Predictors of electrocardiographic screening failure for the subcutaneous implantable cardioverter-defibrillator in children: A prospective multicenter study

Matthew Campbell, Jeremy P. Moore, Narayanswami Sreeram, Johannes C. von Alvensleben, Anjan Shah, Anjan Batra, Ian Law, Shubhayan Sanatani, Vincent Thomas, Farnoosh Nik-Ahd, Stephen Williams, Nina Nosavan, Jennifer Maldonado, Amelia Hart, Thuan Nguyen, Seshadri Balaji

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Subcutaneous implantable cardioverter-defibrillator (SICD) shows promise for select patients at risk of sudden cardiac death. However, patients need to pass an electrocardiographic (ECG) screening (ECG-S) test before they can receive an SICD. Predictors of ECG-S failure in children are unclear. Objective: The purpose of this study was to identify the incidence and predictive factors for failure of ECG-S in children. Methods: Patients 18 years and younger with a preexisting ICD underwent ECG-S for SICD. ECG and demographic data were analyzed for factors predictive of failure. Results: Seventy-three patients (mean age 14.2 ± 3.3 years; range 5–18 years) with hypertrophic cardiomyopathy (n = 24, 33%), long QT syndrome (n =18, 25%), other inherited arrhythmia syndromes (n = 20, 27%), congenital heart disease (n = 9, 12%), and miscellaneous conditions (n = 2) with an existing transvenous ICD underwent prospective ECG-S. Nineteen (26%) failed ECG-S. Failed patients had a longer corrected QT (QTc) interval (457 ms vs 425 ms; P =.03), a longer QRS duration (120 ms vs 98 ms; P =.04), and a lower ratio of R-wave to T-wave amplitudes (R:T ratio) in lead aVF (4 vs 5; P =.001). Multivariable logistic regression identified QTc interval (odds ratio [OR] 4.31; P =.04), QRS duration (OR 4.93; P =.03), R:T ratio in lead aVF (OR 3.13; P =.08) as predictors of failure. A risk score with 1 point each for QTc interval >440 ms, QRS duration >120 ms, and R:T ratio <6.5 in lead aVF was associated with probability of failure of 15.4% (1 point), 47.4% (2 points), and 88.6% (3 points), respectively. Conclusion: ECG-S failure for SICD occurred in 26% of children, which is higher than the reported incidence in adults. Factors predicting ECG-S failure included longer QTc interval, longer QRS duration, and lower R:T ratio in lead aVF.

Original languageEnglish (US)
Pages (from-to)703-707
Number of pages5
JournalHeart Rhythm
Volume15
Issue number5
DOIs
StatePublished - May 1 2018

Fingerprint

Implantable Defibrillators
Multicenter Studies
Prospective Studies
Odds Ratio
Long QT Syndrome
Hypertrophic Cardiomyopathy
Sudden Cardiac Death
Incidence
Cardiac Arrhythmias
Heart Diseases
Logistic Models
Demography
Lead

Keywords

  • ECG screening (ECG-S)
  • Electrocardiogram (ECG)
  • Implantable cardioverter-defibrillators (ICDs)
  • Subcutaneous ICD (SICD)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Predictors of electrocardiographic screening failure for the subcutaneous implantable cardioverter-defibrillator in children : A prospective multicenter study. / Campbell, Matthew; Moore, Jeremy P.; Sreeram, Narayanswami; von Alvensleben, Johannes C.; Shah, Anjan; Batra, Anjan; Law, Ian; Sanatani, Shubhayan; Thomas, Vincent; Nik-Ahd, Farnoosh; Williams, Stephen; Nosavan, Nina; Maldonado, Jennifer; Hart, Amelia; Nguyen, Thuan; Balaji, Seshadri.

In: Heart Rhythm, Vol. 15, No. 5, 01.05.2018, p. 703-707.

Research output: Contribution to journalArticle

Campbell, M, Moore, JP, Sreeram, N, von Alvensleben, JC, Shah, A, Batra, A, Law, I, Sanatani, S, Thomas, V, Nik-Ahd, F, Williams, S, Nosavan, N, Maldonado, J, Hart, A, Nguyen, T & Balaji, S 2018, 'Predictors of electrocardiographic screening failure for the subcutaneous implantable cardioverter-defibrillator in children: A prospective multicenter study', Heart Rhythm, vol. 15, no. 5, pp. 703-707. https://doi.org/10.1016/j.hrthm.2018.01.004
Campbell, Matthew ; Moore, Jeremy P. ; Sreeram, Narayanswami ; von Alvensleben, Johannes C. ; Shah, Anjan ; Batra, Anjan ; Law, Ian ; Sanatani, Shubhayan ; Thomas, Vincent ; Nik-Ahd, Farnoosh ; Williams, Stephen ; Nosavan, Nina ; Maldonado, Jennifer ; Hart, Amelia ; Nguyen, Thuan ; Balaji, Seshadri. / Predictors of electrocardiographic screening failure for the subcutaneous implantable cardioverter-defibrillator in children : A prospective multicenter study. In: Heart Rhythm. 2018 ; Vol. 15, No. 5. pp. 703-707.
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abstract = "Background: Subcutaneous implantable cardioverter-defibrillator (SICD) shows promise for select patients at risk of sudden cardiac death. However, patients need to pass an electrocardiographic (ECG) screening (ECG-S) test before they can receive an SICD. Predictors of ECG-S failure in children are unclear. Objective: The purpose of this study was to identify the incidence and predictive factors for failure of ECG-S in children. Methods: Patients 18 years and younger with a preexisting ICD underwent ECG-S for SICD. ECG and demographic data were analyzed for factors predictive of failure. Results: Seventy-three patients (mean age 14.2 ± 3.3 years; range 5–18 years) with hypertrophic cardiomyopathy (n = 24, 33{\%}), long QT syndrome (n =18, 25{\%}), other inherited arrhythmia syndromes (n = 20, 27{\%}), congenital heart disease (n = 9, 12{\%}), and miscellaneous conditions (n = 2) with an existing transvenous ICD underwent prospective ECG-S. Nineteen (26{\%}) failed ECG-S. Failed patients had a longer corrected QT (QTc) interval (457 ms vs 425 ms; P =.03), a longer QRS duration (120 ms vs 98 ms; P =.04), and a lower ratio of R-wave to T-wave amplitudes (R:T ratio) in lead aVF (4 vs 5; P =.001). Multivariable logistic regression identified QTc interval (odds ratio [OR] 4.31; P =.04), QRS duration (OR 4.93; P =.03), R:T ratio in lead aVF (OR 3.13; P =.08) as predictors of failure. A risk score with 1 point each for QTc interval >440 ms, QRS duration >120 ms, and R:T ratio <6.5 in lead aVF was associated with probability of failure of 15.4{\%} (1 point), 47.4{\%} (2 points), and 88.6{\%} (3 points), respectively. Conclusion: ECG-S failure for SICD occurred in 26{\%} of children, which is higher than the reported incidence in adults. Factors predicting ECG-S failure included longer QTc interval, longer QRS duration, and lower R:T ratio in lead aVF.",
keywords = "ECG screening (ECG-S), Electrocardiogram (ECG), Implantable cardioverter-defibrillators (ICDs), Subcutaneous ICD (SICD)",
author = "Matthew Campbell and Moore, {Jeremy P.} and Narayanswami Sreeram and {von Alvensleben}, {Johannes C.} and Anjan Shah and Anjan Batra and Ian Law and Shubhayan Sanatani and Vincent Thomas and Farnoosh Nik-Ahd and Stephen Williams and Nina Nosavan and Jennifer Maldonado and Amelia Hart and Thuan Nguyen and Seshadri Balaji",
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T1 - Predictors of electrocardiographic screening failure for the subcutaneous implantable cardioverter-defibrillator in children

T2 - A prospective multicenter study

AU - Campbell, Matthew

AU - Moore, Jeremy P.

AU - Sreeram, Narayanswami

AU - von Alvensleben, Johannes C.

AU - Shah, Anjan

AU - Batra, Anjan

AU - Law, Ian

AU - Sanatani, Shubhayan

AU - Thomas, Vincent

AU - Nik-Ahd, Farnoosh

AU - Williams, Stephen

AU - Nosavan, Nina

AU - Maldonado, Jennifer

AU - Hart, Amelia

AU - Nguyen, Thuan

AU - Balaji, Seshadri

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Background: Subcutaneous implantable cardioverter-defibrillator (SICD) shows promise for select patients at risk of sudden cardiac death. However, patients need to pass an electrocardiographic (ECG) screening (ECG-S) test before they can receive an SICD. Predictors of ECG-S failure in children are unclear. Objective: The purpose of this study was to identify the incidence and predictive factors for failure of ECG-S in children. Methods: Patients 18 years and younger with a preexisting ICD underwent ECG-S for SICD. ECG and demographic data were analyzed for factors predictive of failure. Results: Seventy-three patients (mean age 14.2 ± 3.3 years; range 5–18 years) with hypertrophic cardiomyopathy (n = 24, 33%), long QT syndrome (n =18, 25%), other inherited arrhythmia syndromes (n = 20, 27%), congenital heart disease (n = 9, 12%), and miscellaneous conditions (n = 2) with an existing transvenous ICD underwent prospective ECG-S. Nineteen (26%) failed ECG-S. Failed patients had a longer corrected QT (QTc) interval (457 ms vs 425 ms; P =.03), a longer QRS duration (120 ms vs 98 ms; P =.04), and a lower ratio of R-wave to T-wave amplitudes (R:T ratio) in lead aVF (4 vs 5; P =.001). Multivariable logistic regression identified QTc interval (odds ratio [OR] 4.31; P =.04), QRS duration (OR 4.93; P =.03), R:T ratio in lead aVF (OR 3.13; P =.08) as predictors of failure. A risk score with 1 point each for QTc interval >440 ms, QRS duration >120 ms, and R:T ratio <6.5 in lead aVF was associated with probability of failure of 15.4% (1 point), 47.4% (2 points), and 88.6% (3 points), respectively. Conclusion: ECG-S failure for SICD occurred in 26% of children, which is higher than the reported incidence in adults. Factors predicting ECG-S failure included longer QTc interval, longer QRS duration, and lower R:T ratio in lead aVF.

AB - Background: Subcutaneous implantable cardioverter-defibrillator (SICD) shows promise for select patients at risk of sudden cardiac death. However, patients need to pass an electrocardiographic (ECG) screening (ECG-S) test before they can receive an SICD. Predictors of ECG-S failure in children are unclear. Objective: The purpose of this study was to identify the incidence and predictive factors for failure of ECG-S in children. Methods: Patients 18 years and younger with a preexisting ICD underwent ECG-S for SICD. ECG and demographic data were analyzed for factors predictive of failure. Results: Seventy-three patients (mean age 14.2 ± 3.3 years; range 5–18 years) with hypertrophic cardiomyopathy (n = 24, 33%), long QT syndrome (n =18, 25%), other inherited arrhythmia syndromes (n = 20, 27%), congenital heart disease (n = 9, 12%), and miscellaneous conditions (n = 2) with an existing transvenous ICD underwent prospective ECG-S. Nineteen (26%) failed ECG-S. Failed patients had a longer corrected QT (QTc) interval (457 ms vs 425 ms; P =.03), a longer QRS duration (120 ms vs 98 ms; P =.04), and a lower ratio of R-wave to T-wave amplitudes (R:T ratio) in lead aVF (4 vs 5; P =.001). Multivariable logistic regression identified QTc interval (odds ratio [OR] 4.31; P =.04), QRS duration (OR 4.93; P =.03), R:T ratio in lead aVF (OR 3.13; P =.08) as predictors of failure. A risk score with 1 point each for QTc interval >440 ms, QRS duration >120 ms, and R:T ratio <6.5 in lead aVF was associated with probability of failure of 15.4% (1 point), 47.4% (2 points), and 88.6% (3 points), respectively. Conclusion: ECG-S failure for SICD occurred in 26% of children, which is higher than the reported incidence in adults. Factors predicting ECG-S failure included longer QTc interval, longer QRS duration, and lower R:T ratio in lead aVF.

KW - ECG screening (ECG-S)

KW - Electrocardiogram (ECG)

KW - Implantable cardioverter-defibrillators (ICDs)

KW - Subcutaneous ICD (SICD)

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