Q waves are the strongest electrocardiographic variable associated with primary prophylactic implantable cardioverter-defibrillator benefit: a prospective multicentre study

PELLI, Ari, Juhani M. JUNTTILA, Tuomas V. KENTTÄ, Simon SCHLÖGL, Markus ZABEL, Marek MALÍK, Tobias REICHLIN, Rik WILLEMS, Marc A. VOS, Markus HARDEN, Tim FRIEDE, Christian STICHERLING and Heikki V HUIKURI. Q waves are the strongest electrocardiographic variable associated with primary prophylactic implantable cardioverter-defibrillator benefit: a prospective multicentre study. EP Europace. Oxford: Oxford University Press, 2022, vol. 24, No 5, p. 774-783. ISSN 1099-5129. Available from: https://dx.doi.org/10.1093/europace/euab260.

Basic information

• Original name: Q waves are the strongest electrocardiographic variable associated with primary prophylactic implantable cardioverter-defibrillator benefit: a prospective multicentre study
• Authors: PELLI, Ari, Juhani M. JUNTTILA (guarantor), Tuomas V. KENTTÄ, Simon SCHLÖGL, Markus ZABEL, Marek MALÍK (203 Czech Republic, belonging to the institution), Tobias REICHLIN, Rik WILLEMS, Marc A. VOS, Markus HARDEN, Tim FRIEDE, Christian STICHERLING and Heikki V HUIKURI.
• Edition: EP Europace, Oxford, Oxford University Press, 2022, 1099-5129.

Other information

• Original language: English
• Type of outcome: Article in a journal
• Field of Study: 30201 Cardiac and Cardiovascular systems
• Country of publisher: United Kingdom of Great Britain and Northern Ireland
• Confidentiality degree: is not subject to a state or trade secret
• WWW: URL
• Impact factor: Impact factor: 6.100
• RIV identification code: RIV/00216224:14110/22:00125980
• Organization unit: Faculty of Medicine
• Doi: http://dx.doi.org/10.1093/europace/euab260
• UT WoS: 000790073500001
• Keywords in English: Implantable cardioverter-defibrillator; Primary prevention; Mortality; Appropriate shock; Benefit; Heart failure; Electrocardiogram; Q wave; QT interval
• Tags: 14110211, rivok
• Tags: International impact, Reviewed

Abstract

Aim The association of standard 12-lead electrocardiogram (ECG) markers with benefits of the primary prophylactic implantable cardioverter-defibrillator (ICD) has not been determined in the contemporary era. We analysed traditional and novel ECG variables in a large prospective, controlled primary prophylactic ICD population to assess the predictive value of ECG in terms of ICD benefit. Methods and results Electrocardiograms from 1477 ICD patients and 700 control patients (EU-CERT-ICD; non-randomized, controlled, prospective multicentre study; ClinicalTrials.gov Identifier: NCT02064192), who met ICD implantation criteria but did not receive the device, were analysed. The primary outcome was all-cause mortality. In ICD patients, the co-primary outcome of first appropriate shock was used. Mean follow-up time was 2.4 +/- 1.1 years to death and 2.3 +/- 1.2 years to the first appropriate shock. Pathological Q waves were associated with decreased mortality in ICD patients [hazard ratio (HR) 0.54, 95% confidence interval (CI) 0.35-0.84; P < 0.01] and patients with pathological Q waves had significantly more benefit from ICD (HR 0.44, 95% CI 0.21-0.93; P = 0.03). QTc interval increase taken as a continuous variable was associated with both mortality and appropriate shock incidence, but commonly used cut-off values, were not statistically significantly associated with either of the outcomes. Conclusion Pathological Q waves were a strong ECG predictor of ICD benefit in primary prophylactic ICD patients. Excess mortality among Q wave patients seems to be due to arrhythmic death which can be prevented by ICD.