Left ventricular hypertrophy increased the risk of arrhythmic mortality (HR 1.35; 95% CI 1.08-1.69), while left bundle-branch block and conduction delay increased arrhythmic and total mortality by 50%.
Cohort (n=1,638)
Yes
Do ECG markers of conduction abnormalities and left ventricular hypertrophy predict arrhythmic death and total mortality in patients with coronary artery disease, depressed left ventricular function, and nonsustained ventricular tachycardia?
In patients with coronary artery disease, depressed left ventricular function, and nonsustained ventricular tachycardia, left bundle-branch block and intraventricular conduction delay are independent predictors of both arrhythmic and total mortality.
Hazard Ratio: 1.35 (95% CI 1.08–1.69)
BACKGROUND: Stratifiers of sudden and total mortality risk are needed to optimally target preventive therapies in patients with coronary artery disease and impaired ventricular function. We assessed the prognostic significance of ECG markers of conduction abnormalities and left ventricular hypertrophy in the Multicenter Unsustained Tachycardia Trial (MUSTT). METHODS AND RESULTS: We analyzed the ECGs of 1638 patients from MUSTT who did not receive antiarrhythmic therapy (antiarrhythmic medication or implantable cardioverter-defibrillator). After adjustment for other significant factors, left bundle-branch block and intraventricular conduction delay were associated with a 50% increase in the risk of both arrhythmic and total mortality. Right bundle-branch block was not associated with arrhythmic or total mortality. Left ventricular hypertrophy was the only ECG predictor of arrhythmic (hazard ratio, 1.35; 95% CI, 1.08 to 1.69) but not total mortality. CONCLUSIONS: In patients with coronary artery disease, depressed left ventricular function, and nonsustained ventricular tachycardia, QRS prolongation resulting from left bundle-branch block or intraventricular conduction delay but not right bundle-branch block provided prognostic information about the risk of arrhythmic and total mortality independently of electrophysiological evaluation and ejection fraction. Left ventricular hypertrophy was associated with increased arrhythmic but not total mortality.
Zimetbaum et al. (2004) conducted a cohort in Coronary artery disease, impaired ventricular function, nonsustained ventricular tachycardia (n=1,638). ECG markers of conduction abnormalities and left ventricular hypertrophy vs. Absence of these ECG markers was evaluated on Arrhythmic death and total mortality (HR 1.35, 95% CI 1.08 to 1.69). Left ventricular hypertrophy increased the risk of arrhythmic mortality (HR 1.35; 95% CI 1.08-1.69), while left bundle-branch block and conduction delay increased arrhythmic and total mortality by 50%.
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