Document Detail


Usefulness of QRS prolongation in predicting risk of inducible monomorphic ventricular tachycardia in patients referred for electrophysiologic studies.
MedLine Citation:
PMID:  14516880     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
QRS prolongation on surface electrocardiography has been identified as a marker for increased cardiac mortality. A potential mechanism for increased mortality is ventricular tachycardia (VT). This study aimed to evaluate the relation between bundle branch block and sustained monomorphic VT inducibility in patients referred for electrophysiologic studies. We analyzed a cohort of 777 patients (age 63 +/- 18 years, 67% men, left ventricular [LV] ejection fraction [EF] 45% +/- 16, prior myocardial infarction 41%) referred for electrophysiologic studies between 1994 and 2001 who underwent programmed stimulation for VT. Forty-five percent of patients were referred for syncope or a history of VT and/or ventricular fibrillation. Thirty-one percent of patients had prolonged QRS duration (> or =120 ms). Patients with prolonged QRS duration were older, had lower LVEFs, and were more likely to have a history of myocardial infarction. Prolonged QRS was a significant predictor of sustained monomorphic VT inducibility (p <0.0001). On multivariate analysis correcting for age, sex, LVEF, history of myocardial infarction, medications, and QRS conduction delay proved to be independently associated with sustained monomorphic VT inducibility (relative risk 3.290, 95% confidence interval 2.185 to 4.953 for prolonged vs normal QRS duration). Thus, a prolonged QRS duration on surface electrocardiography is a strong, independent predictor of inducible sustained monomorphic VT. Conduction delay may be an important risk factor, providing a substrate for the development of reentrant monomorphic VT, and furthermore suggests a potential mechanism for the increased mortality observed in patients with prolonged QRS.
Authors:
Tamara Horwich; Seung-Joon Lee; Leslie Saxon
Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  The American journal of cardiology     Volume:  92     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2003 Oct 
Date Detail:
Created Date:  2003-09-30     Completed Date:  2003-10-28     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  804-9     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, University of California-San Francisco, San Francisco, California 90093, USA.
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MeSH Terms
Descriptor/Qualifier:
Academic Medical Centers
Adolescent
Adult
Aged
Aged, 80 and over
Cohort Studies
Electrocardiography / statistics & numerical data*
Electrophysiologic Techniques, Cardiac / statistics & numerical data*
Female
Humans
Male
Middle Aged
Multivariate Analysis
Outcome Assessment (Health Care)
Predictive Value of Tests
Prognosis
Risk Assessment / methods
San Francisco / epidemiology
Tachycardia, Ventricular / diagnosis*,  epidemiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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