Publication details

Q waves are the strongest electrocardiographic variable associated with primary prophylactic implantable cardioverter-defibrillator benefit: a prospective multicentre study

Authors	PELLI Ari JUNTTILA Juhani M. KENTTÄ Tuomas V. SCHLÖGL Simon ZABEL Markus MALÍK Marek REICHLIN Tobias WILLEMS Rik VOS Marc A. HARDEN Markus FRIEDE Tim STICHERLING Christian HUIKURI Heikki V
Year of publication	2022
Type	Article in Periodical
Magazine / Source	EP Europace
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://academic.oup.com/europace/article/24/5/774/6446242?login=true
Doi	http://dx.doi.org/10.1093/europace/euab260
Keywords	Implantable cardioverter-defibrillator; Primary prevention; Mortality; Appropriate shock; Benefit; Heart failure; Electrocardiogram; Q wave; QT interval
Description	Aim The association of standard 12-lead electrocardiogram (ECG) markers with benefits of the primary prophylactic implantable cardioverter-defibrillator (ICD) has not been determined in the contemporary era. We analysed traditional and novel ECG variables in a large prospective, controlled primary prophylactic ICD population to assess the predictive value of ECG in terms of ICD benefit. Methods and results Electrocardiograms from 1477 ICD patients and 700 control patients (EU-CERT-ICD; non-randomized, controlled, prospective multicentre study; ClinicalTrials.gov Identifier: NCT02064192), who met ICD implantation criteria but did not receive the device, were analysed. The primary outcome was all-cause mortality. In ICD patients, the co-primary outcome of first appropriate shock was used. Mean follow-up time was 2.4 +/- 1.1 years to death and 2.3 +/- 1.2 years to the first appropriate shock. Pathological Q waves were associated with decreased mortality in ICD patients [hazard ratio (HR) 0.54, 95% confidence interval (CI) 0.35-0.84; P < 0.01] and patients with pathological Q waves had significantly more benefit from ICD (HR 0.44, 95% CI 0.21-0.93; P = 0.03). QTc interval increase taken as a continuous variable was associated with both mortality and appropriate shock incidence, but commonly used cut-off values, were not statistically significantly associated with either of the outcomes. Conclusion Pathological Q waves were a strong ECG predictor of ICD benefit in primary prophylactic ICD patients. Excess mortality among Q wave patients seems to be due to arrhythmic death which can be prevented by ICD.