Short-term variability of repolarization predicts ventricular tachycardia and sudden cardiac death in patients with structural heart disease: A comparison with QT variability index

Peter Oosterhoff, Larisa Tereshchenko, Marcel A G Van Der Heyden, Raja N. Ghanem, Barry J. Fetics, Ronald D. Berger, Marc A. Vos

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Background: Monitoring arrhythmic risk may improve management of patients with implantable cardioverter-defibrillators (ICD) and prevent ICD shocks. Changes in repolarization duration between subsequent beats quantified as short-term variability (STV) is associated with ventricular arrhythmias in several animal models. Objective: We evaluated STV of QT from right ventricular intracardiac ICD electrograms in patients with structural heart disease and compared its predictive value with the QT variability index (QTVI). Methods: In 233 patients, STV over 60 beats for QT and RR intervals and their ratio was calculated (STV QT, STV RR, STV Ratio, respectively). QTVI was derived from mean and SD of QT and heart rate. Follow-up duration was 26 ± 15 months. Predictive value was determined for sudden arrhythmic death (SAD) defined as sudden cardiac death or fast ventricular tachycardia/fibrillation [CL <240 ms]. Results: In univariate analysis, STV Ratio, but not STV QT or STV RR, was predictive of SAD. Hazard ratios for highest quartile STV Ratio and QTVI were comparable (STV Ratio: 1.9, 95% confidence interval [CI] 1.1 to 3.3, P =.038, QTVI: 2.2, 95% CI 1.2 to 3.8, P =.010). In a multivariate model, highest quartile STV Ratio was predictive of SAD after adjustment for New York Heart Association class, history of ischemia, ICD indication, and use of class I antiarrhythmics (hazard ratio 1.8, 95% CI 1.0 to 3.4, P Ratio and QTVI identified patients at highest risk (hazard ratio 2.4, 95% CI 1.3 to 4.3, P =.005, positive predictive value 38%, negative predictive value 82%). Conclusion: STV Ratio from ICD electrograms is predictive of SAD. Predictive value is similar for order-based STV Ratio and distribution-based QTVI, but the combination of both parameters can further improve results.

Original languageEnglish (US)
Pages (from-to)1584-1590
Number of pages7
JournalHeart Rhythm
Volume8
Issue number10
DOIs
StatePublished - Oct 2011
Externally publishedYes

Fingerprint

Implantable Defibrillators
Sudden Cardiac Death
Ventricular Tachycardia
Heart Diseases
Sudden Death
Confidence Intervals
Ventricular Fibrillation
Cardiac Arrhythmias
Shock
Ischemia
Animal Models
Heart Rate
Odds Ratio

Keywords

  • Arrhythmia
  • ICD
  • intracardiac electrogram
  • Risk stratification
  • Structural heart disease
  • Variability or repolarization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Short-term variability of repolarization predicts ventricular tachycardia and sudden cardiac death in patients with structural heart disease : A comparison with QT variability index. / Oosterhoff, Peter; Tereshchenko, Larisa; Van Der Heyden, Marcel A G; Ghanem, Raja N.; Fetics, Barry J.; Berger, Ronald D.; Vos, Marc A.

In: Heart Rhythm, Vol. 8, No. 10, 10.2011, p. 1584-1590.

Research output: Contribution to journalArticle

Oosterhoff, Peter ; Tereshchenko, Larisa ; Van Der Heyden, Marcel A G ; Ghanem, Raja N. ; Fetics, Barry J. ; Berger, Ronald D. ; Vos, Marc A. / Short-term variability of repolarization predicts ventricular tachycardia and sudden cardiac death in patients with structural heart disease : A comparison with QT variability index. In: Heart Rhythm. 2011 ; Vol. 8, No. 10. pp. 1584-1590.
@article{e38505c210004fef9a3d9deacb551fce,
title = "Short-term variability of repolarization predicts ventricular tachycardia and sudden cardiac death in patients with structural heart disease: A comparison with QT variability index",
abstract = "Background: Monitoring arrhythmic risk may improve management of patients with implantable cardioverter-defibrillators (ICD) and prevent ICD shocks. Changes in repolarization duration between subsequent beats quantified as short-term variability (STV) is associated with ventricular arrhythmias in several animal models. Objective: We evaluated STV of QT from right ventricular intracardiac ICD electrograms in patients with structural heart disease and compared its predictive value with the QT variability index (QTVI). Methods: In 233 patients, STV over 60 beats for QT and RR intervals and their ratio was calculated (STV QT, STV RR, STV Ratio, respectively). QTVI was derived from mean and SD of QT and heart rate. Follow-up duration was 26 ± 15 months. Predictive value was determined for sudden arrhythmic death (SAD) defined as sudden cardiac death or fast ventricular tachycardia/fibrillation [CL <240 ms]. Results: In univariate analysis, STV Ratio, but not STV QT or STV RR, was predictive of SAD. Hazard ratios for highest quartile STV Ratio and QTVI were comparable (STV Ratio: 1.9, 95{\%} confidence interval [CI] 1.1 to 3.3, P =.038, QTVI: 2.2, 95{\%} CI 1.2 to 3.8, P =.010). In a multivariate model, highest quartile STV Ratio was predictive of SAD after adjustment for New York Heart Association class, history of ischemia, ICD indication, and use of class I antiarrhythmics (hazard ratio 1.8, 95{\%} CI 1.0 to 3.4, P Ratio and QTVI identified patients at highest risk (hazard ratio 2.4, 95{\%} CI 1.3 to 4.3, P =.005, positive predictive value 38{\%}, negative predictive value 82{\%}). Conclusion: STV Ratio from ICD electrograms is predictive of SAD. Predictive value is similar for order-based STV Ratio and distribution-based QTVI, but the combination of both parameters can further improve results.",
keywords = "Arrhythmia, ICD, intracardiac electrogram, Risk stratification, Structural heart disease, Variability or repolarization",
author = "Peter Oosterhoff and Larisa Tereshchenko and {Van Der Heyden}, {Marcel A G} and Ghanem, {Raja N.} and Fetics, {Barry J.} and Berger, {Ronald D.} and Vos, {Marc A.}",
year = "2011",
month = "10",
doi = "10.1016/j.hrthm.2011.04.033",
language = "English (US)",
volume = "8",
pages = "1584--1590",
journal = "Heart Rhythm",
issn = "1547-5271",
publisher = "Elsevier",
number = "10",

}

TY - JOUR

T1 - Short-term variability of repolarization predicts ventricular tachycardia and sudden cardiac death in patients with structural heart disease

T2 - A comparison with QT variability index

AU - Oosterhoff, Peter

AU - Tereshchenko, Larisa

AU - Van Der Heyden, Marcel A G

AU - Ghanem, Raja N.

AU - Fetics, Barry J.

AU - Berger, Ronald D.

AU - Vos, Marc A.

PY - 2011/10

Y1 - 2011/10

N2 - Background: Monitoring arrhythmic risk may improve management of patients with implantable cardioverter-defibrillators (ICD) and prevent ICD shocks. Changes in repolarization duration between subsequent beats quantified as short-term variability (STV) is associated with ventricular arrhythmias in several animal models. Objective: We evaluated STV of QT from right ventricular intracardiac ICD electrograms in patients with structural heart disease and compared its predictive value with the QT variability index (QTVI). Methods: In 233 patients, STV over 60 beats for QT and RR intervals and their ratio was calculated (STV QT, STV RR, STV Ratio, respectively). QTVI was derived from mean and SD of QT and heart rate. Follow-up duration was 26 ± 15 months. Predictive value was determined for sudden arrhythmic death (SAD) defined as sudden cardiac death or fast ventricular tachycardia/fibrillation [CL <240 ms]. Results: In univariate analysis, STV Ratio, but not STV QT or STV RR, was predictive of SAD. Hazard ratios for highest quartile STV Ratio and QTVI were comparable (STV Ratio: 1.9, 95% confidence interval [CI] 1.1 to 3.3, P =.038, QTVI: 2.2, 95% CI 1.2 to 3.8, P =.010). In a multivariate model, highest quartile STV Ratio was predictive of SAD after adjustment for New York Heart Association class, history of ischemia, ICD indication, and use of class I antiarrhythmics (hazard ratio 1.8, 95% CI 1.0 to 3.4, P Ratio and QTVI identified patients at highest risk (hazard ratio 2.4, 95% CI 1.3 to 4.3, P =.005, positive predictive value 38%, negative predictive value 82%). Conclusion: STV Ratio from ICD electrograms is predictive of SAD. Predictive value is similar for order-based STV Ratio and distribution-based QTVI, but the combination of both parameters can further improve results.

AB - Background: Monitoring arrhythmic risk may improve management of patients with implantable cardioverter-defibrillators (ICD) and prevent ICD shocks. Changes in repolarization duration between subsequent beats quantified as short-term variability (STV) is associated with ventricular arrhythmias in several animal models. Objective: We evaluated STV of QT from right ventricular intracardiac ICD electrograms in patients with structural heart disease and compared its predictive value with the QT variability index (QTVI). Methods: In 233 patients, STV over 60 beats for QT and RR intervals and their ratio was calculated (STV QT, STV RR, STV Ratio, respectively). QTVI was derived from mean and SD of QT and heart rate. Follow-up duration was 26 ± 15 months. Predictive value was determined for sudden arrhythmic death (SAD) defined as sudden cardiac death or fast ventricular tachycardia/fibrillation [CL <240 ms]. Results: In univariate analysis, STV Ratio, but not STV QT or STV RR, was predictive of SAD. Hazard ratios for highest quartile STV Ratio and QTVI were comparable (STV Ratio: 1.9, 95% confidence interval [CI] 1.1 to 3.3, P =.038, QTVI: 2.2, 95% CI 1.2 to 3.8, P =.010). In a multivariate model, highest quartile STV Ratio was predictive of SAD after adjustment for New York Heart Association class, history of ischemia, ICD indication, and use of class I antiarrhythmics (hazard ratio 1.8, 95% CI 1.0 to 3.4, P Ratio and QTVI identified patients at highest risk (hazard ratio 2.4, 95% CI 1.3 to 4.3, P =.005, positive predictive value 38%, negative predictive value 82%). Conclusion: STV Ratio from ICD electrograms is predictive of SAD. Predictive value is similar for order-based STV Ratio and distribution-based QTVI, but the combination of both parameters can further improve results.

KW - Arrhythmia

KW - ICD

KW - intracardiac electrogram

KW - Risk stratification

KW - Structural heart disease

KW - Variability or repolarization

UR - http://www.scopus.com/inward/record.url?scp=84860390075&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84860390075&partnerID=8YFLogxK

U2 - 10.1016/j.hrthm.2011.04.033

DO - 10.1016/j.hrthm.2011.04.033

M3 - Article

C2 - 21699842

AN - SCOPUS:84860390075

VL - 8

SP - 1584

EP - 1590

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

IS - 10

ER -