Association of prolonged QRS duration with ventricular tachyarrhythmias and sudden cardiac death in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II)

Dhar, Ritesh; Alsheikh‐Ali, Alawi A.; Estes, N.A. Mark; Moss, Arthur J.; Zaręba, Wojciech; Daubert, James P.; Greenberg, Henry; Case, Robert B.; Kent, David M.

doi:10.1016/j.hrthm.2008.02.013

Cited by 60 publications

(30 citation statements)

References 23 publications

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“…While we did find an increased risk of appropriate shocks with increasing time after MI, ICD shocks are a limited surrogate for SCD and all-cause mortality. 17 …”

Section: Discussionmentioning

confidence: 99%

Mortality benefits from implantable cardioverter-defibrillator therapy are not restricted to patients with remote myocardial infarction: an analysis from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)

et al. 2011

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Background The implantable cardioverter-defibrillator (ICD) is an effective therapy for preventing sudden cardiac death (SCD) in patients with prior myocardial infarction (MI) and reduced left ventricular function; however, the optimal timing of ICD implantation after MI remains unknown. Objective The purpose of this study was to determine whether the benefit of single-lead conservatively programmed ICD therapy varies as a function of time from MI to ICD implantation. Methods We compared time to all-cause death and SCD between the ICD and placebo arms in the Sudden Cardiac Death in Heart Failure Trial. Rates of appropriate shocks in the ICD arm were also assessed as a function of time after MI. Results Among the 712 patients with a history of MI, 274 died (38.5%), and 68 of these deaths were SCD (24.8%). Appropriate shocks were more common with increasing time after MI (adjusted hazard ratio [HR] per year after MI 1.04 [1.00–1.08]). Despite these differences, there was no evidence of differential mortality benefit with ICD implantation as a function of time after MI: continuous variable adjusted HR 1.00 [0.98,1.03] and shortest versus longest tertile adjusted HR 0.95 [0.66–1.34]. Sensitivity analyses also failed to show differential mortality benefit by quartile or with the use of an 18-month cutoff: <18 versus ≥ 18 months adjusted HR 1.08 [0.77, 1.51]. Conclusion There is no evidence that ICD benefit varied with time from MI to implantation/randomization in this primary prevention population. Single-lead ICD benefit is not restricted to patients with a remote MI (>18 months).

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“…While we did find an increased risk of appropriate shocks with increasing time after MI, ICD shocks are a limited surrogate for SCD and all-cause mortality. 17 …”

Section: Discussionmentioning

confidence: 99%

Mortality benefits from implantable cardioverter-defibrillator therapy are not restricted to patients with remote myocardial infarction: an analysis from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)

et al. 2011

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“…Left bundle (but not right bundle) branch block or LV hypertrophy on electrocardiography are associated with a mildly increased risk of SCD (hazard ratio ~1.5 for both). 58,80 In addition, prolonged QRS duration was associated with SCD and ventricular tachyarrhythmias in two large clinical trials, 81,82 and Das et al have suggested that fragmented QRS on electrocardiography is a marker of structural heart disease and predicts SCD. 83 …”

Section: Risk Factors For Scdmentioning

confidence: 99%

Sudden cardiac death: epidemiology and risk factors

Adabag¹,

et al. 2010

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Sudden cardiac death (SCD) is an important public-health problem with multiple etiologies, risk factors, and changing temporal trends. Substantial progress has been made over the past few decades in identifying markers that confer increased SCD risk at the population level. However, the quest for predicting the high-risk individual who could be a candidate for an implantable cardioverter-defibrillator, or other therapy, continues. In this article, we review the incidence, temporal trends, and triggers of SCD, and its demographic, clinical, and genetic risk factors. We also discuss the available evidence supporting the use of public-access defibrillators.

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“…In the early analysis of the MADIT II study, a wide QRS >150 ms was associated with a more substantial benefit from ICD1 than was a narrow QRS <120 ms. Subsequent studies did not confirm the relation between QRS width and ventricular arrhythmia (VA) occurrence in primary and secondary prevention ICD patients with structural heart disease 2, 3. However, QRS width predicted SCD in medically treated MADIT II heart failure patients 3…”

Section: Introductionmentioning

confidence: 99%

Ventricular arrhythmia is predicted by sum absolute QRST integralbut not by QRS width

Tereshchenko

Cheng

Fetics

et al. 2010

Journal of Electrocardiology

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Background There is a controversy regarding the association between QRS width and ventricular arrhythmias (VA). We hypothesized that predictive value of the QRS width could be improved if QRS width were considered in the context of the sum magnitude of the absolute QRST integral in three orthogonal leads (SAI QRST). We explored correlations between QRS width, SAI QRST, and VA in primary prevention ICD patients with structural heart disease. Methods Baseline orthogonal ECGs were recorded at rest in 355 patients with implanted primary prevention ICDs (mean age 59.5±12.4; 279 male [79%]). Patients were followed prospectively at least 6 months; appropriate ICD therapies due to sustained VA served as endpoints. The sum magnitude of the absolute QRST integral in three orthogonal leads (SAI QRST) was calculated. Results During a mean follow-up of 18 months, 48 patients had sustained VA and received appropriate ICD therapies. There was no difference in baseline QRS width between patients with and those without arrhythmia (114.9±32.8 vs. 108.9±24.7 ms, p=0.230). SAI QRST was significantly lower in patients with VA at follow-up than in patients without VA (102.6±27.6 vs. 112.0±31.9 mV*ms, p=0.034). Patients with SAI QRST ≤145 mV*ms had a3-fold higher risk of VT/VF (HR 3.25; 95% CI: 1.59–6.75, p=0.001). In the univariate analysis QRS width did not predict VT/VF. In the bivariate Cox regression model every 1 ms of incremental QRS widening with a simultaneous 1 mV*ms SAI QRST decrease raised the risk of VT/VF by 2% (HR 1.02; 95% CI 1.01–1.03, p=0.005). Conclusion QRS widening is associated with ventricular tachyarrhythmia only if accompanied by low SAI QRST.

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Association of prolonged QRS duration with ventricular tachyarrhythmias and sudden cardiac death in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II)

Cited by 60 publications

References 23 publications

Mortality benefits from implantable cardioverter-defibrillator therapy are not restricted to patients with remote myocardial infarction: an analysis from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)

Mortality benefits from implantable cardioverter-defibrillator therapy are not restricted to patients with remote myocardial infarction: an analysis from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)

Sudden cardiac death: epidemiology and risk factors

Ventricular arrhythmia is predicted by sum absolute QRST integralbut not by QRS width

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