ArticleHeart rhythm O22025
R-wave amplitude changes in lead aVL predict outcomes in cardiac resynchronization therapy: Exploring the role of papillary muscle dyssynchrony and mitral regurgitation.
Article in Heart rhythm O2, 2025. 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
Background: Reduction in R-wave amplitude in lead aVL (RaVL) is often noted after cardiac resynchronization therapy (CRT), together with a shorter QRS duration and reduced mitral regurgitation (MR). Given that lead aVL reflects electrical activity in the anterolateral left ventricular wall, where the anterolateral papillary muscle (PM) resides, opposing the posteromedial one, we hypothesized that these electrocardiographic changes may reflect improved electrical resynchronization of the PMs, contributing to MR reduction. Objective: This study aimed to evaluate the relationship between post-CRT changes in RaVL and MR severity and assess whether RaVL can serve as a surface electrocardiographic marker of PM dyssynchrony and a predictor of clinical response and long-term survival. Methods: We analyzed 231 patients who underwent CRT implantation and were followed for a median of 41 months (interquartile range 29-55); 88 patients died during this period. Results: Baseline RaVL correlated with QRS duration ( Conclusion: A decrease in RaVL after CRT predicts MR improvement and survival, likely reflecting improved PM synchronization and mechanical resynchronization.
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