Prediction of ventricular tachyarrhythmias by intracardiac repolarization variability analysis

Larisa G. Tereshchenko, Barry J. Fetics, Peter P. Domitrovich, Bruce D. Lindsay, Ronald D Berger

Research output: Contribution to journalArticle

Abstract

Background-Arrhythmic sudden cardiac death (SCD) is generally mediated by ventricular fibrillation (VF) or fast ventricular tachycardia (FVT). We studied the predictive value of temporal QT variability detected from various sources of cardiac electric signal: surface ECG, far-field (FF), and near-field (NF) intracardiac electrograms (EGMs) in patients with implantable cardioverter-defibrillators (ICDs). Methods and Results-Surface ECG and FF and NF intracardiac EGMs were simultaneously recorded at rest (mean heart rate, 74±15 bpm) for 4.5±1.3 minutes in 298 patients (mean age, 59±14; 216 male [73%]) with structural heart disease and an implanted Medtronic ICD for primary (231 patients, 78%) or secondary (67 patients, 22%) prevention of SCD. During mean follow-up of 16±8 months, 52 (13.1% per person-year of follow-up) patients sustained VT/VF and received appropriate ICD therapies, but only 19 (4.8% per person-year of follow-up) patients sustained FVT/VF with cycle length ≤240 ms. The Kaplan-Meier survival analysis showed that the highest QT variability index (QTVI) quartile from all cardiac sources (surface ECG; NF and FF EGMs) is associated with event-free survival (P=0.038 for ECG; P=0.024 for FF EGM; P=0.012 for NF EGM). QTVI was a predictor of all VT/VF events and FVT/VF in the multivariate Cox model (including ischemic or nonischemic cardiomyopathy, history of revascularization procedures, LVEF, New York Heart Association class). Strong significant correlation among QTVI determined from all 3 sources was found. Conclusion-Repolarization lability is present throughout the ventricular myocardium. Increased intracardiac QT variability predicts VT/VF events in patients with structural heart disease.

Original languageEnglish (US)
Pages (from-to)276-284
Number of pages9
JournalCirculation: Arrhythmia and Electrophysiology
Volume2
Issue number3
DOIs
StatePublished - Jun 2009

Fingerprint

Tachycardia
Ventricular Fibrillation
Implantable Defibrillators
Electrocardiography
Ventricular Tachycardia
Cardiac Electrophysiologic Techniques
Sudden Cardiac Death
Heart Diseases
Kaplan-Meier Estimate
Survival Analysis
Cardiomyopathies
Proportional Hazards Models
Disease-Free Survival
Myocardium
Heart Rate

Keywords

  • Defibrillation
  • Electrophysiology
  • Heart arrest
  • Prognosis
  • Tachyarrhythmias

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Prediction of ventricular tachyarrhythmias by intracardiac repolarization variability analysis. / Tereshchenko, Larisa G.; Fetics, Barry J.; Domitrovich, Peter P.; Lindsay, Bruce D.; Berger, Ronald D.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 2, No. 3, 06.2009, p. 276-284.

Research output: Contribution to journalArticle

Tereshchenko, Larisa G. ; Fetics, Barry J. ; Domitrovich, Peter P. ; Lindsay, Bruce D. ; Berger, Ronald D. / Prediction of ventricular tachyarrhythmias by intracardiac repolarization variability analysis. In: Circulation: Arrhythmia and Electrophysiology. 2009 ; Vol. 2, No. 3. pp. 276-284.
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abstract = "Background-Arrhythmic sudden cardiac death (SCD) is generally mediated by ventricular fibrillation (VF) or fast ventricular tachycardia (FVT). We studied the predictive value of temporal QT variability detected from various sources of cardiac electric signal: surface ECG, far-field (FF), and near-field (NF) intracardiac electrograms (EGMs) in patients with implantable cardioverter-defibrillators (ICDs). Methods and Results-Surface ECG and FF and NF intracardiac EGMs were simultaneously recorded at rest (mean heart rate, 74±15 bpm) for 4.5±1.3 minutes in 298 patients (mean age, 59±14; 216 male [73{\%}]) with structural heart disease and an implanted Medtronic ICD for primary (231 patients, 78{\%}) or secondary (67 patients, 22{\%}) prevention of SCD. During mean follow-up of 16±8 months, 52 (13.1{\%} per person-year of follow-up) patients sustained VT/VF and received appropriate ICD therapies, but only 19 (4.8{\%} per person-year of follow-up) patients sustained FVT/VF with cycle length ≤240 ms. The Kaplan-Meier survival analysis showed that the highest QT variability index (QTVI) quartile from all cardiac sources (surface ECG; NF and FF EGMs) is associated with event-free survival (P=0.038 for ECG; P=0.024 for FF EGM; P=0.012 for NF EGM). QTVI was a predictor of all VT/VF events and FVT/VF in the multivariate Cox model (including ischemic or nonischemic cardiomyopathy, history of revascularization procedures, LVEF, New York Heart Association class). Strong significant correlation among QTVI determined from all 3 sources was found. Conclusion-Repolarization lability is present throughout the ventricular myocardium. Increased intracardiac QT variability predicts VT/VF events in patients with structural heart disease.",
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AU - Lindsay, Bruce D.

AU - Berger, Ronald D

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AB - Background-Arrhythmic sudden cardiac death (SCD) is generally mediated by ventricular fibrillation (VF) or fast ventricular tachycardia (FVT). We studied the predictive value of temporal QT variability detected from various sources of cardiac electric signal: surface ECG, far-field (FF), and near-field (NF) intracardiac electrograms (EGMs) in patients with implantable cardioverter-defibrillators (ICDs). Methods and Results-Surface ECG and FF and NF intracardiac EGMs were simultaneously recorded at rest (mean heart rate, 74±15 bpm) for 4.5±1.3 minutes in 298 patients (mean age, 59±14; 216 male [73%]) with structural heart disease and an implanted Medtronic ICD for primary (231 patients, 78%) or secondary (67 patients, 22%) prevention of SCD. During mean follow-up of 16±8 months, 52 (13.1% per person-year of follow-up) patients sustained VT/VF and received appropriate ICD therapies, but only 19 (4.8% per person-year of follow-up) patients sustained FVT/VF with cycle length ≤240 ms. The Kaplan-Meier survival analysis showed that the highest QT variability index (QTVI) quartile from all cardiac sources (surface ECG; NF and FF EGMs) is associated with event-free survival (P=0.038 for ECG; P=0.024 for FF EGM; P=0.012 for NF EGM). QTVI was a predictor of all VT/VF events and FVT/VF in the multivariate Cox model (including ischemic or nonischemic cardiomyopathy, history of revascularization procedures, LVEF, New York Heart Association class). Strong significant correlation among QTVI determined from all 3 sources was found. Conclusion-Repolarization lability is present throughout the ventricular myocardium. Increased intracardiac QT variability predicts VT/VF events in patients with structural heart disease.

KW - Defibrillation

KW - Electrophysiology

KW - Heart arrest

KW - Prognosis

KW - Tachyarrhythmias

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