Using Cornell Product to Predict Echocardiographic Response of Left Bundle Branch Area Pacing

OBJECTIVE
Cardiac resynchronization therapy with left bundle branch area pacing (LBBAP) is a novel resynchronization technique that serves as an alternative to biventricular pacing. This study investigated the predictive value of electrocardiographic Cornell Product (CP) in identifying super-responders to LBBAP among heart failure patients with left bundle branch block (LBBB).


METHOD
This retrospective study included 32 patients who underwent LBBAP, had a left ventricular ejection fraction (LVEF) ≤ 35%, were in sinus rhythm with LBBB and a QRS duration ≥ 150 ms, and had been receiving optimal medical therapy for at least three months. CP was calculated from baseline 12-lead electrocardiography (ECG) using the following formula: CP (mm x ms) = [(RaVL + SV3) x QRS duration]. Super-response was defined as an increase of at least 15% in LVEF six months after the procedure. Patients were classified as super-responders or non-super-responders, and their clinical, electrocardiographic, and echocardiographic parameters were compared.


RESULTS
Among the 32 patients, 53% (n = 17) were identified as super-responders. The mean age of participants was 65.2 ± 9.9 years, and 46.9% were female. Based on baseline 12-lead ECG, CP was significantly lower in the super-responder group (3788.4 [3222.4-4569.6] mm*ms vs. 5174.0 [4516.4-5296.0] mm*ms, P = 0.044). Additionally, multivariate analysis revealed that systolic pulmonary artery pressure (odds ratio [OR]: 1.08; P = 0.041) and CP (OR: 1.01; P = 0.036) were independent predictors of super-response to LBBAP.


CONCLUSION
CP, a simple and readily applicable electrocardiographic parameter, can serve as a predictor of which patients will benefit from LBBAP.