Ventricular arrhythmia is predicted by sum absolute QRST integralbut not by QRS width

Larisa Tereshchenko, Alan Cheng, Barry J. Fetics, Joseph E. Marine, David D. Spragg, Sunil Sinha, Hugh Calkins, Gordon F. Tomaselli, Ronald D. Berger

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)548-552
Number of pages5
JournalJournal of Electrocardiology
Volume43
Issue number6
DOIs
StatePublished - Nov 2010
Externally publishedYes

Fingerprint

Cardiac Arrhythmias
Implantable Defibrillators
Ventricular Fibrillation
Ventricular Tachycardia
Primary Prevention
Confidence Intervals
Proportional Hazards Models
Tachycardia
Heart Diseases
Electrocardiography
Therapeutics

Keywords

  • Implantable cardioverter-defibrillator
  • QRS
  • Risk stratification
  • Ventricular tachyarrhythmia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Ventricular arrhythmia is predicted by sum absolute QRST integralbut not by QRS width. / Tereshchenko, Larisa; Cheng, Alan; Fetics, Barry J.; Marine, Joseph E.; Spragg, David D.; Sinha, Sunil; Calkins, Hugh; Tomaselli, Gordon F.; Berger, Ronald D.

In: Journal of Electrocardiology, Vol. 43, No. 6, 11.2010, p. 548-552.

Research output: Contribution to journalArticle

Tereshchenko, L, Cheng, A, Fetics, BJ, Marine, JE, Spragg, DD, Sinha, S, Calkins, H, Tomaselli, GF & Berger, RD 2010, 'Ventricular arrhythmia is predicted by sum absolute QRST integralbut not by QRS width', Journal of Electrocardiology, vol. 43, no. 6, pp. 548-552. https://doi.org/10.1016/j.jelectrocard.2010.07.013
Tereshchenko, Larisa ; Cheng, Alan ; Fetics, Barry J. ; Marine, Joseph E. ; Spragg, David D. ; Sinha, Sunil ; Calkins, Hugh ; Tomaselli, Gordon F. ; Berger, Ronald D. / Ventricular arrhythmia is predicted by sum absolute QRST integralbut not by QRS width. In: Journal of Electrocardiology. 2010 ; Vol. 43, No. 6. pp. 548-552.
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abstract = "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.",
keywords = "Implantable cardioverter-defibrillator, QRS, Risk stratification, Ventricular tachyarrhythmia",
author = "Larisa Tereshchenko and Alan Cheng and Fetics, {Barry J.} and Marine, {Joseph E.} and Spragg, {David D.} and Sunil Sinha and Hugh Calkins and Tomaselli, {Gordon F.} and Berger, {Ronald D.}",
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AU - Tereshchenko, Larisa

AU - Cheng, Alan

AU - Fetics, Barry J.

AU - Marine, Joseph E.

AU - Spragg, David D.

AU - Sinha, Sunil

AU - Calkins, Hugh

AU - Tomaselli, Gordon F.

AU - Berger, Ronald D.

PY - 2010/11

Y1 - 2010/11

N2 - 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.

AB - 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.

KW - Implantable cardioverter-defibrillator

KW - QRS

KW - Risk stratification

KW - Ventricular tachyarrhythmia

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