A new electrocardiogram marker to identify patients at low risk for ventricular tachyarrhythmias: Sum magnitude of the absolute QRST integral

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

Research output: Contribution to journalArticle


Objective: We proposed and tested a novel electrocardiogram marker of risk of ventricular arrhythmias (VAs). Methods: Digital orthogonal electrocardiograms were recorded at rest before implantable cardioverter-defibrillator (ICD) implantation in 508 participants of a primary prevention ICDs prospective cohort study (mean ± SD age, 60 ± 12 years; 377 male [74%]). The sum magnitude of the absolute QRST integral in 3 orthogonal leads (SAI QRST) was calculated. A derivation cohort of 128 patients was used to define a cutoff; a validation cohort (n = 380) was used to test a predictive value. Results: During a mean follow-up of 18 months, 58 patients received appropriate ICD therapies. The SAI QRST was lower in patients with VA (105.2 ± 60.1 vs 138.4 ± 85.7 mV - ms, P = .002). In the Cox proportional hazards analysis, patients with SAI QRST not exceeding 145 mV - ms had about 4-fold higher risk of VA (hazard ratio, 3.6; 95% confidence interval, 1.96-6.71; P < .0001) and a 6-fold higher risk of monomorphic ventricular tachycardia (hazard ratio, 6.58; 95% confidence interval, 1.46-29.69; P = .014), whereas prediction of polymorphic ventricular tachycardia or ventricular fibrillation did not reach statistical significance. Conclusion: High SAI QRST is associated with low risk of sustained VA in patients with structural heart disease.

Original languageEnglish (US)
Pages (from-to)208-216
Number of pages9
JournalJournal of Electrocardiology
Issue number2
StatePublished - Mar 1 2011


ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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