ECG as a risk stratification tool in patients with wearable cardioverter-defibrillator

Gassanov, Natig; Mutallimov, Mirza; Caglayan, Evren; Erdmann, Erland; Er, Fikret

doi:10.1016/j.jjcc.2022.08.001

Cited by 1 publication

(1 citation statement)

References 33 publications

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“…Follow-up trials would include patients with low LVEF (< 35%), mid-range LVEF (40–49%) and preserved LVEF (≥ 50%). The latter would be of great interest because ~ 50% of HF patients worldwide have preserved LVEF [ 24 , 25 ], and ~ 18% of these patients are reported to have fQRS [ 26 ]. This trial study has the potential to advance the field of ICD selection.…”

Section: Testing the Hypothesismentioning

confidence: 99%

Ventriculo-arterial (VA) coupling and fQRS as new selection criteria for primary prevention ICD placement

Engstrom,

Letson,

et al. 2024

ICMx

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For decades, left ventricular ejection fraction (LVEF < 35%) has been a mainstay for identifying heart failure (HF) patients most likely to benefit from an implantable cardioverter defibrillator (ICD). However, LVEF is a poor predictor of sudden cardiac death (SCD) and ignores 50% of HF patients with mildly reduced and preserved LVEF. The current international guidelines for primary prophylaxis ICD therapy are inadequate. Instead of LVEF, which is not a good measure of LV contractility or hemodynamic characterization, we hypothesize ventriculo-arterial (VA) coupling combined with fragmented QRS (fQRS) will improve risk stratification and patient suitability for an ICD. Quantifying cardiac and aortic mechanics, and predicting active arrhythmogenic substrate, from varying fQRS morphologies, may help to stratify ischemic and non-ischemic patients with different functional capacities and predisposition for lethal arrhythmias. We propose HF patients with a low physiological reserve may not benefit from ICD therapy, whereas those patients with higher reserves and extensive arrhythmogenic substrate may benefit. Our hypothesis combining VA coupling with fQRS changes has the potential to widen HF patient participation (low and high LVEF) and advance personalized medicine for HF patients at high risk of SCD.

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Section: Testing the Hypothesismentioning

confidence: 99%