Trial reportClinical research in cardiology : official journal of the German Cardiac Society2026
A novel measure of AV-conduction predicts clinical outcomes and benefit from CRT-D in non-LBBB patients with wide QRS and a low left ventricular ejection fraction.
Trial report in Clinical research in cardiology : official journal of the German Cardiac Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPR-interval reflects atrioventricular timing but does not well characterize adverse hemodynamics. Novel ECG parameters of conduction may identify benefit from non-dyssynchronous ventricular pacing to correct long atrioventricular conduction delays.
objectiveEvaluating novel ECG parameters to identify risk of heart failure (HF)/death and benefit vs harm by CRT-D in MADIT-CRT non-LBBB patients.
methodsWe analyzed intervals from ECGs in 535 non-LBBB patients enrolled in MADIT-CRT, using ImageJ. Onset of atrial activation, P wave zero crossing in V1, latest P offset, earliest QRS onset, and time to the first R peak in V1 and V6 were determined. Endpoints included HF or death. Associations between novel conduction measures and clinical outcomes in ICD patients (n = 209), and CRT-D (n = 326) vs. ICD benefit, were assessed using Kaplan-Meier and multivariable Cox regression analyses.
resultsWe identified the delay from P zero crossing to the first R peak in V1 (P0PV1) at quintile 5 as the strongest risk predictor in ICD patients (n = 159, 30%), over PR-interval, for all endpoints (p < 0.001), with a more than threefold risk increase. In this group, CRT-D was associated with a 66% lower risk of HF/Death (95% CI: 0.22-0.68, p = 0.001) vs. an ICD. However, in patients with a P0PV1 < 201 ms, CRT-D vs. an ICD was associated with a 64% increased risk of HF/death (95% CI: 1.12-2.55, p = 0.012), with significant bidirectional interaction (p-value < 0.001).
conclusionsWe propose a novel variable, P0PV1, to identify risk and benefit vs. harm from CRT-D in HF patients with non-LBBB. Prospective studies are warranted to confirm our findings.
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