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Das M, Suszko AM, Nayyar S, Viswanathan K, Spears DA, Tomlinson G, Pinter A, Crystal E, Dalvi R, Krishnan S, Chauhan VS. Automated Quantification of Low-Amplitude Abnormal QRS Peaks From High-Resolution ECG Recordings Predicts Arrhythmic Events in Patients With Cardiomyopathy. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004874. [PMID: 28705874 DOI: 10.1161/circep.116.004874] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 06/08/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiomyopathy patients are at risk of sudden death, typically from scar-related abnormalities of electrical activation that promote ventricular tachyarrhythmias. Abnormal intra-QRS peaks may provide a measure of altered activation. We hypothesized that quantification of such QRS peaks (QRSp) in high-resolution ECGs would predict arrhythmic events in implantable cardioverter-defibrillator (ICD)-eligible cardiomyopathy patients. METHODS AND RESULTS Ninety-nine patients with ischemic or non-ischemic dilated cardiomyopathy undergoing prophylactic ICD implantation were prospectively enrolled (age 62±11 years, left ventricular ejection fraction 27±7%). High-resolution (1024 Hz) digital 12-lead ECGs were recorded during intrinsic rhythm. QRSp was quantified for each precordial lead as the total number of low-amplitude deflections that deviated from their respective naive QRS template. The primary end point of arrhythmic events was defined as appropriate ICD therapy or sustained ventricular tachyarrhythmias. After a median follow-up of 24 (15-43) months, 20 (20%) patients had arrhythmic events. Both QRSp and QRS duration were greater in those with arrhythmic events (both P<0.001) and this was consistent for QRSp for both cardiomyopathy types. In a multivariable Cox regression model that included age, left ventricular ejection fraction, QRS duration, and QRSp, only QRSp was an independent predictor of arrhythmic events (hazard ratio, 2.1; P<0.001). Receiver operating characteristic analysis revealed that a QRSp ≥2.25 identified arrhythmic events with greater sensitivity (100% versus 70%, P<0.05) and negative predictive value (100% versus 89%, P<0.05) than QRS duration ≥120 ms. CONCLUSIONS QRSp measured from high-resolution digital 12-lead ECGs independently predicts ventricular tachyarrhythmias in ICD-eligible cardiomyopathy patients. This novel QRS morphology index has the potential to improve sudden death risk stratification and patient selection for prophylactic ICD therapy.
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Affiliation(s)
- Moloy Das
- From the Peter Munk Cardiac Center, Division of Cardiology, University Health Network, Toronto, Ontario, Canada (M.D., A.M.S., S.N., K.V., D.A.S., G.T., R.D., V.S.C.); Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom (M.D.); Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada (A.P.); Division of Cardiology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada (E.C.); and Department of Electrical and Computer Engineering, Ryerson University, Toronto, Ontario, Canada (S.K.)
| | - Adrian M Suszko
- From the Peter Munk Cardiac Center, Division of Cardiology, University Health Network, Toronto, Ontario, Canada (M.D., A.M.S., S.N., K.V., D.A.S., G.T., R.D., V.S.C.); Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom (M.D.); Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada (A.P.); Division of Cardiology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada (E.C.); and Department of Electrical and Computer Engineering, Ryerson University, Toronto, Ontario, Canada (S.K.)
| | - Sachin Nayyar
- From the Peter Munk Cardiac Center, Division of Cardiology, University Health Network, Toronto, Ontario, Canada (M.D., A.M.S., S.N., K.V., D.A.S., G.T., R.D., V.S.C.); Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom (M.D.); Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada (A.P.); Division of Cardiology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada (E.C.); and Department of Electrical and Computer Engineering, Ryerson University, Toronto, Ontario, Canada (S.K.)
| | - Karthik Viswanathan
- From the Peter Munk Cardiac Center, Division of Cardiology, University Health Network, Toronto, Ontario, Canada (M.D., A.M.S., S.N., K.V., D.A.S., G.T., R.D., V.S.C.); Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom (M.D.); Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada (A.P.); Division of Cardiology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada (E.C.); and Department of Electrical and Computer Engineering, Ryerson University, Toronto, Ontario, Canada (S.K.)
| | - Danna A Spears
- From the Peter Munk Cardiac Center, Division of Cardiology, University Health Network, Toronto, Ontario, Canada (M.D., A.M.S., S.N., K.V., D.A.S., G.T., R.D., V.S.C.); Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom (M.D.); Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada (A.P.); Division of Cardiology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada (E.C.); and Department of Electrical and Computer Engineering, Ryerson University, Toronto, Ontario, Canada (S.K.)
| | - George Tomlinson
- From the Peter Munk Cardiac Center, Division of Cardiology, University Health Network, Toronto, Ontario, Canada (M.D., A.M.S., S.N., K.V., D.A.S., G.T., R.D., V.S.C.); Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom (M.D.); Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada (A.P.); Division of Cardiology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada (E.C.); and Department of Electrical and Computer Engineering, Ryerson University, Toronto, Ontario, Canada (S.K.)
| | - Arnold Pinter
- From the Peter Munk Cardiac Center, Division of Cardiology, University Health Network, Toronto, Ontario, Canada (M.D., A.M.S., S.N., K.V., D.A.S., G.T., R.D., V.S.C.); Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom (M.D.); Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada (A.P.); Division of Cardiology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada (E.C.); and Department of Electrical and Computer Engineering, Ryerson University, Toronto, Ontario, Canada (S.K.)
| | - Eugene Crystal
- From the Peter Munk Cardiac Center, Division of Cardiology, University Health Network, Toronto, Ontario, Canada (M.D., A.M.S., S.N., K.V., D.A.S., G.T., R.D., V.S.C.); Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom (M.D.); Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada (A.P.); Division of Cardiology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada (E.C.); and Department of Electrical and Computer Engineering, Ryerson University, Toronto, Ontario, Canada (S.K.)
| | - Rupin Dalvi
- From the Peter Munk Cardiac Center, Division of Cardiology, University Health Network, Toronto, Ontario, Canada (M.D., A.M.S., S.N., K.V., D.A.S., G.T., R.D., V.S.C.); Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom (M.D.); Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada (A.P.); Division of Cardiology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada (E.C.); and Department of Electrical and Computer Engineering, Ryerson University, Toronto, Ontario, Canada (S.K.)
| | - Sridhar Krishnan
- From the Peter Munk Cardiac Center, Division of Cardiology, University Health Network, Toronto, Ontario, Canada (M.D., A.M.S., S.N., K.V., D.A.S., G.T., R.D., V.S.C.); Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom (M.D.); Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada (A.P.); Division of Cardiology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada (E.C.); and Department of Electrical and Computer Engineering, Ryerson University, Toronto, Ontario, Canada (S.K.)
| | - Vijay S Chauhan
- From the Peter Munk Cardiac Center, Division of Cardiology, University Health Network, Toronto, Ontario, Canada (M.D., A.M.S., S.N., K.V., D.A.S., G.T., R.D., V.S.C.); Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom (M.D.); Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada (A.P.); Division of Cardiology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada (E.C.); and Department of Electrical and Computer Engineering, Ryerson University, Toronto, Ontario, Canada (S.K.).
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