Key result
Alternative ECG screening combined with conventional screening increased the proportion of high-risk HCM patients qualifying for S-ICD implantation compared to conventional screening alone.
Why the study?
Patients with hypertrophic cardiomyopathy relatively often fail preimplantation ECG screening for S-ICD implantation.
Does alternative ECG screening electrode placement improve eligibility for S-ICD implantation in high-risk HCM patients compared to conventional placement?
Cross-Sectional (n=17)
Does alternative ECG screening electrode placement improve eligibility for S-ICD implantation in high-risk HCM patients compared to conventional placement?
Alternative placement of screening electrodes significantly increases eligibility for S-ICD implantation in high-risk HCM patients who might otherwise fail conventional screening.
Answers are grounded in this paper and cite their sources.
May expand S-ICD eligibility in high-risk HCM via modified screening; hypothesis-generating, prospective validation required.
INTRODUCTION: Patients with hypertrophic cardiomyopathy (HCM) relatively often fail preimplantation ECG screening for subcutaneous implantable cardioverter-defibrillator (S-ICD). We aimed to evaluate impact of conventional and alternative ECG electrodes placement on eligibility for S-ICD implantation in HCM patients at high risk of sudden cardiac death (SCD). We hypothesized that modified electrodes placement will influence QRS-T morphology and thus it will increase S-ICD eligibility in the screening process. MATERIAL AND METHODS: This study enrolled 17 HCM patients at high risk of SCD (5-year SCD risk above 5%) referred for an ICD implantation. ECG screening for S-ICD eligibility in horizontal and vertical position was performed in each patient, in two different screening electrodes configuration: conventional (recommended by manufacturer) and alternative (precordial electrodes shifted rightwards and lateral electrodes dorsally). We evaluated QRS and T waves amplitude as well as T wave index. Primary, secondary and alternate sensing vectors were assessed. RESULTS: Preimplantation ECG screening with alternative electrodes placement resulted in more sensing vectors that were screened successfully (77 vs. 88, p = 0.05). Modified screening combined with a standard one allowed more patients to qualify for S-ICD implantation (17/17 vs. 12/17, p = 0.04). Electrocardiographically, the alternative positioning of ECG electrodes resulted in significant decrease in absolute values of QRS complex and T waves amplitudes in almost all sensing vectors, which was responsible for successful screening. CONCLUSIONS: The use of alternative placement of screening electrodes may be a valuable method to increase eligibility for S-ICD implantation in HCM patients at high risk of SCD.
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Kaczmarek et al. (2019) conducted a cross-sectional in Hypertrophic cardiomyopathy (HCM) at high risk of sudden cardiac death (n=17). Alternative ECG screening electrodes placement vs. Conventional ECG screening electrodes placement was evaluated on Patients qualifying for S-ICD implantation (p=0.04). Alternative ECG screening combined with conventional screening increased the proportion of high-risk HCM patients qualifying for S-ICD implantation compared to conventional screening alone.
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