ECG as a risk stratification tool in patients with wearable cardioverter-defibrillator
The wearable cardioverter defibrillator (WCD) is increasingly used in patients at elevated risk for ventricular arrhythmias but not fulfilling the indications for an implantable cardioverter defibrillator (ICD). Currently, there is an insufficient risk prediction of fatal arrhythmias in patients at...
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| Veröffentlicht in: | Journal of cardiology 2022-12, Vol.80 (6), p.573-577 |
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| creator | Gassanov, Natig Mutallimov, Mirza Caglayan, Evren Erdmann, Erland Er, Fikret |
| description | The wearable cardioverter defibrillator (WCD) is increasingly used in patients at elevated risk for ventricular arrhythmias but not fulfilling the indications for an implantable cardioverter defibrillator (ICD). Currently, there is an insufficient risk prediction of fatal arrhythmias in patients at risk. In this study, we assessed the prognostic role of baseline electrocardiogram (ECG) in WCD patients.
WCD patients from diverse clinical institutions in Germany (n = 227) were retrospectively enrolled and investigated for the incidences of death or ventricular arrhythmias during WCD wearing. In addition, the widely accepted ECG predictors of adverse outcome were analyzed in patients with arrhythmic events.
Life-threatening arrhythmias occurred in 22 (9.7 %) patients, mostly in subjects with ischemic heart disease (15 of 22). There was no difference in baseline left ventricular ejection fraction (LVEF) in subjects with and without arrhythmic events (31.3 ± 7.9 % vs. 32.6 ± 8.3 %; p = 0,24). Patients with arrhythmia exhibited significantly longer QRS duration (109.5 ± 23.1 ms vs. 100.6 ± 22.3 ms, p = 0,04), Tpeak-Tend (Tp-e) (103.1 ± 15.6 ms vs. 93.2 ± 19.2 ms, p = 0,01) and QTc (475.0 ± 60.0 ms vs. 429.6 ± 59.4 ms, p |
| doi_str_mv | 10.1016/j.jjcc.2022.08.001 |
| format | Article |
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WCD patients from diverse clinical institutions in Germany (n = 227) were retrospectively enrolled and investigated for the incidences of death or ventricular arrhythmias during WCD wearing. In addition, the widely accepted ECG predictors of adverse outcome were analyzed in patients with arrhythmic events.
Life-threatening arrhythmias occurred in 22 (9.7 %) patients, mostly in subjects with ischemic heart disease (15 of 22). There was no difference in baseline left ventricular ejection fraction (LVEF) in subjects with and without arrhythmic events (31.3 ± 7.9 % vs. 32.6 ± 8.3 %; p = 0,24). Patients with arrhythmia exhibited significantly longer QRS duration (109.5 ± 23.1 ms vs. 100.6 ± 22.3 ms, p = 0,04), Tpeak-Tend (Tp-e) (103.1 ± 15.6 ms vs. 93.2 ± 19.2 ms, p = 0,01) and QTc (475.0 ± 60.0 ms vs. 429.6 ± 59.4 ms, p < 0,001) intervals. In contrast, no significant differences were found for incidences of fragmented QRS (27.3 % vs. 24 %, p = 0.79) and inverted/biphasic T-waves (16.6 % vs. 22.7 %, p = 0,55). In multivariate regression analysis both Tp-e (HR 1.03; 95 % CI 1.001–1.057; p = 0.02) and QTc (HR 1.02; 95 % CI 1.006–1.026; p < 0.001) were identified as independent predictors of ventricular arrhythmias.
After WCD use, the prophylactic ICD was indicated in 76 patients (33 %) with uneventful clinical course but persistent LVEF ≤35 %. The ECG analysis in these subjects did not reveal any relevant changes in arrhythmogenesis markers.
ECG repolarization markers Tp-e and QTc are associated with malignant arrhythmias in WCD patients and may be used - in addition to other established risk markers - to identify appropriate patients for ICD implantation.
[Display omitted]
•The wearable cardioverter defibrillator is safe and effective in patients with elevated risk for fatal arrhythmias.•Tp-e and QTc are independent electrocardiographic (ECG) predictors of adverse events in these patients.•ECG can serve as an additional risk stratification tool in this high-risk subgroup.</description><identifier>ISSN: 0914-5087</identifier><identifier>EISSN: 1876-4738</identifier><identifier>DOI: 10.1016/j.jjcc.2022.08.001</identifier><identifier>PMID: 35985868</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Arrhythmias, Cardiac - diagnosis ; Arrhythmias, Cardiac - etiology ; Arrhythmias, Cardiac - therapy ; Death, Sudden, Cardiac - epidemiology ; Death, Sudden, Cardiac - etiology ; Death, Sudden, Cardiac - prevention & control ; Defibrillator ; Defibrillators, Implantable - adverse effects ; Electric Countershock - adverse effects ; Electrocardiogram ; Electrocardiography ; Humans ; Retrospective Studies ; Risk Assessment ; Stroke Volume ; Sudden cardiac death ; Ventricular Function, Left ; Wearable Electronic Devices - adverse effects</subject><ispartof>Journal of cardiology, 2022-12, Vol.80 (6), p.573-577</ispartof><rights>2022 Elsevier Ltd</rights><rights>Copyright © 2022 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3391-9975e08c798aa3ea7b2c28136f20c4a0deab5abfe5a254fa07894e9bc102d7f03</citedby><cites>FETCH-LOGICAL-c3391-9975e08c798aa3ea7b2c28136f20c4a0deab5abfe5a254fa07894e9bc102d7f03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jjcc.2022.08.001$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35985868$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gassanov, Natig</creatorcontrib><creatorcontrib>Mutallimov, Mirza</creatorcontrib><creatorcontrib>Caglayan, Evren</creatorcontrib><creatorcontrib>Erdmann, Erland</creatorcontrib><creatorcontrib>Er, Fikret</creatorcontrib><title>ECG as a risk stratification tool in patients with wearable cardioverter-defibrillator</title><title>Journal of cardiology</title><addtitle>J Cardiol</addtitle><description>The wearable cardioverter defibrillator (WCD) is increasingly used in patients at elevated risk for ventricular arrhythmias but not fulfilling the indications for an implantable cardioverter defibrillator (ICD). Currently, there is an insufficient risk prediction of fatal arrhythmias in patients at risk. In this study, we assessed the prognostic role of baseline electrocardiogram (ECG) in WCD patients.
WCD patients from diverse clinical institutions in Germany (n = 227) were retrospectively enrolled and investigated for the incidences of death or ventricular arrhythmias during WCD wearing. In addition, the widely accepted ECG predictors of adverse outcome were analyzed in patients with arrhythmic events.
Life-threatening arrhythmias occurred in 22 (9.7 %) patients, mostly in subjects with ischemic heart disease (15 of 22). There was no difference in baseline left ventricular ejection fraction (LVEF) in subjects with and without arrhythmic events (31.3 ± 7.9 % vs. 32.6 ± 8.3 %; p = 0,24). Patients with arrhythmia exhibited significantly longer QRS duration (109.5 ± 23.1 ms vs. 100.6 ± 22.3 ms, p = 0,04), Tpeak-Tend (Tp-e) (103.1 ± 15.6 ms vs. 93.2 ± 19.2 ms, p = 0,01) and QTc (475.0 ± 60.0 ms vs. 429.6 ± 59.4 ms, p < 0,001) intervals. In contrast, no significant differences were found for incidences of fragmented QRS (27.3 % vs. 24 %, p = 0.79) and inverted/biphasic T-waves (16.6 % vs. 22.7 %, p = 0,55). In multivariate regression analysis both Tp-e (HR 1.03; 95 % CI 1.001–1.057; p = 0.02) and QTc (HR 1.02; 95 % CI 1.006–1.026; p < 0.001) were identified as independent predictors of ventricular arrhythmias.
After WCD use, the prophylactic ICD was indicated in 76 patients (33 %) with uneventful clinical course but persistent LVEF ≤35 %. The ECG analysis in these subjects did not reveal any relevant changes in arrhythmogenesis markers.
ECG repolarization markers Tp-e and QTc are associated with malignant arrhythmias in WCD patients and may be used - in addition to other established risk markers - to identify appropriate patients for ICD implantation.
[Display omitted]
•The wearable cardioverter defibrillator is safe and effective in patients with elevated risk for fatal arrhythmias.•Tp-e and QTc are independent electrocardiographic (ECG) predictors of adverse events in these patients.•ECG can serve as an additional risk stratification tool in this high-risk subgroup.</description><subject>Arrhythmias, Cardiac - diagnosis</subject><subject>Arrhythmias, Cardiac - etiology</subject><subject>Arrhythmias, Cardiac - therapy</subject><subject>Death, Sudden, Cardiac - epidemiology</subject><subject>Death, Sudden, Cardiac - etiology</subject><subject>Death, Sudden, Cardiac - prevention & control</subject><subject>Defibrillator</subject><subject>Defibrillators, Implantable - adverse effects</subject><subject>Electric Countershock - adverse effects</subject><subject>Electrocardiogram</subject><subject>Electrocardiography</subject><subject>Humans</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Stroke Volume</subject><subject>Sudden cardiac death</subject><subject>Ventricular Function, Left</subject><subject>Wearable Electronic Devices - adverse effects</subject><issn>0914-5087</issn><issn>1876-4738</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1PHDEMhqOqVdlC_wAHlCOXmTqZjyRSL9UKaCWkXlqukSfjUTPMbpYkC-Lfk9UCx15sWXr8yn4YOxdQCxD9t7meZ-dqCVLWoGsA8YGthFZ91apGf2QrMKKtOtDqhH1JaQbowej-MztpOqM73esVu7ta33BMHHn06Z6nHDH7ybtSw5bnEBbut3xXRtrmxJ98_sefCCMOC3GHcfThkWKmWI00-SH6ZcEc4hn7NOGS6OtrP2V_r6_-rH9Wt79vfq1_3FauaYyojFEdgXbKaMSGUA3SSS2afpLgWoSRcOhwmKhD2bUTgtKmJTM4AXJUEzSn7PKYu4vhYU8p241PjsoRWwr7ZKWCVveqkW1B5RF1MaQUabK76DcYn60Ae_BpZ3vwaQ8-LWhbfJali9f8_bCh8X3lTWABvh8BKl8-eoo2uaLK0egjuWzH4P-X_wKrLId5</recordid><startdate>202212</startdate><enddate>202212</enddate><creator>Gassanov, Natig</creator><creator>Mutallimov, Mirza</creator><creator>Caglayan, Evren</creator><creator>Erdmann, Erland</creator><creator>Er, Fikret</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202212</creationdate><title>ECG as a risk stratification tool in patients with wearable cardioverter-defibrillator</title><author>Gassanov, Natig ; Mutallimov, Mirza ; Caglayan, Evren ; Erdmann, Erland ; Er, Fikret</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3391-9975e08c798aa3ea7b2c28136f20c4a0deab5abfe5a254fa07894e9bc102d7f03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Arrhythmias, Cardiac - diagnosis</topic><topic>Arrhythmias, Cardiac - etiology</topic><topic>Arrhythmias, Cardiac - therapy</topic><topic>Death, Sudden, Cardiac - epidemiology</topic><topic>Death, Sudden, Cardiac - etiology</topic><topic>Death, Sudden, Cardiac - prevention & control</topic><topic>Defibrillator</topic><topic>Defibrillators, Implantable - adverse effects</topic><topic>Electric Countershock - adverse effects</topic><topic>Electrocardiogram</topic><topic>Electrocardiography</topic><topic>Humans</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Stroke Volume</topic><topic>Sudden cardiac death</topic><topic>Ventricular Function, Left</topic><topic>Wearable Electronic Devices - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gassanov, Natig</creatorcontrib><creatorcontrib>Mutallimov, Mirza</creatorcontrib><creatorcontrib>Caglayan, Evren</creatorcontrib><creatorcontrib>Erdmann, Erland</creatorcontrib><creatorcontrib>Er, Fikret</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gassanov, Natig</au><au>Mutallimov, Mirza</au><au>Caglayan, Evren</au><au>Erdmann, Erland</au><au>Er, Fikret</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>ECG as a risk stratification tool in patients with wearable cardioverter-defibrillator</atitle><jtitle>Journal of cardiology</jtitle><addtitle>J Cardiol</addtitle><date>2022-12</date><risdate>2022</risdate><volume>80</volume><issue>6</issue><spage>573</spage><epage>577</epage><pages>573-577</pages><issn>0914-5087</issn><eissn>1876-4738</eissn><abstract>The wearable cardioverter defibrillator (WCD) is increasingly used in patients at elevated risk for ventricular arrhythmias but not fulfilling the indications for an implantable cardioverter defibrillator (ICD). Currently, there is an insufficient risk prediction of fatal arrhythmias in patients at risk. In this study, we assessed the prognostic role of baseline electrocardiogram (ECG) in WCD patients.
WCD patients from diverse clinical institutions in Germany (n = 227) were retrospectively enrolled and investigated for the incidences of death or ventricular arrhythmias during WCD wearing. In addition, the widely accepted ECG predictors of adverse outcome were analyzed in patients with arrhythmic events.
Life-threatening arrhythmias occurred in 22 (9.7 %) patients, mostly in subjects with ischemic heart disease (15 of 22). There was no difference in baseline left ventricular ejection fraction (LVEF) in subjects with and without arrhythmic events (31.3 ± 7.9 % vs. 32.6 ± 8.3 %; p = 0,24). Patients with arrhythmia exhibited significantly longer QRS duration (109.5 ± 23.1 ms vs. 100.6 ± 22.3 ms, p = 0,04), Tpeak-Tend (Tp-e) (103.1 ± 15.6 ms vs. 93.2 ± 19.2 ms, p = 0,01) and QTc (475.0 ± 60.0 ms vs. 429.6 ± 59.4 ms, p < 0,001) intervals. In contrast, no significant differences were found for incidences of fragmented QRS (27.3 % vs. 24 %, p = 0.79) and inverted/biphasic T-waves (16.6 % vs. 22.7 %, p = 0,55). In multivariate regression analysis both Tp-e (HR 1.03; 95 % CI 1.001–1.057; p = 0.02) and QTc (HR 1.02; 95 % CI 1.006–1.026; p < 0.001) were identified as independent predictors of ventricular arrhythmias.
After WCD use, the prophylactic ICD was indicated in 76 patients (33 %) with uneventful clinical course but persistent LVEF ≤35 %. The ECG analysis in these subjects did not reveal any relevant changes in arrhythmogenesis markers.
ECG repolarization markers Tp-e and QTc are associated with malignant arrhythmias in WCD patients and may be used - in addition to other established risk markers - to identify appropriate patients for ICD implantation.
[Display omitted]
•The wearable cardioverter defibrillator is safe and effective in patients with elevated risk for fatal arrhythmias.•Tp-e and QTc are independent electrocardiographic (ECG) predictors of adverse events in these patients.•ECG can serve as an additional risk stratification tool in this high-risk subgroup.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>35985868</pmid><doi>10.1016/j.jjcc.2022.08.001</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Arrhythmias, Cardiac - diagnosis Arrhythmias, Cardiac - etiology Arrhythmias, Cardiac - therapy Death, Sudden, Cardiac - epidemiology Death, Sudden, Cardiac - etiology Death, Sudden, Cardiac - prevention & control Defibrillator Defibrillators, Implantable - adverse effects Electric Countershock - adverse effects Electrocardiogram Electrocardiography Humans Retrospective Studies Risk Assessment Stroke Volume Sudden cardiac death Ventricular Function, Left Wearable Electronic Devices - adverse effects |
| title | ECG as a risk stratification tool in patients with wearable cardioverter-defibrillator |
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