Usefulness of QRS prolongation in predicting risk of inducible monomorphic ventricular tachycardia in patients referred for electrophysiologic studies

QRS prolongation on surface electrocardiography has been identified as a marker for increased cardiac mortality. A potential mechanism for increased mortality is ventricular tachycardia (VT). This study aimed to evaluate the relation between bundle branch block and sustained monomorphic VT inducibility in patients referred for electrophysiologic studies. We analyzed a cohort of 777 patients (age 63 +/- 18 years, 67% men, left ventricular [LV] ejection fraction [EF] 45% +/- 16, prior myocardial infarction 41%) referred for electrophysiologic studies between 1994 and 2001 who underwent programmed stimulation for VT. Forty-five percent of patients were referred for syncope or a history of VT and/or ventricular fibrillation. Thirty-one percent of patients had prolonged QRS duration (> or =120 ms). Patients with prolonged QRS duration were older, had lower LVEFs, and were more likely to have a history of myocardial infarction. Prolonged QRS was a significant predictor of sustained monomorphic VT inducibility (p <0.0001). On multivariate analysis correcting for age, sex, LVEF, history of myocardial infarction, medications, and QRS conduction delay proved to be independently associated with sustained monomorphic VT inducibility (relative risk 3.290, 95% confidence interval 2.185 to 4.953 for prolonged vs normal QRS duration). Thus, a prolonged QRS duration on surface electrocardiography is a strong, independent predictor of inducible sustained monomorphic VT. Conduction delay may be an important risk factor, providing a substrate for the development of reentrant monomorphic VT, and furthermore suggests a potential mechanism for the increased mortality observed in patients with prolonged QRS.