Q waves are the strongest electrocardiographic variable associated with primary prophylactic implantable cardioverter-defibrillator benefit: a prospective multicentre study.

Pelli, Ari; Junttila, M Juhani; Kenttä, Tuomas V; Schlögl, Simon; Zabel, Markus; Malik, Marek; Reichlin, Tobias; Willems, Rik; Vos, Marc A; Harden, Markus; Friede, Tim; Sticherling, Christian; Huikuri, Heikki V (2022). Q waves are the strongest electrocardiographic variable associated with primary prophylactic implantable cardioverter-defibrillator benefit: a prospective multicentre study. Europace, 24(5), pp. 774-783. Oxford University Press 10.1093/europace/euab260

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AIM

The association of standard 12-lead electrocardiogram (ECG) markers with benefits of the primary prophylactic implantable cardioverter-defibrillator (ICD) has not been determined in the contemporary era. We analysed traditional and novel ECG variables in a large prospective, controlled primary prophylactic ICD population to assess the predictive value of ECG in terms of ICD benefit.

METHODS AND RESULTS

Electrocardiograms from 1477 ICD patients and 700 control patients (EU-CERT-ICD; non-randomized, controlled, prospective multicentre study; ClinicalTrials.gov Identifier: NCT02064192), who met ICD implantation criteria but did not receive the device, were analysed. The primary outcome was all-cause mortality. In ICD patients, the co-primary outcome of first appropriate shock was used. Mean follow-up time was 2.4 ± 1.1 years to death and 2.3 ± 1.2 years to the first appropriate shock. Pathological Q waves were associated with decreased mortality in ICD patients [hazard ratio (HR) 0.54, 95% confidence interval (CI) 0.35-0.84; P < 0.01] and patients with pathological Q waves had significantly more benefit from ICD (HR 0.44, 95% CI 0.21-0.93; P = 0.03). QTc interval increase taken as a continuous variable was associated with both mortality and appropriate shock incidence, but commonly used cut-off values, were not statistically significantly associated with either of the outcomes.

CONCLUSION

Pathological Q waves were a strong ECG predictor of ICD benefit in primary prophylactic ICD patients. Excess mortality among Q wave patients seems to be due to arrhythmic death which can be prevented by ICD.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Reichlin, Tobias Roman

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1099-5129

Publisher:

Oxford University Press

Language:

English

Submitter:

Vjollca Coli

Date Deposited:

21 Jan 2022 14:43

Last Modified:

05 Dec 2022 16:00

Publisher DOI:

10.1093/europace/euab260

PubMed ID:

34849744

Uncontrolled Keywords:

Appropriate shock Benefit Electrocardiogram Heart failure Implantable cardioverter-defibrillator Mortality Primary prevention Q wave QT interval

BORIS DOI:

10.48350/163344

URI:

https://boris.unibe.ch/id/eprint/163344

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