Relation of 12-Lead Electrocardiogram Patterns to Implanted Defibrillator-Terminated Ventricular Tachyarrhythmias in Hypertrophic Cardiomyopathy

Mark V. Sherrid, Delia Cotiga, David Hart, Frederick Ehlert, Tammy S. Haas, Win Kuang Shen, Mark S. Link, N. A.Mark Estes, Andrew E. Epstein, Christopher Semsarian, James P. Daubert, Stephen Winters, Michael C. Giudici, Barry J. Maron

Research output: Contribution to journalArticle

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Abstract

Electrocardiographic (ECG) abnormalities are common in hypertrophic cardiomyopathy (HC) and have been associated with the distribution of left ventricular hypertrophy and myocardial fibrosis. Such abnormalities may predispose patients to electrophysiologic instability, ventricular arrhythmias, and sudden cardiac death (SCD). We studied 330 patients with HC who were judged clinically to be at high risk for SCD and therefore received automatic implantable cardioverter-defibrillators (ICDs). Surface 12-lead electrocardiograms acquired at the time of ICD implantation were analyzed and the ECG characteristics of patients with appropriate device interventions for ventricular tachycardia and fibrillation were compared to those patients without appropriate device interventions. The 330 patients were followed for 3.7 ± 3.0 years after implantation and 57 patients (17%) had appropriate discharges. No differences in the ECG characteristics of patients with and without appropriate device interventions were identified. Markedly increased ECG voltages, QRS duration, left or rightward QRS axis, abnormal Q waves, and QTc or QT dispersion were not associated with appropriate ICD discharge. Conversely, normal electrocardiograms and electrocardiograms normal except for a repolarization abnormality in only 1 anatomic distribution were not associated with freedom from ICD discharge. Moreover, no combination of ECG variables was associated with the likelihood of an appropriate ICD discharge. In conclusion, in a cohort of patients with HC selected because of their high risk for SCD, 12-lead surface electrocardiogram did not predict subsequent appropriate ICD intervention for ventricular tachyarrhythmias and was not useful in risk stratification for sudden death.

Original languageEnglish (US)
Pages (from-to)1722-1726
Number of pages5
JournalAmerican Journal of Cardiology
Volume104
Issue number12
DOIs
StatePublished - Dec 15 2009

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Defibrillators
Hypertrophic Cardiomyopathy
Tachycardia
Implantable Defibrillators
Electrocardiography
Sudden Cardiac Death
Equipment and Supplies
Lead
Left Ventricular Hypertrophy
Ventricular Fibrillation
Ventricular Tachycardia
Sudden Death
Cardiac Arrhythmias
Fibrosis

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Sherrid, Mark V. ; Cotiga, Delia ; Hart, David ; Ehlert, Frederick ; Haas, Tammy S. ; Shen, Win Kuang ; Link, Mark S. ; Estes, N. A.Mark ; Epstein, Andrew E. ; Semsarian, Christopher ; Daubert, James P. ; Winters, Stephen ; Giudici, Michael C. ; Maron, Barry J. / Relation of 12-Lead Electrocardiogram Patterns to Implanted Defibrillator-Terminated Ventricular Tachyarrhythmias in Hypertrophic Cardiomyopathy. In: American Journal of Cardiology. 2009 ; Vol. 104, No. 12. pp. 1722-1726.
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title = "Relation of 12-Lead Electrocardiogram Patterns to Implanted Defibrillator-Terminated Ventricular Tachyarrhythmias in Hypertrophic Cardiomyopathy",
abstract = "Electrocardiographic (ECG) abnormalities are common in hypertrophic cardiomyopathy (HC) and have been associated with the distribution of left ventricular hypertrophy and myocardial fibrosis. Such abnormalities may predispose patients to electrophysiologic instability, ventricular arrhythmias, and sudden cardiac death (SCD). We studied 330 patients with HC who were judged clinically to be at high risk for SCD and therefore received automatic implantable cardioverter-defibrillators (ICDs). Surface 12-lead electrocardiograms acquired at the time of ICD implantation were analyzed and the ECG characteristics of patients with appropriate device interventions for ventricular tachycardia and fibrillation were compared to those patients without appropriate device interventions. The 330 patients were followed for 3.7 ± 3.0 years after implantation and 57 patients (17{\%}) had appropriate discharges. No differences in the ECG characteristics of patients with and without appropriate device interventions were identified. Markedly increased ECG voltages, QRS duration, left or rightward QRS axis, abnormal Q waves, and QTc or QT dispersion were not associated with appropriate ICD discharge. Conversely, normal electrocardiograms and electrocardiograms normal except for a repolarization abnormality in only 1 anatomic distribution were not associated with freedom from ICD discharge. Moreover, no combination of ECG variables was associated with the likelihood of an appropriate ICD discharge. In conclusion, in a cohort of patients with HC selected because of their high risk for SCD, 12-lead surface electrocardiogram did not predict subsequent appropriate ICD intervention for ventricular tachyarrhythmias and was not useful in risk stratification for sudden death.",
author = "Sherrid, {Mark V.} and Delia Cotiga and David Hart and Frederick Ehlert and Haas, {Tammy S.} and Shen, {Win Kuang} and Link, {Mark S.} and Estes, {N. A.Mark} and Epstein, {Andrew E.} and Christopher Semsarian and Daubert, {James P.} and Stephen Winters and Giudici, {Michael C.} and Maron, {Barry J.}",
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Sherrid, MV, Cotiga, D, Hart, D, Ehlert, F, Haas, TS, Shen, WK, Link, MS, Estes, NAM, Epstein, AE, Semsarian, C, Daubert, JP, Winters, S, Giudici, MC & Maron, BJ 2009, 'Relation of 12-Lead Electrocardiogram Patterns to Implanted Defibrillator-Terminated Ventricular Tachyarrhythmias in Hypertrophic Cardiomyopathy', American Journal of Cardiology, vol. 104, no. 12, pp. 1722-1726. https://doi.org/10.1016/j.amjcard.2009.07.056

Relation of 12-Lead Electrocardiogram Patterns to Implanted Defibrillator-Terminated Ventricular Tachyarrhythmias in Hypertrophic Cardiomyopathy. / Sherrid, Mark V.; Cotiga, Delia; Hart, David; Ehlert, Frederick; Haas, Tammy S.; Shen, Win Kuang; Link, Mark S.; Estes, N. A.Mark; Epstein, Andrew E.; Semsarian, Christopher; Daubert, James P.; Winters, Stephen; Giudici, Michael C.; Maron, Barry J.

In: American Journal of Cardiology, Vol. 104, No. 12, 15.12.2009, p. 1722-1726.

Research output: Contribution to journalArticle

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T1 - Relation of 12-Lead Electrocardiogram Patterns to Implanted Defibrillator-Terminated Ventricular Tachyarrhythmias in Hypertrophic Cardiomyopathy

AU - Sherrid, Mark V.

AU - Cotiga, Delia

AU - Hart, David

AU - Ehlert, Frederick

AU - Haas, Tammy S.

AU - Shen, Win Kuang

AU - Link, Mark S.

AU - Estes, N. A.Mark

AU - Epstein, Andrew E.

AU - Semsarian, Christopher

AU - Daubert, James P.

AU - Winters, Stephen

AU - Giudici, Michael C.

AU - Maron, Barry J.

PY - 2009/12/15

Y1 - 2009/12/15

N2 - Electrocardiographic (ECG) abnormalities are common in hypertrophic cardiomyopathy (HC) and have been associated with the distribution of left ventricular hypertrophy and myocardial fibrosis. Such abnormalities may predispose patients to electrophysiologic instability, ventricular arrhythmias, and sudden cardiac death (SCD). We studied 330 patients with HC who were judged clinically to be at high risk for SCD and therefore received automatic implantable cardioverter-defibrillators (ICDs). Surface 12-lead electrocardiograms acquired at the time of ICD implantation were analyzed and the ECG characteristics of patients with appropriate device interventions for ventricular tachycardia and fibrillation were compared to those patients without appropriate device interventions. The 330 patients were followed for 3.7 ± 3.0 years after implantation and 57 patients (17%) had appropriate discharges. No differences in the ECG characteristics of patients with and without appropriate device interventions were identified. Markedly increased ECG voltages, QRS duration, left or rightward QRS axis, abnormal Q waves, and QTc or QT dispersion were not associated with appropriate ICD discharge. Conversely, normal electrocardiograms and electrocardiograms normal except for a repolarization abnormality in only 1 anatomic distribution were not associated with freedom from ICD discharge. Moreover, no combination of ECG variables was associated with the likelihood of an appropriate ICD discharge. In conclusion, in a cohort of patients with HC selected because of their high risk for SCD, 12-lead surface electrocardiogram did not predict subsequent appropriate ICD intervention for ventricular tachyarrhythmias and was not useful in risk stratification for sudden death.

AB - Electrocardiographic (ECG) abnormalities are common in hypertrophic cardiomyopathy (HC) and have been associated with the distribution of left ventricular hypertrophy and myocardial fibrosis. Such abnormalities may predispose patients to electrophysiologic instability, ventricular arrhythmias, and sudden cardiac death (SCD). We studied 330 patients with HC who were judged clinically to be at high risk for SCD and therefore received automatic implantable cardioverter-defibrillators (ICDs). Surface 12-lead electrocardiograms acquired at the time of ICD implantation were analyzed and the ECG characteristics of patients with appropriate device interventions for ventricular tachycardia and fibrillation were compared to those patients without appropriate device interventions. The 330 patients were followed for 3.7 ± 3.0 years after implantation and 57 patients (17%) had appropriate discharges. No differences in the ECG characteristics of patients with and without appropriate device interventions were identified. Markedly increased ECG voltages, QRS duration, left or rightward QRS axis, abnormal Q waves, and QTc or QT dispersion were not associated with appropriate ICD discharge. Conversely, normal electrocardiograms and electrocardiograms normal except for a repolarization abnormality in only 1 anatomic distribution were not associated with freedom from ICD discharge. Moreover, no combination of ECG variables was associated with the likelihood of an appropriate ICD discharge. In conclusion, in a cohort of patients with HC selected because of their high risk for SCD, 12-lead surface electrocardiogram did not predict subsequent appropriate ICD intervention for ventricular tachyarrhythmias and was not useful in risk stratification for sudden death.

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