Electrocardiogram‐Based Predictors of Sudden Cardiac Death in Patients With Coronary Artery Disease

Abstract

Current recommendations on which patients with coronary artery disease (CAD) should be offered an implantable cardioverter defibrillator for the primary prevention of sudden cardiac death (SCD) rely heavily on the presence of depressed left ventricular ejection fraction. Because the majority of SCD victims with CAD have preserved left ventricular function, additional cardiac investigations are likely to play an increasing role in the risk stratification of CAD patients. A number of studies have demonstrated that certain parameters on the traditional 12-lead electrocardiogram (ECG) and other ECG-based investigations (such as signal-averaged ECG, heart rate turbulence, T-wave alternans) can provide important information on the underlying cardiac substrate abnormality that may predispose to ventricular arrhythmias and SCD. This article reviews some of the evidence for these ECG-based tests as predictors of SCD in patients with CAD and addresses their advantages and limitations.

A Deviation Analysis Framework for ECG Signals Using Controlled Spatial Transformation

“…The second and perhaps more important drawback of the existing ECG classification systems is their incapability of providing predictive alarms before the occurrence of abnormalities. Nevertheless, it has been proven by researchers that certain features of ECG signals reflect underlying cardiac abnormalities before the occurrences of cardiac disease [4,5]. Due to the large variety of ECG parameters, the selection of optimal predictor set is a demanding task if performed manually.…”

Late Ventricular Potentials in Cardiac and Extracardiac Diseases

“…Increased QRS duration has been previously associated with increased mortality in patients with coronary heart disease and hypertensive patients (Brembilla-Perrot et al, 2001;Liew, 2011). Syncope and dizziness may be related either to atrio-ventricular conduction disturbances or to ventricular arrhythmias.…”

“…Significantly impaired LVEF is an established predictor of SCD and is included in the current guidelines for primary prevention of SCD. But patients with a preserved LVEF are not included in the current guidelines (Liew, 2011). Combination of LVPs with LVEF (Jain & Avasthi, 1992; Konta et al, Kudaiberdieva et al, 2003), ventricular volumes (Pollak et al, 1985), heart rate variability (Gomes et al, 2001), ventricular diskinezia (Olinic & Zdrenghea, 1998), programmed ventricular stimulation (Ho et al, 1996), atrial pacing (Steinbigler et al, 1999), a high Killip class (3 or 4) in a patient with a history of a MI, may improve the predictive value of LVPs for ventricular arrhythmias.…”

Analysis of T-wave Alternans in ambulatory recordings using the ADTWA index

“…Most of them are based either on the analysis of echocardiographic images [3] or on the analysis of electrocardiographic signals (QRS duration, QT dispersion, heart rate variability, etc.) [4]. The main limitation of existing indices is their low specificity and predictive value.…”