Noninvasive Predictors of Ventricular Arrhythmias in Patients With Tetralogy of Fallot Undergoing Pulmonary Valve Replacement

Cortez, Daniel; Barham, Waseem; Ruckdeschel, Emily; Sharma, Nandita; McCanta, Anthony C.; Alvensleben, Johannes von; Sauer, William H.; Collins, Kathryn K.; Kay, Joseph; Patel, Sonali S.; Nguyen, Duy T.

doi:10.1016/j.jacep.2016.08.007

Cited by 13 publications

(16 citation statements)

References 20 publications

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“…Dispersion of ventricular depolarization, as measured by the QRS vector magnitude has had predictive value in ventricular arrhythmia development pre-operatively and peri-operatively in patients with congenital heart disease, independent of QRSd [21, 22]. Furthermore, a low P-wave amplitude in lead I is associated with displaced conduction and clinical recurrence of paroxysmal AF post-radiofrequency ablation [23].…”

Section: Introductionmentioning

confidence: 99%

Atrial time and voltage dispersion are both needed to predict new-onset atrial fibrillation in ischemic stroke patients

Cortez

Baturova

Lindgren

et al. 2017

BMC Cardiovasc Disord

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BackgroundAtrial fibrillation (AF) is a known risk factor for ischemic stroke. Electrocardiographic predictors of AF in population studies such as the Framingham Heart Study, as well as in hypertensive patients have demonstrated a predictive value of the P-wave duration for development of AF. QRS vector magnitude has had a predictive value in ventricular arrhythmia development. We aimed to assess the value of the three-dimensional P-wave vector magnitude and its relationship to P-wave duration for prediction of new-onset AF after ischemic stroke.MethodsFirst-ever ischemic stroke patients without AF at inclusion in the Lund Stroke Register were included. Measurements of P wave duration (Pd), QRS duration, corrected QT interval, and PQ interval were performed automatically using the University of Glasgow 12-lead ECG analysis algorithm. The P-wave vector magnitude (Pvm) was calculated automatically as the square root of the sum of the squared P-wave magnitudes in leads V6, II and one half of the P-wave amplitude in V2 (), based on the P-wave magnitude (Pvm) as defined by the visually transformed Kors’ Quasi-orthogonal method.ResultsThe median age was 73 (IQR 63–80) years at stroke onset (135 males, 92 females). Multivariate predictors of new-onset atrial fibrillation included age > 65 years, hypertension, and Pd/Pvm. A cut-off value of 870 ms/mV gave sensitivity, specificity, positive and negative predictive values of 51, 79, 30 and 87%, respectively. The Pd/Pvm was the only ECG predictor of AF with a significant multivariate hazard ratio of 2.02 (95% CI 1.18 to 3.46, p = 0.010).ConclusionP-wave dispersion as measured by the Pd/Pvm was the only ECG parameter measured which independently predicted subsequent AF identification in a cohort of stroke patients. Further prospective studies in larger cohorts are needed to validate its clinical usefulness.

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Section: Introductionmentioning

confidence: 99%

Atrial time and voltage dispersion are both needed to predict new-onset atrial fibrillation in ischemic stroke patients

Cortez

Baturova

Lindgren

et al. 2017

BMC Cardiovasc Disord

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“…However, new onset of arrhythmia in a previously stable patient also very frequently leads to signifi cant clinical worsening. Although right heart hypertrophy as well as dilatation can represent a potential arrhythmogenic substrate, it is very diffi cult to predict at which point the patient is prone to increased risk for life-threatening arrhythmias (43,44,45,46,47,48,49). It might be therefore very important to establish any relevant quantitative RV cut-off values as a prognostic marker in the long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Though it is very diffi cult to establish the level of QRS prolongation that represents a relevant arrhythmogenic substrate (3,41,43). In most studies with the model of pure RV volume overload (in tetralogy of Fallot after correction with severe pulmonary regurgitation) QRS > 180 ms is described as indication for re-intervention (3,48). Yet in most other studies QRS length > 120 ms already correlates with RV dysfunction (34,41), therefore we also used this as the cut-off value.…”

Section: Discussionmentioning

confidence: 99%

Eisenmenger syndrome – an electrocardiographic and echocardiographic assessment of the right ventricle

Valkovicova¹,

Kaldarárová²,

Reptová³

et al. 2018

BLL

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“…Electrocardiogram (ECG)‐derived vectorcardiographic (VCG) repolarization parameters offer the possibility of objective T‐wave morphology measure and have demonstrated significant diagnostic and prognostic value in patients at risk for sudden cardiac death . ECG‐derived VCG has shown prognostic utility in LQTS patients with prolonged QTc values, while in LQTS patients without QTc prolongation, neither spatial durations nor the spatial QRS‐T angle was able to differentiate symptomatic from asymptomatic LQTS patients …”

Section: Introductionmentioning

confidence: 99%

“…9 Electrocardiogram (ECG)-derived vectorcardiographic (VCG) repolarization parameters offer the possibility of objective T-wave morphology measure and have demonstrated significant diagnostic and prognostic value in patients at risk for sudden cardiac death. [10][11][12][13][14][15][16][17][18][19] ECG-derived VCG has shown prognostic utility in LQTS patients with prolonged QTc values, while in LQTS patients without QTc prolongation, neither spatial durations nor the spatial QRS-T angle was able to differentiate symptomatic from asymptomatic LQTS patients. 20,21 Assessment of the shape of the T-wave can be a way to identify patients with LQT2 without QTc prolongation at risk for cardiac events 4,9 ; however, qualitative methods may be operator-dependent and subject to interindividual variability.…”

Section: Introductionmentioning

confidence: 99%

Quantitative T‐wave morphology assessment from surface ECG is linked with cardiac events risk in genotype‐positive KCNH2 mutation carriers with normal QTc values

Cortez

Zaręba

McNitt

et al. 2019

Cardiovasc electrophysiol

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Introduction Long QT syndrome (LQTS) mutation carriers have elevated the risk of cardiac events even in the absence of QTc prolongation; however, mutation penetrance in patients with normal QTc may be reflected in abnormal T‐wave shape, particularly in KCNH2 mutation carriers. We aimed to assess whether the magnitude of a three‐dimensional T‐wave vector (TwVM) will identify KCNH2‐mutation carriers with normal QTc at risk for cardiac events. Methods Adult LQT2 patients with QTc < 460 ms in men and <470 ms in women (n = 113, age 42 ± 16 years, 43% male) were compared with genotype‐negative family members (n = 1007). The TwVM was calculated using T‐wave amplitudes in leads V6, II, and V2 as the square root of (TV62 + TII2 + (0.5*TV2)2). Cox regression analysis adjusted for gender and time‐dependent beta‐blocker use was performed to assess cardiac event (CE) risk, defined as syncope, aborted cardiac arrest, implantable cardioverter‐defibrillator therapy, or sudden death. Results Dichotomized by median of 0.30 mV, lower TwVM was associated with elevated CE risk compared to those with high TwVM (HR = 2.95, 95% CI, 1.25‐6.98, P = .014) and also remained significant after including sex and time‐dependent beta‐blocker usage in the Cox regression analysis (HR = 2.64, 95% CI, 1.64‐4.24, P < .001). However, these associations were found only in women but not in men who had low event rates. Conclusion T‐wave morphology quantified as repolarization vector magnitude using T‐wave amplitudes retrieved from standard 12‐lead electrocardiogram predicts cardiac events risk in LQT2 women and appears useful for risk stratification of KCNH2‐mutation carriers without QTc prolongation.

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Noninvasive Predictors of Ventricular Arrhythmias in Patients With Tetralogy of Fallot Undergoing Pulmonary Valve Replacement

Cited by 13 publications

References 20 publications

Atrial time and voltage dispersion are both needed to predict new-onset atrial fibrillation in ischemic stroke patients

Atrial time and voltage dispersion are both needed to predict new-onset atrial fibrillation in ischemic stroke patients

Eisenmenger syndrome – an electrocardiographic and echocardiographic assessment of the right ventricle

Quantitative T‐wave morphology assessment from surface ECG is linked with cardiac events risk in genotype‐positive KCNH2 mutation carriers with normal QTc values

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