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Hnatkova K, Andršová I, Novotný T, Vanderberk B, Sprenkeler D, Junttila J, Reichlin T, Schlögl S, Vos MA, Friede T, Bauer A, Huikuri HV, Willems R, Schmidt G, Sticherling C, Zabel M, Malik M. QRS complex and T wave planarity for the efficacy prediction of automatic implantable defibrillators. Heart 2024; 110:178-187. [PMID: 37714697 PMCID: PMC10850677 DOI: 10.1136/heartjnl-2023-322878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/19/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE To test the hypothesis that in recipients of primary prophylactic implantable cardioverter-defibrillators (ICDs), the non-planarity of ECG vector loops predicts (a) deaths despite ICD protection and (b) appropriate ICD shocks. METHODS Digital pre-implant ECGs were collected in 1948 ICD recipients: 21.4% females, median age 65 years, 61.5% ischaemic heart disease (IHD). QRS and T wave three-dimensional loops were constructed using singular value decomposition that allowed to measure the vector loop planarity. The non-planarity, that is, the twist of the three-dimensional loops out of a single plane, was related to all-cause mortality (n=294; 15.3% females; 68.7% IHD) and appropriate ICD shocks (n=162; 10.5% females; 87.7% IHD) during 5-year follow-up after device implantation. Using multivariable Cox regression, the predictive power of QRS and T wave non-planarity was compared with that of age, heart rate, left ventricular ejection fraction, QRS duration, spatial QRS-T angle, QTc interval and T-peak to T-end interval. RESULTS QRS non-planarity was significantly (p<0.001) associated with follow-up deaths despite ICD protection with HR of 1.339 (95% CI 1.165 to 1.540) but was only univariably associated with appropriate ICD shocks. Non-planarity of the T wave loop was the only ECG-derived index significantly (p<0.001) associated with appropriate ICD shocks with multivariable Cox regression HR of 1.364 (1.180 to 1.576) but was not associated with follow-up mortality. CONCLUSIONS The analysed data suggest that QRS and T wave non-planarity might offer distinction between patients who are at greater risk of death despite ICD protection and those who are likely to use the defibrillator protection.
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Affiliation(s)
- Katerina Hnatkova
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Irena Andršová
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
- Department of Internal Medicine and Cardiology, Masaryk University, Brno, Czech Republic
| | - Tomáš Novotný
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
- Department of Internal Medicine and Cardiology, Masaryk University, Brno, Czech Republic
| | - Bert Vanderberk
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - David Sprenkeler
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Juhani Junttila
- MRC Oulu, University Central Hospital of Oulu and University of Oulu, Oulu, Finland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Simon Schlögl
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Gottingen, Germany
- German Center of Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Marc A Vos
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tim Friede
- German Center of Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Axel Bauer
- University Hospital for Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Heikki V Huikuri
- University Central Hospital of Oulu and University of Oulu, Oulu, Finland
| | - Rik Willems
- Division of Experimental Cardiology, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
- Division of Clinical Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Georg Schmidt
- Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | | | - Markus Zabel
- German Center of Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
- Cardiology and Pneumology, Heart Center, University Hospital Göttingen, Göttingen, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
- Department of Internal Medicine and Cardiology, Masaryk University, Brno, Czech Republic
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Bergau L, Willems R, Tuinenburg A, Vos MA, Flevari P, Luethje L, Fischer TH, Vandenberk B, Sprenkeler D, Roever C, Hasenfuss G, Lehnart SE, Friede T, Zabel M. P1223Prediction model for shock risk and mortality in ICD patients. Europace 2018. [DOI: 10.1093/europace/euy015.705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L Bergau
- University Medical Center Goettingen, Goettingen, Germany
| | - R Willems
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - A Tuinenburg
- University Medical Center Utrecht, Utrecht, Netherlands
| | - M A Vos
- University Medical Center Utrecht, Utrecht, Netherlands
| | - P Flevari
- Attikon University Hospital, Athens, Greece
| | - L Luethje
- University Medical Center Goettingen, Goettingen, Germany
| | - T H Fischer
- University Medical Center Goettingen, Goettingen, Germany
| | - B Vandenberk
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - D Sprenkeler
- University Medical Center Utrecht, Utrecht, Netherlands
| | - C Roever
- University Medical Center Goettingen, Goettingen, Germany
| | - G Hasenfuss
- University Medical Center Goettingen, Goettingen, Germany
| | - S E Lehnart
- University Medical Center Goettingen, Goettingen, Germany
| | - T Friede
- University Medical Center Goettingen, Goettingen, Germany
| | - M Zabel
- University Medical Center Goettingen, Goettingen, Germany
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