Electrocardiographic Predictors of Arrhythmic Death and Total Mortality in the Multicenter Unsustained Tachycardia Trial

Abstract

Background-Stratifiers of sudden and total mortality risk are needed to optimally target preventive therapies in patients with coronary artery disease and impaired ventricular function. We assessed the prognostic significance of ECG markers of conduction abnormalities and left ventricular hypertrophy in the Multicenter Unsustained Tachycardia Trial (MUSTT). Methods and Results-We analyzed the ECGs of 1638 patients from MUSTT who did not receive antiarrhythmic therapy (antiarrhythmic medication or implantable cardioverter-defibrillator). After adjustment for other significant factors, left bundle-branch block and intraventricular conduction delay were associated with a 50% increase in the risk of both arrhythmic and total mortality. Right bundle-branch block was not associated with arrhythmic or total mortality. Left ventricular hypertrophy was the only ECG predictor of arrhythmic (hazard ratio, 1.35; 95% CI, 1.08 to 1.69) but not total mortality. Conclusions-In patients with coronary artery disease, depressed left ventricular function, and nonsustained ventricular tachycardia, QRS prolongation resulting from left bundle-branch block or intraventricular conduction delay but not right bundle-branch block provided prognostic information about the risk of arrhythmic and total mortality independently of electrophysiological evaluation and ejection fraction. Left ventricular hypertrophy was associated with increased arrhythmic but not total mortality.

Long‐term prognosis in patients with bifascicular block – the predictive value of noninvasive and invasive assessment

“…An annual all-cause mortality and sudden death of 4.7% and 2%, respectively, were observed in our study, which is similar to previous reports [3,5,21]. Some studies have shown that BFB per se is an independent risk factor of mortality [12][13][14], whereas others have reported that BFB merely reflects underlying heart disease, explaining the higher mortality rate in this population [3,6,7,15]. While only a limited number of clinical variables and investigations have been examined in some studies [3,6], the follow-up period in other studies has not been long enough to study the natural history regarding mortality [7,12,13].…”

Sudden Cardiac Death Early After Myocardial Infarction

“…No randomized trials Observational study: nonpredictive of arrhythmic death 48 No randomized trials Observational studies: predictive 57,58 and nonpredictive 59 of arrhythmic death Nonsustained VT Randomized ICD trials: no survival benefit (combined with LVEF) 17 Observational study: predictive of arrhythmic death 60 Randomized ICD trials: survival benefit (combined with LVEF and a positive EPS) 15 …”

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

“…However, the association between prolonged QRSd and sudden cardiac death (SCD) is less certain (2)(3)(4). While the largest study to date examining the relationship of prolonged QRSd to SCD reported a significant independent association (4), other smaller studies have had inconsistent results (2,3).…”