医学
心脏病学
内科学
QT间期
心源性猝死
肥厚性心肌病
QRS波群
室性心动过速
植入式心律转复除颤器
心室颤动
猝死
作者
Philippe Debonnaire,Spyridon Katsanos,Emer Joyce,Olivier V.W. Van Den Brink,Douwe E. Atsma,Martin J. Schalij,Jeroen J. Bax,Victoria Delgado,Nina Ajmone Marsan
摘要
QRS Fragmentation and QTc in Hypertrophic Cardiomyopathy Background QRS fragmentation (fQRS) and prolonged QTc interval on surface ECG are prognostic in various cardiomyopathies other than hypertrophic cardiomyopathy (HCM). The association between fQRS and prolonged QTc duration with occurrence of ventricular tachyarrhythmias or sudden cardiac death (VTA/SCD) in patients with HCM was explored. Methods and Results One hundred and ninety‐five clinical HCM patients were studied. QTc duration was derived applying Bazett's formula; fQRS was defined as presence of various RSR’ patterns, R or S notching and/or >1 additional R wave in any non‐aVR lead in patients without pacing or (in)complete bundle branch block. The endpoints comprised SCD, ECG documented sustained VTA (tachycardia or fibrillation) or appropriate implantable cardioverter defibrillator (ICD) therapies (antitachycardia pacing [ATP] or shock) for VTA in ICD recipients (n = 58 [30%]). QT prolonging drugs recipients were excluded. After a median follow‐up of 5.7 years (IQR 2.7–9.1), 26 (13%) patients experienced VTA or SCD. Patients with fQRS in ≥3 territories (inferior, lateral, septal, and/or anterior) (p = 0.004) or QTc ≥460 ms (p = 0.009) had worse cumulative survival free of VTA/SCD than patients with fQRS in <3 territories or QTc <460 ms. fQRS in ≥3 territories (ß 4.5, p = 0.020, 95%CI 1.41–14.1) and QTc ≥460 ms (ß 2.7, p = 0.037, 95%CI 1.12–6.33) were independently associated with VTA/SCD. Likelihood ratio test indicated assessment of fQRS and QTc on top of conventional SCD risk factors provides incremental predictive value for VTA/SCD (p = 0.035). Conclusions Both fQRS in ≥3 territories and QTc duration are associated with VTA/SCD in HCM patients, independently of and incremental to conventional SCD risk factors.
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