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

OBJECTIVE
Cardiac resynchronization with left bundle branch area pacing (LBBAP) is a new resynchronization technique that is an alternative to biventricular pacing. This study investigated the predictive value of electrocardiographic Cornell product (CP) in demonstrating super-response to LBBAP in heart failure patients with left bundle branch block (LBBB).

METHOD
We retrospectively included 32 patients in the study who underwent LBBAP, had a left ventricular ejection fraction (LVEF) ≤35%, were in sinus rhythm and LBBB with QRS duration ≥150 ms, and were receiving optimal medication for at least 3 months. The CP was defined on baseline 12-lead electrocardiography (ECG) as follows: CP (mm x ms) = [(RaVL + SV3) X QRS duration]. Super-response was defined as a minimum ≥15% increase in LVEF at the sixth months after the procedure. Patients were classified as super-responder and non-super responder and clinical, electrocardiographic and echocardiographic parameters were compared.

RESULTS
It was observed that 53% (n=17) of 32 patients were super-responders. The mean age was 65.2±9.9 years and 46.9% of the participants were female. Based on baseline 12-lead ECG; the 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). Also, multivariate analyses showed that the systolic pulmonary artery pressure (OR: 1.08; P = 0.041) and CP (OR: 1.01; P = 0.036) were the independent predictors of super-response to LBBAP.

CONCLUSION
CP, a simple and applicable electrocardiographic parameter, can predict which patients will benefit from LBBAP.