BACKGROUND: Only a minority of patients receiving implantable cardioverter-defibrillators (ICDs) for the primary prevention of sudden death receive appropriate shocks, yet almost as many are subjected to inappropriate shocks and device complications. Identifying and quantifying myocardial scar, which forms the substrate for ventricular tachyarrhythmias, may improve risk stratification. OBJECTIVE: This study sought to determine whether the absence of myocardial scar detected by novel 12-lead electrocardiographic (ECG) Selvester QRS scoring criteria identifies patients with low risk for appropriate ICD shocks. METHODS: We applied QRS scoring to 797 patients from the ICD arm of the Sudden Cardiac Death in Heart Failure Trial. Patients were followed up for a median of 45.5 months for ventricular tachycardia/fibrillation treated by the ICD or sudden tachyarrhythmic death (combined group referred to as VT/VF). RESULTS: Increasing QRS score scar size predicted higher rates of VT/VF. Patients with no scar (QRS score = 0) represented a particularly low-risk cohort with 48% fewer VT/VF events than the rest of the population (absolute difference 11%; hazard ratio 0.52, 95% confidence interval 0.31 to 0.88). QRS score scar absence versus presence remained a significant prognostic factor after controlling for 10 clinically relevant variables. Combining QRS score (scar absence versus presence) with ejection fraction (≥ 25% versus < 25%) distinguished low-, middle-, and high-risk subgroups with 73% fewer VT/VF events in the low-risk versus high-risk group (absolute difference 22%; hazard ratio = 0.27, 95% confidence interval 0.12 to 0.62). CONCLUSION: Patients with no scar by QRS scoring have significantly fewer VT/VF events. This inexpensive 12-lead ECG tool provides unique, incremental prognostic information and should be considered in risk-stratifying algorithms for selecting patients for ICDs.
BACKGROUND: Only a minority of patients receiving implantable cardioverter-defibrillators (ICDs) for the primary prevention of sudden death receive appropriate shocks, yet almost as many are subjected to inappropriate shocks and device complications. Identifying and quantifying myocardial scar, which forms the substrate for ventricular tachyarrhythmias, may improve risk stratification. OBJECTIVE: This study sought to determine whether the absence of myocardial scar detected by novel 12-lead electrocardiographic (ECG) Selvester QRS scoring criteria identifies patients with low risk for appropriate ICD shocks. METHODS: We applied QRS scoring to 797 patients from the ICD arm of the Sudden Cardiac Death in Heart Failure Trial. Patients were followed up for a median of 45.5 months for ventricular tachycardia/fibrillation treated by the ICD or sudden tachyarrhythmic death (combined group referred to as VT/VF). RESULTS: Increasing QRS score scar size predicted higher rates of VT/VF. Patients with no scar (QRS score = 0) represented a particularly low-risk cohort with 48% fewer VT/VF events than the rest of the population (absolute difference 11%; hazard ratio 0.52, 95% confidence interval 0.31 to 0.88). QRS score scar absence versus presence remained a significant prognostic factor after controlling for 10 clinically relevant variables. Combining QRS score (scar absence versus presence) with ejection fraction (≥ 25% versus < 25%) distinguished low-, middle-, and high-risk subgroups with 73% fewer VT/VF events in the low-risk versus high-risk group (absolute difference 22%; hazard ratio = 0.27, 95% confidence interval 0.12 to 0.62). CONCLUSION:Patients with no scar by QRS scoring have significantly fewer VT/VF events. This inexpensive 12-lead ECG tool provides unique, incremental prognostic information and should be considered in risk-stratifying algorithms for selecting patients for ICDs.
Authors: Stijntje D Roes; C Jan Willem Borleffs; Rob J van der Geest; Jos J M Westenberg; Nina Ajmone Marsan; Theodorus A M Kaandorp; Johan H C Reiber; Katja Zeppenfeld; Hildo J Lamb; Albert de Roos; Martin J Schalij; Jeroen J Bax Journal: Circ Cardiovasc Imaging Date: 2009-03-23 Impact factor: 7.792
Authors: Arthur J Moss; Wojciech Zareba; W Jackson Hall; Helmut Klein; David J Wilber; David S Cannom; James P Daubert; Steven L Higgins; Mary W Brown; Mark L Andrews Journal: N Engl J Med Date: 2002-03-19 Impact factor: 91.245
Authors: S T Palmeri; D G Harrison; F R Cobb; K G Morris; F E Harrell; R E Ideker; R H Selvester; G S Wagner Journal: N Engl J Med Date: 1982-01-07 Impact factor: 91.245
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Authors: David G Strauss; Ronald H Selvester; João A C Lima; Håkan Arheden; Julie M Miller; Gary Gerstenblith; Eduardo Marbán; Robert G Weiss; Gordon F Tomaselli; Galen S Wagner; Katherine C Wu Journal: Circ Arrhythm Electrophysiol Date: 2008-12-02
Authors: Michael O Sweeney; Rutger J van Bommel; Martin J Schalij; C Jan Willem Borleffs; Anne S Hellkamp; Jeroen J Bax Journal: Circulation Date: 2010-01-25 Impact factor: 29.690
Authors: David G Strauss; Nathan Mewton; Richard L Verrier; Bruce D Nearing; Francis E Marchlinski; Tony Killian; John Moxley; Larisa G Tereshchenko; Katherine C Wu; Raimond Winslow; Christopher Cox; Peter M Spooner; João A C Lima Journal: Circ Arrhythm Electrophysiol Date: 2013-10-12
Authors: Zak Loring; Brett D Atwater; Xiaojuan Xia; Jimmy Axelsson; Igor Klem; Robin Nijveldt; Erik B Schelbert; Jean-Philippe Couderc; David G Strauss; Martin Ugander; Björn Wieslander Journal: J Cardiovasc Electrophysiol Date: 2019-02-19
Authors: Patrick Badertscher; Ivo Strebel; Ursina Honegger; Nicolas Schaerli; Deborah Mueller; Christian Puelacher; Max Wagener; Roger Abächerli; Joan Walter; Zaid Sabti; Lorraine Sazgary; Stella Marbot; Jeanne du Fay de Lavallaz; Raphael Twerenbold; Jasper Boeddinghaus; Thomas Nestelberger; Nikola Kozhuharov; Tobias Breidthardt; Samyut Shrestha; Dayana Flores; Carmela Schumacher; Damian Wild; Stefan Osswald; Michael J Zellweger; Christian Mueller; Tobias Reichlin Journal: Clin Res Cardiol Date: 2018-04-17 Impact factor: 5.460
Authors: Zak Loring; Wojciech Zareba; Scott McNitt; David G Strauss; Galen S Wagner; James P Daubert Journal: Ann Noninvasive Electrocardiol Date: 2013-06-09 Impact factor: 1.468