1 ms, P < 0.05), whereas among patients who experienced heart failure events, the prolonged pQRSd at 3 years seemed more pronounced as compared with baseline (184.1 ± 21.1 vs. 179.8 ± 21 ms, P < 0.001). Linear regression demonstrated that a decrease in LVEF was positively correlated with pQRSd over time (relative risk 0.423; P < 0.05). The receiver operating charactersitic curve showed that the cut-off value of pQRSd was 165 ms with a sensitivity of 0.789.
  
  
  CONCLUSIONS
  A prolonged pQRSd has a detrimental effect on long-term cardiac function during RVAP in patients with complete atrioventricular block. pQRSd could be a useful predictor to identify patients who are at risk for heart failure events during RVAP.
authors.affiliation: Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
authors.forename: Shaojie
authors.initials: S
authors.lastname: Chen
authors.forename: Yuehui
authors.initials: Y
authors.lastname: Yin
authors.forename: Xianbin
authors.initials: X
authors.lastname: Lan
authors.forename: Zengzhang
authors.initials: Z
authors.lastname: Liu
authors.forename: Zhiyu
authors.initials: Z
authors.lastname: Ling
authors.forename: Li
authors.initials: L
authors.lastname: Su
authors.forename: Márcio Galindo
authors.initials: MG
authors.lastname: Kiuchi
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Li
authors.forename: Bin
authors.initials: B
authors.lastname: Zhong
authors.forename: Mitchell W
authors.initials: MW
authors.lastname: Krucoff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D054537:Atrioventricular Block / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome