{"doi":"10.1111/pace.13916","title":"Lead one ratio in left bundle branch block predicts poor cardiac resynchronization therapy response","abstract":"BACKGROUND: A low electrocardiogram (ECG) lead one ratio (LOR) of the maximum positive/negative QRS amplitudes is associated with lower left ventricular ejection fraction (LVEF) and worse outcomes in left bundle branch block (LBBB); however, the impact of LOR on cardiac resynchronization therapy (CRT) outcomes is unknown. We compared clinical outcomes and echocardiographic changes after CRT implantation by LOR. METHODS: Consecutive CRT-defibrillator recipients with LBBB implanted between 2006 and 2015 at Duke University Medical Center were included (N = 496). Time to heart transplant, left ventricular assist device (LVAD) implantation, or death was compared among patients with LOR <12 vs ≥12 using Cox-proportional hazard models. Changes in LVEF and LV volumes after CRT were compared by LOR. RESULTS: Baseline ECG LOR <12 was associated with an adjusted hazard ratio (HR) of 1.69 (95% CI: 1.12-2.40, P = .01) for heart transplant, LVAD, or death. Patients with LOR <12 had less reduction of LV end diastolic volume (ΔLVEDV -4 ± 21 vs -13 ± 23%, P = .04) and LV end systolic volume (ΔLVESV -9 ± 27 vs -22 ± 26%, P = .03) after CRT. In patients with QRS duration (QRSd) ≥150 ms, LOR <12 was associated with an adjusted HR of 2.01 (95% CI 1.21-3.35, P = .008) for heart transplant, LVAD, or death, compared with LOR ≥12. CONCLUSIONS: Baseline ECG LOR <12 portends worse outcomes after CRT implantation in patients with LBBB, specifically among those with QRSd ≥150 ms. This ECG ratio may identify patients with a class I indication for CRT implantation at high risk for poor postimplantation outcomes.","journal":"Pacing and Clinical Electrophysiology","year":2020,"id":113603,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":3,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9653,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":383115,"name":"Daniel J. Friedman","orcid":"0000-0001-5791-1954","position":1,"is_corresponding":false},{"id":383116,"name":"Kasper Emerek","orcid":"0000-0002-5194-2044","position":2,"is_corresponding":false},{"id":535544,"name":"Claus Graff","orcid":"0000-0001-9650-9781","position":3,"is_corresponding":false},{"id":535545,"name":"Peter L. Sørensen","orcid":"0000-0001-9328-5436","position":4,"is_corresponding":false},{"id":536139,"name":"Steen Møller Hansen","orcid":null,"position":5,"is_corresponding":false},{"id":535546,"name":"Björn Wieslander","orcid":"0000-0002-5606-0008","position":6,"is_corresponding":false},{"id":430360,"name":"Martin Ugander","orcid":"0000-0003-3665-2038","position":7,"is_corresponding":false},{"id":383117,"name":"Peter Søgaard","orcid":"0000-0002-7441-0630","position":8,"is_corresponding":false},{"id":337351,"name":"Brett D. Atwater","orcid":"0000-0002-0468-3668","position":9,"is_corresponding":false},{"id":337349,"name":"Zak Loring","orcid":"0000-0002-4613-582X","position":0,"is_corresponding":true}],"reference_count":26,"raw_metadata":null,"created_at":"2026-07-18T23:13:21.458038Z","pmid":"32285950","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}