Department of Cardiology, Heart Center, Academic Medical Center-University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Department of Cardiology, UZ Leuven, and Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium.
Europace. 2018 Jun 1;20(FI1):f122-f128. doi: 10.1093/europace/eux044.
Sudden cardiac death (SCD) causes a large portion of all mortality in adult congenital heart disease (ACHD) patients. However, identification of high-risk patients remains challenging. Fragmented QRS-complexes (fQRS) are a marker for SCD in patients with acquired heart disease but data in ACHD patients are lacking. We therefore aim to evaluate the prognostic value of fQRS for SCD in ACHD patients.
From a multicentre cohort of 25 790 ACHD patients, we included tachyarrhythmic SCD cases (n = 147), and controls (n = 266) matched by age, gender, congenital defect and (surgical) intervention. fQRS was defined as ≥1 discontinuous deflection in narrow QRS-complexes, and ≥2 in wide QRS-complexes (>120 ms), in two contiguous ECG leads. We calculated odds ratios (OR) using univariable and multivariable conditional logistic regression models correcting for impaired systemic ventricular function, heart failure and QRS duration >120 ms. ECGs of 147 SCD cases (65% male, median age of death 34 years) and of 266 controls were assessed. fQRS was present in 51% of cases and 34% of controls (OR 2.0, P = 0.003). In multivariable analysis, fQRS was independently associated with SCD (OR 1.9, P = 0.01). The most common diagnose of SCD cases was tetralogy of Fallot (ToF, 34 cases). In ToF, fQRS was present in 71% of cases vs. 43% of controls (OR for SCD 2.8, P = 0.03).
fQRS was independently associated with SCD in ACHD patients in a cohort of SCD patients and matched controls. fQRS may therefore contribute to the decision when evaluating ACHD patients for primary prevention of SCD.
在成人先天性心脏病（ACHD）患者中，心源性猝死（SCD）导致了大部分的死亡率。然而，识别高危患者仍然具有挑战性。碎裂 QRS 复合波（fQRS）是获得性心脏病患者发生 SCD 的标志物，但 ACHD 患者的数据却很缺乏。因此，我们旨在评估 fQRS 在 ACHD 患者中的 SCD 预后价值。
我们从一个多中心的 25790 例 ACHD 患者队列中，纳入了心律失常性 SCD 病例（n=147），并通过年龄、性别、先天性缺陷和（手术）干预进行匹配对照（n=266）。fQRS 定义为两个连续心电图导联中存在≥1 个窄 QRS 复合波中的不连续偏转，或≥2 个宽 QRS 复合波（>120ms）。我们使用单变量和多变量条件逻辑回归模型计算比值比（OR），并校正了系统性心室功能障碍、心力衰竭和 QRS 持续时间>120ms。评估了 147 例 SCD 病例（65%为男性，死亡时的中位年龄为 34 岁）和 266 例对照者的心电图。病例组中 51%存在 fQRS，对照组中 34%存在 fQRS（OR 2.0，P=0.003）。多变量分析中，fQRS 与 SCD 独立相关（OR 1.9，P=0.01）。SCD 病例最常见的诊断是法洛四联症（ToF，34 例）。在 ToF 中，71%的病例存在 fQRS，而对照组中为 43%（SCD 的 OR 为 2.8，P=0.03）。
在 SCD 病例和匹配对照的 ACHD 患者队列中，fQRS 与 SCD 独立相关。因此，fQRS 可能有助于评估 ACHD 患者进行 SCD 一级预防时的决策。
