Abstract 20129: T Wave Area is an Electrocardiographic Marker of Cardiac Events Following Left Cardiac Sympathetic Denervation
Introduction: Long QT syndrome (LQTS) is a genetic channelopathy associated with a risk of sudden cardiac death (SCD). Left cardiac sympathetic denervation (LCSD) is one of the current treatment options for LQTS, which in several studies has shown to significantly reduce the number of cardiac events. However, approximately ≈50% of high-risk LQTS patients experienced ≥1 breakthrough cardiac event (BCE) post-LCSD.
Hypothesis: Quantitative T wave analysis can identify those at risk of BCE following LCSD.
Methods: Ninety-four patients underwent LCSD at our institution between 2005 and 2015, of which 39 had pre and post procedural ECGs performed within 3 -12 months of LCSD. A BCE was defined as either: (1) appropriate ventricular fibrillation-terminating implantable cardioverter-defibrillator shock, (2) arrhythmogenic syncope, (3) seizures, or (4) aborted cardiac arrest post-LCSD. ECG analysis was conducted using novel software to automatically detect subtle changes in T wave morphology.
Results: Of the 39 patients (51% male, mean age 17 ± 11), 11 (28%) of these individuals experienced ≥1 BCE (Kaplan-Meier rate 20% at 2 years) over a median follow up of 1.9 years. Reduction in T wave area in lead V6 (pre vs post-LCSD ECG) was associated with post-LCSD BCEs, with a 2 year KM event rates in those with changes above median > -1521mm2 of 92% vs. 69% in those with changes below the median. When analyzed as a trend across quartiles, with each quartile of reduction in T-wave area, there was a significantly higher risk of events (HR 3.37, p=0.01), and this result was unchanged after adjustment for baseline T wave area.
Conclusions: Reduction in T wave area in Lead V6 after LCSD may help provide an individualized approach to LQTS therapy by identifying those at higher risk of BCEs.
Author Disclosures: A. Sugrue: None. P.A. Noseworthy: None. R.K. Rohatgi: None. C.V. DeSimone: None. J. Bos: None. B. Qiang: None. V. Kremen: None. C. Scott: None. Y. Sapir: None. Z. Attiae: None. P. Brady: None. S.J. Asirvatham: Other; Modest; Intellectual property. P.A. Friedman: Other; Modest; Intellectual property. M.J. Ackerman: Research Grant; Modest; Sheikh Zayed Saif Mohammed Al Nahyan Fund in Pediatric Cardiology Research, Dr. Scholl Fund, hannah M. Wernke Memorial Fund. Other Research Support; Modest; Mayo Clinic’s Center for Individualized Medicine. Consultant/Advisory Board; Modest; Boston Scientific, Gilead Sciences, Medtronic, St. Jude Medical.
- © 2016 by American Heart Association, Inc.