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Fragmented QRS as a predictor of arrhythmic events in patients with hypertrophic obstructive cardiomyopathy

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Objectives

This study aims to determine whether fragmented QRS (fQRS) in the surface electrocardiogram (ECG) at implantable cardioverter defibrillator (ICD) implant can predict arrhythmic events using appropriate therapy delivered by the ICD as a surrogate.

Background

Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic disorder associated with life-threatening arrhythmias frequently requiring an ICD. Seeking a noninvasive method of risk stratification remains a challenge.

Methods

This paper is a retrospective, multicenter study of patients with HOCM and ICD. Surface 12-lead ECGs were analyzed. Appropriate therapy was validated by a blinded Core Lab. Univariate and multivariate analyses were performed. A p value of <0.05 was considered significant.

Results

We included 102 patients from 13 centers. Mean age at implant was 41.16 ± 18.25 years, 52 % were male. Mean left ventricular ejection fraction was 61.56 ± 9.46 % and two thirds had heart failure according to the New York Heart Association class I. Secondary prophylaxis ICD implantation was the indication for implant in 40.2 % of cases. About half received a single-chamber ICD. fQRS was present at the time of diagnosis in 21 and in 54 % at ICD implant. At a mean follow-up of 47.8 ± 39.3 months, 41 patients (40.2 %) presented with appropriate therapy. In a multivariate logistic regression, predictors of appropriate therapy included fQRS at implant (odds ratio [OR], 16.4; 95 % confidence interval [CI], 3.6–74.0; p = 0.0003), history of combined ventricular tachycardia/fibrillation/sudden death (OR, 14.3; 95 % CI, 3.2–69.3; p = 0.001) and history of syncope (OR, 5.5; 95 % CI, 1.5–20.4; p = 0.009). Ten deaths (9.8 %) occurred during the follow-up. fQRS in the lateral location increased the risk of appropriate therapy (p < 0.0001).

Conclusions

fQRS predicts arrhythmic events in patients with HOCM and should be considered in a model of risk stratification.

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Abbreviations

CAD:

Coronary artery disease

ECG:

12-Lead electrocardiogram

fQRS:

Fragmented QRS

HOCM:

Hypertrophic obstructive cardiomyopathy

ICD:

Implantable cardioverter defibrillator

SCD:

Sudden cardiac death

VF:

Ventricular fibrillation

VT:

Ventricular tachycardia

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Authors and Affiliations

  1. Arrhythmia Unit, Department of Cardiology, Hospital Español de Mendoza, Mendoza, Argentina

    Francisco Femenía, Maurico Arce & Jorge Van Grieken

  2. Cardiovascular Institute, Villa Mercedes, San Luis, 5730, Argentina

    Francisco Femenía, Maurico Arce & Jorge Van Grieken

  3. Arrhythmia Service, Thorax Institute, Hospital Clinic, Barcelona, Spain

    Emilce Trucco & Luis Mont

  4. Arrhythmia Service, FLENI, Buenos Aires, Argentina

    Mauricio Abello

  5. Robotic Cardiac Electrophysiology Unit, Department of Cardiology, University Hospital La Paz, Madrid, Madrid, Spain

    José L. Merino

  6. Department of Cardiovascular Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium

    Máximo Rivero-Ayerza

  7. Eskisehir Osmangazi University, Cardiology Department, Eskisehir, Turkey

    Bulent Gorenek

  8. Department of Arrhythmia and Pacemaker, IECTAS, Maracaibo, Venezuela

    Carlos Rodriguez

  9. Arrhythmia Service, Kingston General Hospital, Queen’s University, Kingston, ON, Canada

    Wilma M. Hopman & Adrian Baranchuk

Authors
  1. Francisco Femenía
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  2. Maurico Arce
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  3. Jorge Van Grieken
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  4. Emilce Trucco
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  8. Máximo Rivero-Ayerza
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  9. Bulent Gorenek
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  10. Carlos Rodriguez
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  11. Wilma M. Hopman
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  12. Adrian Baranchuk
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Consortia

on behalf of Fragmented QRS in Hypertrophic Obstructive Cardiomyopathy (FHOCM) Study Investigators

Corresponding author

Correspondence to Francisco Femenía.

Additional information

The FHOCM Study participating investigators and centers include: Francisco Femenía, Mauricio Arce, Jorge Van Grieken, Martín Arrieta, Hospital Español de Mendoza, Argentina; Adrian Baranchuk, Wilma Hopman, Heart Rhythm Service, Queen’s University, Kingston, Ontario, Canada; Luis Mont Girbau, Emilce Trucco, Servicio de Arritmias, Hospital Clinic, Barcelona, España; Carlos Rodriguez Artuza, IECTAS, Zulía, Venezuela; Alfredo Bravo, Claudio Fessia, Instituto Cardiovascular, Villa Mercedes, San Luis, Argentina; Mauricio Abello, FLENI, Buenos Aires, Argentina; Bulent Gorenek, Eskisehir Osmangazi University, Turkey; Máximo Rivero-Ayerza, Bruselas, Bélgica; José Luis Merino, Jorge Figueroa, Hospital La Paz, Madrid, España.

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Femenía, F., Arce, M., Van Grieken, J. et al. Fragmented QRS as a predictor of arrhythmic events in patients with hypertrophic obstructive cardiomyopathy. J Interv Card Electrophysiol 38, 159–165 (2013). https://doi.org/10.1007/s10840-013-9829-z

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  • DOI: https://doi.org/10.1007/s10840-013-9829-z

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