Electrocardiographic predictors of clinical outcomes in nonischemic cardiomyopathy patients with left bundle branch area pacing cardiac resynchronization therapy

Background: Paced QRS morphology may vary during left bundle branch area pacing (LBBAP) per the pacing location. It remains unclear whether electrocardiographic changes observed during LBBAP can predict clinical outcomes. Objective: We aimed to assess correlation between characteristics of paced QRS on the electrocardiogram and clinical outcomes in heart failure patients with nonischemic cardiomyopathy. Methods: Of 79 consecutive heart failure patients receiving LBBAP, 59 patients were included in this prospective study after exclusions. LBBAP was performed using Medtronic 3830 lead. Patients were assigned to various groups on the basis of paced QRS morphology in lead V₁ (qR and Qr), QRS axis (normal, left, or right), and V₆ R-wave peak time (RWPT, ≤80 ms or >80 ms) to compare echocardiographic outcomes. Results: RWPT was significantly shorter (75.7 ± 17.5 ms vs 85.3 ± 11.3 ms; P =.014), transition during threshold testing was more commonly observed (81.5% vs 53%; P =.02), and improvement in left ventricular ejection fraction (LVEF) was significantly greater in the qR group (21.4% ± 6.4% vs 16.4% ± 8.3%; P =.013) compared with the Qr group. RWPT or LVEF did not differ in patients with different paced QRS axis (P >.05). Whereas qR morphology and presence of transition during threshold testing independently predicted LVEF improvement, RWPT lacked predictive value. Nonresponders had greater incidence of loss of R′ (P =.009) and prolonged RWPT (P =.003) on follow-up compared with average responders and superresponders. Conclusion: Paced qR morphology and transition during threshold testing predicted greater improvement in LVEF, whereas RWPT lacked predictive value. Loss of terminal R in lead V₁ and prolongation of RWPT on follow-up prognosticated nonresponse to LBBAP.