Beat-to-beat three-dimensional ECG variability predicts ventricular arrhythmia in ICD recipients

Larisa Tereshchenko, Lichy Han, Alan Cheng, Joseph E. Marine, David D. Spragg, Sunil Sinha, Darshan Dalal, Hugh Calkins, Gordon F. Tomaselli, Ronald D. Berger

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background Methodological difficulties associated with QT measurements prompt the search for new electrocardiographic markers of repolarization heterogeneity. Objective We hypothesized that beat-to-beat 3-dimensional vectorcardiogram variability predicts ventricular arrhythmia (VA) in patients with structural heart disease, left ventricular systolic dysfunction, and implanted implantable cardioverter-defibrillators (ICDs). Methods Baseline orthogonal electrocardiograms were recorded in 414 patients with structural heart disease (mean age 59.4 ± 12.0; 280 white [68%] and 134 black [32%]) at rest before implantation of ICD for primary prevention of sudden cardiac death. R and T peaks of 30 consecutive sinus beats were plotted in 3 dimensions to form an R peaks cloud and a T peaks cloud. The volume of the peaks cloud was calculated as the volume within the convex hull. Patients were followed up for at least 6 months; sustained VA with appropriate ICD therapies served as an end point. Results During a mean follow-up time of 18.4 ± 12.5 months, 61 of the 414 patients (14.73% or 9.6% per person-year of follow-up) experienced sustained VA with appropriate ICD therapies: 41 of them were white and 20 were black. In the multivariate Cox model that included inducibility of VA and use of beta-blockers, the highest tertile of T/R peaks cloud volume ratio significantly predicted VA (hazard ratio 1.68, 95% confidence interval 1.01 to 2.80; P = .046) in all patients. T peaks cloud volume and T/R peaks cloud volume ratio were significantly smaller in black subjects (median 0.09 [interquartile range 0.04 to 0.15] vs. median 0.11 [interquartile range 0.06 to 0.22], P = .002). Conclusion A relatively large T peaks cloud volume is associated with increased risk of VA in patients with structural heart disease and systolic dysfunction.

Original languageEnglish (US)
Pages (from-to)1606-1613
Number of pages8
JournalHeart Rhythm
Volume7
Issue number11
DOIs
StatePublished - Nov 2010
Externally publishedYes

Fingerprint

Implantable Defibrillators
Cardiac Arrhythmias
Electrocardiography
Heart Diseases
Sudden Cardiac Death
Left Ventricular Dysfunction
Primary Prevention
Proportional Hazards Models
Confidence Intervals
Therapeutics

Keywords

  • Repolarization
  • Risk stratification
  • Variability
  • Vectorcardiogram
  • Ventricular arrhythmia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Beat-to-beat three-dimensional ECG variability predicts ventricular arrhythmia in ICD recipients. / Tereshchenko, Larisa; Han, Lichy; Cheng, Alan; Marine, Joseph E.; Spragg, David D.; Sinha, Sunil; Dalal, Darshan; Calkins, Hugh; Tomaselli, Gordon F.; Berger, Ronald D.

In: Heart Rhythm, Vol. 7, No. 11, 11.2010, p. 1606-1613.

Research output: Contribution to journalArticle

Tereshchenko, L, Han, L, Cheng, A, Marine, JE, Spragg, DD, Sinha, S, Dalal, D, Calkins, H, Tomaselli, GF & Berger, RD 2010, 'Beat-to-beat three-dimensional ECG variability predicts ventricular arrhythmia in ICD recipients', Heart Rhythm, vol. 7, no. 11, pp. 1606-1613. https://doi.org/10.1016/j.hrthm.2010.08.022
Tereshchenko, Larisa ; Han, Lichy ; Cheng, Alan ; Marine, Joseph E. ; Spragg, David D. ; Sinha, Sunil ; Dalal, Darshan ; Calkins, Hugh ; Tomaselli, Gordon F. ; Berger, Ronald D. / Beat-to-beat three-dimensional ECG variability predicts ventricular arrhythmia in ICD recipients. In: Heart Rhythm. 2010 ; Vol. 7, No. 11. pp. 1606-1613.
@article{d7aad9905cd041e4a46a5f60da3876fb,
title = "Beat-to-beat three-dimensional ECG variability predicts ventricular arrhythmia in ICD recipients",
abstract = "Background Methodological difficulties associated with QT measurements prompt the search for new electrocardiographic markers of repolarization heterogeneity. Objective We hypothesized that beat-to-beat 3-dimensional vectorcardiogram variability predicts ventricular arrhythmia (VA) in patients with structural heart disease, left ventricular systolic dysfunction, and implanted implantable cardioverter-defibrillators (ICDs). Methods Baseline orthogonal electrocardiograms were recorded in 414 patients with structural heart disease (mean age 59.4 ± 12.0; 280 white [68{\%}] and 134 black [32{\%}]) at rest before implantation of ICD for primary prevention of sudden cardiac death. R and T peaks of 30 consecutive sinus beats were plotted in 3 dimensions to form an R peaks cloud and a T peaks cloud. The volume of the peaks cloud was calculated as the volume within the convex hull. Patients were followed up for at least 6 months; sustained VA with appropriate ICD therapies served as an end point. Results During a mean follow-up time of 18.4 ± 12.5 months, 61 of the 414 patients (14.73{\%} or 9.6{\%} per person-year of follow-up) experienced sustained VA with appropriate ICD therapies: 41 of them were white and 20 were black. In the multivariate Cox model that included inducibility of VA and use of beta-blockers, the highest tertile of T/R peaks cloud volume ratio significantly predicted VA (hazard ratio 1.68, 95{\%} confidence interval 1.01 to 2.80; P = .046) in all patients. T peaks cloud volume and T/R peaks cloud volume ratio were significantly smaller in black subjects (median 0.09 [interquartile range 0.04 to 0.15] vs. median 0.11 [interquartile range 0.06 to 0.22], P = .002). Conclusion A relatively large T peaks cloud volume is associated with increased risk of VA in patients with structural heart disease and systolic dysfunction.",
keywords = "Repolarization, Risk stratification, Variability, Vectorcardiogram, Ventricular arrhythmia",
author = "Larisa Tereshchenko and Lichy Han and Alan Cheng and Marine, {Joseph E.} and Spragg, {David D.} and Sunil Sinha and Darshan Dalal and Hugh Calkins and Tomaselli, {Gordon F.} and Berger, {Ronald D.}",
year = "2010",
month = "11",
doi = "10.1016/j.hrthm.2010.08.022",
language = "English (US)",
volume = "7",
pages = "1606--1613",
journal = "Heart Rhythm",
issn = "1547-5271",
publisher = "Elsevier",
number = "11",

}

TY - JOUR

T1 - Beat-to-beat three-dimensional ECG variability predicts ventricular arrhythmia in ICD recipients

AU - Tereshchenko, Larisa

AU - Han, Lichy

AU - Cheng, Alan

AU - Marine, Joseph E.

AU - Spragg, David D.

AU - Sinha, Sunil

AU - Dalal, Darshan

AU - Calkins, Hugh

AU - Tomaselli, Gordon F.

AU - Berger, Ronald D.

PY - 2010/11

Y1 - 2010/11

N2 - Background Methodological difficulties associated with QT measurements prompt the search for new electrocardiographic markers of repolarization heterogeneity. Objective We hypothesized that beat-to-beat 3-dimensional vectorcardiogram variability predicts ventricular arrhythmia (VA) in patients with structural heart disease, left ventricular systolic dysfunction, and implanted implantable cardioverter-defibrillators (ICDs). Methods Baseline orthogonal electrocardiograms were recorded in 414 patients with structural heart disease (mean age 59.4 ± 12.0; 280 white [68%] and 134 black [32%]) at rest before implantation of ICD for primary prevention of sudden cardiac death. R and T peaks of 30 consecutive sinus beats were plotted in 3 dimensions to form an R peaks cloud and a T peaks cloud. The volume of the peaks cloud was calculated as the volume within the convex hull. Patients were followed up for at least 6 months; sustained VA with appropriate ICD therapies served as an end point. Results During a mean follow-up time of 18.4 ± 12.5 months, 61 of the 414 patients (14.73% or 9.6% per person-year of follow-up) experienced sustained VA with appropriate ICD therapies: 41 of them were white and 20 were black. In the multivariate Cox model that included inducibility of VA and use of beta-blockers, the highest tertile of T/R peaks cloud volume ratio significantly predicted VA (hazard ratio 1.68, 95% confidence interval 1.01 to 2.80; P = .046) in all patients. T peaks cloud volume and T/R peaks cloud volume ratio were significantly smaller in black subjects (median 0.09 [interquartile range 0.04 to 0.15] vs. median 0.11 [interquartile range 0.06 to 0.22], P = .002). Conclusion A relatively large T peaks cloud volume is associated with increased risk of VA in patients with structural heart disease and systolic dysfunction.

AB - Background Methodological difficulties associated with QT measurements prompt the search for new electrocardiographic markers of repolarization heterogeneity. Objective We hypothesized that beat-to-beat 3-dimensional vectorcardiogram variability predicts ventricular arrhythmia (VA) in patients with structural heart disease, left ventricular systolic dysfunction, and implanted implantable cardioverter-defibrillators (ICDs). Methods Baseline orthogonal electrocardiograms were recorded in 414 patients with structural heart disease (mean age 59.4 ± 12.0; 280 white [68%] and 134 black [32%]) at rest before implantation of ICD for primary prevention of sudden cardiac death. R and T peaks of 30 consecutive sinus beats were plotted in 3 dimensions to form an R peaks cloud and a T peaks cloud. The volume of the peaks cloud was calculated as the volume within the convex hull. Patients were followed up for at least 6 months; sustained VA with appropriate ICD therapies served as an end point. Results During a mean follow-up time of 18.4 ± 12.5 months, 61 of the 414 patients (14.73% or 9.6% per person-year of follow-up) experienced sustained VA with appropriate ICD therapies: 41 of them were white and 20 were black. In the multivariate Cox model that included inducibility of VA and use of beta-blockers, the highest tertile of T/R peaks cloud volume ratio significantly predicted VA (hazard ratio 1.68, 95% confidence interval 1.01 to 2.80; P = .046) in all patients. T peaks cloud volume and T/R peaks cloud volume ratio were significantly smaller in black subjects (median 0.09 [interquartile range 0.04 to 0.15] vs. median 0.11 [interquartile range 0.06 to 0.22], P = .002). Conclusion A relatively large T peaks cloud volume is associated with increased risk of VA in patients with structural heart disease and systolic dysfunction.

KW - Repolarization

KW - Risk stratification

KW - Variability

KW - Vectorcardiogram

KW - Ventricular arrhythmia

UR - http://www.scopus.com/inward/record.url?scp=78049452150&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78049452150&partnerID=8YFLogxK

U2 - 10.1016/j.hrthm.2010.08.022

DO - 10.1016/j.hrthm.2010.08.022

M3 - Article

VL - 7

SP - 1606

EP - 1613

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

IS - 11

ER -