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ECG Quantification of Myocardial Scar Does Not Differ between Primary and Secondary Prevention ICD Recipients with Ischemic Heart Disease
Author(s) -
KRAAIER KARIN,
VAN DESSEL PASCAL F.H.M.,
VAN DER PALEN JOB,
WILDE ARTHUR A.M.,
SCHOLTEN MARCOEN F.
Publication year - 2010
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2009.02611.x
Subject(s) - medicine , qrs complex , cardiology , ejection fraction , left ventricular hypertrophy , implantable cardioverter defibrillator , secondary prevention , electrocardiography , signal averaged electrocardiogram , heart failure , blood pressure
Background:Myocardial scar is an anatomic substrate for potentially lethal arrhythmias. Recent study showed that higher QRS‐estimated scar size using the Selvester QRS score was associated with increased arrhythmogenesis during electrophysiologic testing. Therefore, QRS scoring might play a potential role in risk stratification before implantable cardioverter defibrillator (ICD) implantation. In this study, we tested the hypothesis that QRS scores among ICD recipients for secondary prevention are higher than QRS scores in primary prevention patients.Methods and Results:From the hospital database, 100 consecutive patients with ischemic heart disease and prior ICD implantation were selected. Twelve‐lead electrocardiograms (ECGs) had been obtained before implantation. ECGs were scored following the 32‐points Selvester QRS scoring system and corrected for underlying conduction defects and/or hypertrophy. Ninety‐three ECGs were suitable for scoring; seven ECGs were rejected because of noise, missing leads, excessive ventricular extrasystoles, or ventricular pacing. No statistically significant difference in QRS score was found between the primary [6.90 (standard deviation [SD] 3.94), n = 63] and secondary prevention group [6.17 (SD 4.50) (P = 0.260), n = 30]. Left ventricular ejection fraction (LVEF) was significantly higher in the secondary prevention group [31% (SD 13.5) vs 24% (SD 11.7) (P = 0.015)]. When patients with LVEF ≥35% were excluded, QRS scores were still comparable, namely 7.02 (SD 4.04) in the primary prevention group (n = 52) and 6.28 (SD 4.24) in the secondary (P = 0.510) (n = 18).Conclusion:We found no significant difference in QRS score between the ischemic primary and secondary prevention groups. Therefore, a role of the Selvester QRS score as a risk stratifier remains unlikely. (PACE 2010; 33:192–197)