Document Detail


Ventricular arrhythmia is predicted by sum absolute QRST integralbut not by QRS width.
MedLine Citation:
PMID:  20832820     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: There is a controversy regarding the association between QRS width and ventricular arrhythmias (VAs). We hypothesized that predictive value of the QRS width could be improved if QRS width were considered in the context of the sum magnitude of the absolute QRST integral in 3 orthogonal leads sum absolute QRST integral (SAI QRST). We explored correlations between QRS width, SAI QRST, and VA in primary prevention implantable cardioverter-defibrillator (ICD) patients with structural heart disease.
METHODS: Baseline orthogonal electrocardiograms were recorded at rest in 355 patients with implanted primary prevention ICDs (mean age, 59.5 ± 12.4 years; 279 male [79%]). Patients were observed prospectively at least 6 months; appropriate ICD therapies because of sustained VA served as end points. The sum magnitude of the absolute QRST integral in 3 orthogonal leads (SAI QRST) was calculated.
RESULTS: During a mean follow-up of 18 months, 48 patients had sustained VA and received appropriate ICD therapies. There was no difference in baseline QRS width between patients with and those without arrhythmia (114.9 ± 32.8 vs 108.9 ± 24.7 milliseconds; P = .230). SAI QRST was significantly lower in patients with VA at follow-up than in patients without VA (102.6 ± 27.6 vs 112.0 ± 31.9 mV·ms; P = 0.034). Patients with SAI QRST (≤145 mV·ms) had a 3-fold higher risk of ventricular tachycardia (VT)/ventricular fibrillation (VF) (hazard ratio [HR], 3.25; 95% confidence interval [CI], 1.59-6.75; P = .001). In the univariate analysis, QRS width did not predict VT/VF. In the bivariate Cox regression model, every 1 millisecond of incremental QRS widening with a simultaneous 1 mV·ms SAI QRST decrease raised the risk of VT/VF by 2% (HR, 1.02; 95% CI, 1.01-1.03; P = .005).
CONCLUSION: QRS widening is associated with ventricular tachyarrhythmia only if accompanied by low SAI QRST.
Authors:
Larisa G Tereshchenko; Alan Cheng; Barry J Fetics; Joseph E Marine; David D Spragg; Sunil Sinha; Hugh Calkins; Gordon F Tomaselli; Ronald D Berger
Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2010-09-15
Journal Detail:
Title:  Journal of electrocardiology     Volume:  43     ISSN:  1532-8430     ISO Abbreviation:  J Electrocardiol     Publication Date:    2010 Nov-Dec
Date Detail:
Created Date:  2010-11-02     Completed Date:  2011-03-15     Revised Date:  2013-05-28    
Medline Journal Info:
Nlm Unique ID:  0153605     Medline TA:  J Electrocardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  548-52     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Elsevier Inc. All rights reserved.
Affiliation:
Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD 21287, USA. lteresh1@jhmi.edu
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MeSH Terms
Descriptor/Qualifier:
Diagnosis, Computer-Assisted / methods*
Electrocardiography / methods*
Female
Humans
Male
Middle Aged
Reproducibility of Results
Sensitivity and Specificity
Tachycardia, Ventricular / diagnosis*,  prevention & control
Grant Support
ID/Acronym/Agency:
R01 HL091062-01A2/HL/NHLBI NIH HHS
Comments/Corrections

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