A new electrocardiogram marker to identify patients at low risk for ventricular tachyarrhythmias: sum magnitude of the absolute QRST integral

作者：Tereshchenko Larisa G^*; Cheng Alan; Fetics Barry J; Butcher Barbara; Marine Joseph E; Spragg David D; Sinha Sunil; Dalal Darshan; Calkins Hugh; Tomaselli Gordon F; Berger Ronald D

来源：Journal of Electrocardiology, 2011, 44(2): 208-216.

DOI：10.1016/j.jelectrocard.2010.08.012

Objective: We proposed and tested a novel electrocardiogram marker of risk of ventricular arrhythmias (VAs).
Methods: Digital orthogonal electrocardiograms were recorded at rest before implantable cardioverter-defibrillator (ICD) implantation in 508 participants of a primary prevention ICDs prospective cohort study (mean +/- SD age, 60 +/- 12 years; 377 male [74%]). The sum magnitude of the absolute QRST integral in 3 orthogonal leads (SAI QRST) was calculated. A derivation cohort of 128 patients was used to define a cutoff; a validation cohort (n = 380) was used to test a predictive value.
Results: During a mean follow-up of 18 months, 58 patients received appropriate ICD therapies. The SAL QRST was lower in patients with VA (105.2 +/- 60.1 vs 138.4 +/- 85.7 mV * ms, P = .002). In the Cox proportional hazards analysis, patients with SAI QRST not exceeding 145 mV * ms had about 4-fold higher risk of VA (hazard ratio, 3.6; 95% confidence interval, 1.96-6.71; P < .0001) and a 6-fold higher risk of monomorphic ventricular tachycardia (hazard ratio, 6.58; 95% confidence interval, 1.46-29.69; P = .014), whereas prediction of polymorphic ventricular tachycardia or ventricular fibrillation did not reach statistical significance.
Conclusion: High SAI QRST is associated with low risk of sustained VA in patients with structural heart disease.

• 出版日期2011-4