Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PO Box 5000, FIN-90014 Oulu, Finland.
Biocenter Oulu, University of Oulu, Oulu, Finland.
Europace. 2022 May 3;24(5):774-783. doi: 10.1093/europace/euab260.
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.
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.
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.
在当代，标准 12 导联心电图（ECG）标志物与初级预防性植入式心脏复律除颤器（ICD）益处的关联尚未确定。我们分析了大型前瞻性、对照性初级预防性 ICD 人群中的传统和新型 ECG 变量，以评估 ECG 在 ICD 获益方面的预测价值。
对 1477 例 ICD 患者和 700 例对照患者（EU-CERT-ICD；非随机、对照、前瞻性多中心研究；ClinicalTrials.gov 标识符：NCT02064192）的 ECG 进行了分析。这些患者符合 ICD 植入标准，但未植入该设备。主要终点是全因死亡率。在 ICD 患者中，使用了首次适当电击的联合主要终点。死亡的平均随访时间为 2.4±1.1 年，首次适当电击的平均随访时间为 2.3±1.2 年。病理性 Q 波与 ICD 患者死亡率降低相关[风险比（HR）0.54，95%置信区间（CI）0.35-0.84；P<0.01]，且病理性 Q 波患者从 ICD 中获益更多（HR 0.44，95% CI 0.21-0.93；P=0.03）。将 QTc 间期增加视为连续变量与死亡率和适当电击发生率均相关，但常用的截断值与任何一种结果均无统计学显著相关性。
病理性 Q 波是初级预防性 ICD 患者 ICD 获益的有力 ECG 预测指标。Q 波患者的超额死亡率似乎归因于心律失常性死亡，ICD 可预防这种死亡。
