Abstract 13427: The Presence of Fragmented QRS predicts Mortality and Appropriate Shocks in ICD Recipients
Introduction: QRS fragmentation (fQRS) on the 12-lead electrocardiogram (ECG) has been shown to reflect inhomogeneous activation of the ventricles by the presence of myocardial infarction or scarring. Presence of fQRS has been shown to be a predictor of mortality and sudden cardiac death, however data in ICD recipients are scarce.
Methods: All ICD recipients in our hospital with ischemic (ICM) or non-ischemic cardiomyopathy were included in this single-center retrospective registry. Electrocardiograms before implant were analyzed for the presence of fQRS according to the criteria defined by Das in 2006 and 2008. Endpoints were appropriate ICD shocks (AS) and all-cause mortality. Kaplan-Meier and multivariate Cox regression analyses with demographic, clinical and electrocardiographic variables were performed.
Results: A total of 727 patients (84.9% male, 66.4% ICM, 56% primary prevention) with a mean follow-up of 5.2±4.1 y were included. Annual mortality rate was 3.9%/y and for shocks 9.4%/y. Overall 50.6% of patients had fQRS on the ECG, most frequently localized in the inferior (35.4%), followed by the anterior (21.6%) and lateral leads (11.1%). The presence of fQRS in any region was an independent predictor of mortality (HR 1.535, 95%CI 1.141-2.066), particularly in primary prevention patients (HR 1.927, 95%CI 1.206-3.079). Overall fQRS was not an independent predictor of AS. fQRS in the anterior leads was an independent predictor of mortality (HR 1.550, 95%CI 1.130-2.125), particularly in primary prevention patients (HR 2.625, 95%CI 1.575-4.377). Further, in primary prevention anterior fQRS showed a trend towards independent prediction of AS (p=0.059, HR 1.573, 95%CI 0.984-2.514). The presence of fQRS in the lateral leads was an independent predictor of mortality in primary prevention patients (HR 2.037, 95%CI 1.088-3.814), not in the overall study population. Presence of fQRS in the inferior leads did not show any significant results analyzing the complete follow-up.
Conclusions: Presence of fQRS on the ECG before ICD implantation could be used as risk stratification tool identifying patients at increased risk of dying, particularly if present in the anterolateral leads and in patients with primary prevention ICD indications.
Author Disclosures: B. Vandenberk: Other; Modest; The research leading to these results has received funding from the European Community’s Seventh Framework Program FP7/2013-2017 (under grant agreement no. HEALTH-F2-2013-602299, EU-CERT-ICD). T. Robyns: None. V. Floré: None. C. Garweg: Research Grant; Modest; the Fund for Scientific Research Flanders. J. Ector: None. R. Willems: Other; Modest; The university of Leuven receives unconditional grant support from Biotronik, Boston Scientific and Medtronic Belgium. RW is funded as a clincal researcher by the FWO..
- © 2016 by American Heart Association, Inc.