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Fragmented QRS as a predictor of arrhythmic events in patients with hypertrophic obstructive cardiomyopathy |
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| Authors: | Francisco Femenía Maurico Arce Jorge Van Grieken Emilce Trucco Luis Mont Mauricio Abello José L Merino Máximo Rivero-Ayerza Bulent Gorenek Carlos Rodriguez Wilma M Hopman Adrian Baranchuk |
| Institution: | 1. Arrhythmia Unit, Department of Cardiology, Hospital Espa?ol de Mendoza, Mendoza, Argentina 2. Cardiovascular Institute, Villa Mercedes, San Luis, 5730, Argentina 3. Arrhythmia Service, Thorax Institute, Hospital Clinic, Barcelona, Spain 4. Arrhythmia Service, FLENI, Buenos Aires, Argentina 5. Robotic Cardiac Electrophysiology Unit, Department of Cardiology, University Hospital La Paz, Madrid, Madrid, Spain 6. Department of Cardiovascular Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium 7. Eskisehir Osmangazi University, Cardiology Department, Eskisehir, Turkey 8. Department of Arrhythmia and Pacemaker, IECTAS, Maracaibo, Venezuela 9. Arrhythmia Service, Kingston General Hospital, Queen’s University, Kingston, ON, Canada |
| Abstract: | ObjectivesThis study aims to determine whether fragmented QRS (fQRS) in the surface electrocardiogram (ECG) at implantable cardioverter defibrillator (ICD) implant can predict arrhythmic events using appropriate therapy delivered by the ICD as a surrogate.BackgroundHypertrophic obstructive cardiomyopathy (HOCM) is a genetic disorder associated with life-threatening arrhythmias frequently requiring an ICD. Seeking a noninvasive method of risk stratification remains a challenge.MethodsThis paper is a retrospective, multicenter study of patients with HOCM and ICD. Surface 12-lead ECGs were analyzed. Appropriate therapy was validated by a blinded Core Lab. Univariate and multivariate analyses were performed. A p value of <0.05 was considered significant.ResultsWe included 102 patients from 13 centers. Mean age at implant was 41.16?±?18.25 years, 52 % were male. Mean left ventricular ejection fraction was 61.56?±?9.46 % and two thirds had heart failure according to the New York Heart Association class I. Secondary prophylaxis ICD implantation was the indication for implant in 40.2 % of cases. About half received a single-chamber ICD. fQRS was present at the time of diagnosis in 21 and in 54 % at ICD implant. At a mean follow-up of 47.8?±?39.3 months, 41 patients (40.2 %) presented with appropriate therapy. In a multivariate logistic regression, predictors of appropriate therapy included fQRS at implant (odds ratio OR], 16.4; 95 % confidence interval CI], 3.6–74.0; p?=?0.0003), history of combined ventricular tachycardia/fibrillation/sudden death (OR, 14.3; 95 % CI, 3.2–69.3; p?=?0.001) and history of syncope (OR, 5.5; 95 % CI, 1.5–20.4; p?=?0.009). Ten deaths (9.8 %) occurred during the follow-up. fQRS in the lateral location increased the risk of appropriate therapy (p?<?0.0001).ConclusionsfQRS predicts arrhythmic events in patients with HOCM and should be considered in a model of risk stratification. |
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