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Electrical remodeling after cardiac resynchronization therapy and its relationship with the anatomical remodeling

      Ventricular electrical delay at the stimulation site is a fundamental mechanism for the enhanced cardiac resynchronization therapy (CRT) response in the presence of left bundle brunch block (LBBB) or more prolonged QRS duration. Several studies have demonstrated that electrical delay, between the right ventricle (RV) and left ventricle (LV) catheter, impact the acute hemodynamic response, the reverse LV remodeling, and total mortality and hospitalizations for worsening of heart failure in patients undergoing CRT [
      • Singh J.P.
      • Fan D.
      • Heist E.K.
      • et al.
      Left ventricular lead electrical delay predicts response to cardiac resynchronization therapy.
      ,
      • D'Onofrio A.
      • Botto G.L.
      • Mantica M.
      • et al.
      The interventricular conduction time is associated with response to cardiac resynchronization therapy.
      ,
      • D'Onofrio A.
      • Botto G.
      • Mantica M.
      • et al.
      Incremental value of larger interventricular conduction time in improving cardiac resynchronization therapy outcome in patients with different QRS duration.
      ,
      • Stabile G.
      • D'Onofrio A.
      • Pepi P.
      • et al.
      Interlead anatomic and electrical distance predict outcome in CRT patients.
      ,
      • Stabile G.
      • Iuliano A.
      • La Rocca V.
      • Solimene F.
      • Fazio R.
      • De Simone A.
      Geometrical and electrical predictors of cardiac resynchronization therapy response.
      ]. Effective CRT is known to yield LV reverse remodeling at medium term follow-up. The aim of our study was to evaluate the impact of CRT to dispersion in LV electrical activation and its relationship to the amount of echocardiographic response to CRT, in an unselected population of patients with heart failure, left bundle branch block (LBBB), and sinus rhythm, undergoing first-time CRT. The design of the study (CRT MORE: Cardiac Resynchronization Therapy Modular Registry; NCT01573091) has been published previously [
      • Stabile G.
      • Bertaglia E.
      • Botto G.L.
      • et al.
      Cardiac resynchronization therapy modular registry (CRT MORE): ECG and Rx predictors of response to CRT.
      ]. The study protocol was approved by the local institutional Ethics Committee and all patients provided written informed consent.

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