Why the study?
Global electrical heterogeneity is associated with sudden cardiac death in the general population, but whether it predicts sustained VT/VF leading to appropriate ICD therapies in systolic HF patients with primary prevention ICDs remained uninvestigated.
Is global electrical heterogeneity on pre-implant ECG associated with sustained VT/VF leading to appropriate ICD therapies in systolic heart failure patients with primary prevention ICDs?
Is global electrical heterogeneity on pre-implant ECG associated with sustained VT/VF leading to appropriate ICD therapies in systolic heart failure patients with primary prevention ICDs?
In patients with primary prevention ICDs, global electrical heterogeneity on pre-implant ECG is independently associated with appropriate ICD therapies for sustained VT/VF.
Should not yet alter ICD selection or programming; supports prospective validation of ECG heterogeneity for risk stratification.
Background Global electrical heterogeneity (GEH) is associated with sudden cardiac death in the general population. Objective To investigate whether GEH is associated with sustained ventricular tachycardia (VT)/ventricular fibrillation (VF) leading to appropriate implantable cardioverter-defibrillator (ICD) therapies in systolic heart failure (HF) patients with primary prevention ICDs. Methods We conducted a multicenter retrospective cohort study. GEH was measured by spatial ventricular gradient (SVG) direction and magnitude, QRS-T angle, and sum absolute QRST integral (SAIQRST) on pre-implant 12-lead ECGs. Survival analysis using cause-specific hazard functions compared the strength of associations with two competing outcomes: sustained VT/VF leading to appropriate ICD therapies and all-cause death without appropriate ICD therapies. Results We analyzed data from 2,668 patients (age 63±12y; 23% female; 78% white; 43% nonischemic cardiomyopathy (NICM); left ventricular ejection fraction 28±11% from 6 academic medical centers). After adjustment for demographic, clinical, device, and traditional ECG characteristics, SVG elevation (Hazard Ratio (HR) per 1 standard deviation (SD) 1.14 (95% CI 1.04-1.25); P =0.004), SVG azimuth (HR 1.12(1.01-1.24); P =0.039); SVG magnitude (HR per 1 SD 0.75 (0.66-0.85); P <0.0001), and QRS-T angle (HR per 1 SD 1.21 (95% CI 1.08-1.36); P =0.001) were associated with appropriate ICD therapies. The SVG azimuth was also associated with a lower competing risk of death ( P difference =0.007): HR 0.91(0.82-1.02); P =0.095. SAIQRST had different associations in ischemic [HR 1.29(1.04-1.60)] and NICM [HR 0.78(0.62-0.96); P interaction =0.022]. Conclusion In patients with primary prevention ICDs, GEH is independently associated with appropriate ICD therapies. The SVG vector points in distinctly different directions in patients with two competing outcomes. Clinical Trial Registration URL: www.clinicaltrials.gov Unique identifier: NCT03210883 .
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Waks et al. (2020) studied this question.
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