QRS complex and T wave planarity for the efficacy prediction of automatic implantable defibrillators (2024)

Hnatkova, K., Andršová, I., Novotný, T., Vanderberk, B., Sprenkeler, D., Junttila, J., Reichlin, T., Schlögl, S., Vos, M. A., Friede, T., Bauer, A., Huikuri, H. V., Willems, R., Schmidt, G., Sticherling, C., Zabel, M., & Malik, M. (Accepted/In press). QRS complex and T wave planarity for the efficacy prediction of automatic implantable defibrillators. Heart, Article 322878. https://doi.org/10.1136/heartjnl-2023-322878

Hnatkova, Katerina ; Andršová, Irena ; Novotný, Tomáš et al. / QRS complex and T wave planarity for the efficacy prediction of automatic implantable defibrillators. In: Heart. 2023.

@article{2b6946d5657142b78ab03488030e21d2,

title = "QRS complex and T wave planarity for the efficacy prediction of automatic implantable defibrillators",

abstract = "Objective: To test the hypothesis that in recipients of primary prophylactic implantable cardioverter-defibrillators (ICDs), the non-planarity of ECG vector loops predicts (a) deaths despite ICD protection and (b) appropriate ICD shocks. Methods: Digital pre-implant ECGs were collected in 1948 ICD recipients: 21.4% females, median age 65 years, 61.5% ischaemic heart disease (IHD). QRS and T wave three-dimensional loops were constructed using singular value decomposition that allowed to measure the vector loop planarity. The non-planarity, that is, the twist of the three-dimensional loops out of a single plane, was related to all-cause mortality (n=294; 15.3% females; 68.7% IHD) and appropriate ICD shocks (n=162; 10.5% females; 87.7% IHD) during 5-year follow-up after device implantation. Using multivariable Cox regression, the predictive power of QRS and T wave non-planarity was compared with that of age, heart rate, left ventricular ejection fraction, QRS duration, spatial QRS-T angle, QTc interval and T-peak to T-end interval. Results: QRS non-planarity was significantly (p<0.001) associated with follow-up deaths despite ICD protection with HR of 1.339 (95% CI 1.165 to 1.540) but was only univariably associated with appropriate ICD shocks. Non-planarity of the T wave loop was the only ECG-derived index significantly (p<0.001) associated with appropriate ICD shocks with multivariable Cox regression HR of 1.364 (1.180 to 1.576) but was not associated with follow-up mortality. Conclusions: The analysed data suggest that QRS and T wave non-planarity might offer distinction between patients who are at greater risk of death despite ICD protection and those who are likely to use the defibrillator protection.",

keywords = "Biomarkers, Defibrillators, Implantable, Electrocardiography",

author = "Katerina Hnatkova and Irena Andr{\v s}ov{\'a} and Tom{\'a}{\v s} Novotn{\'y} and Bert Vanderberk and David Sprenkeler and Juhani Junttila and Tobias Reichlin and Simon Schl{\"o}gl and Vos, {Marc A.} and Tim Friede and Axel Bauer and Huikuri, {Heikki V.} and Rik Willems and Georg Schmidt and Christian Sticherling and Markus Zabel and Marek Malik",

note = "Publisher Copyright: {\textcopyright} 2023 Author(s) (or their employer(s)).",

year = "2023",

doi = "10.1136/heartjnl-2023-322878",

language = "English",

journal = "Heart",

issn = "1355-6037",

publisher = "BMJ Publishing Group",

}

Hnatkova, K, Andršová, I, Novotný, T, Vanderberk, B, Sprenkeler, D, Junttila, J, Reichlin, T, Schlögl, S, Vos, MA, Friede, T, Bauer, A, Huikuri, HV, Willems, R, Schmidt, G, Sticherling, C, Zabel, M & Malik, M 2023, 'QRS complex and T wave planarity for the efficacy prediction of automatic implantable defibrillators', Heart. https://doi.org/10.1136/heartjnl-2023-322878

QRS complex and T wave planarity for the efficacy prediction of automatic implantable defibrillators. / Hnatkova, Katerina; Andršová, Irena; Novotný, Tomáš et al.
In: Heart, 2023.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - QRS complex and T wave planarity for the efficacy prediction of automatic implantable defibrillators

AU - Hnatkova, Katerina

AU - Andršová, Irena

AU - Novotný, Tomáš

AU - Vanderberk, Bert

AU - Sprenkeler, David

AU - Junttila, Juhani

AU - Reichlin, Tobias

AU - Schlögl, Simon

AU - Vos, Marc A.

AU - Friede, Tim

AU - Bauer, Axel

AU - Huikuri, Heikki V.

AU - Willems, Rik

AU - Schmidt, Georg

AU - Sticherling, Christian

AU - Zabel, Markus

AU - Malik, Marek

N1 - Publisher Copyright:© 2023 Author(s) (or their employer(s)).

PY - 2023

Y1 - 2023

N2 - Objective: To test the hypothesis that in recipients of primary prophylactic implantable cardioverter-defibrillators (ICDs), the non-planarity of ECG vector loops predicts (a) deaths despite ICD protection and (b) appropriate ICD shocks. Methods: Digital pre-implant ECGs were collected in 1948 ICD recipients: 21.4% females, median age 65 years, 61.5% ischaemic heart disease (IHD). QRS and T wave three-dimensional loops were constructed using singular value decomposition that allowed to measure the vector loop planarity. The non-planarity, that is, the twist of the three-dimensional loops out of a single plane, was related to all-cause mortality (n=294; 15.3% females; 68.7% IHD) and appropriate ICD shocks (n=162; 10.5% females; 87.7% IHD) during 5-year follow-up after device implantation. Using multivariable Cox regression, the predictive power of QRS and T wave non-planarity was compared with that of age, heart rate, left ventricular ejection fraction, QRS duration, spatial QRS-T angle, QTc interval and T-peak to T-end interval. Results: QRS non-planarity was significantly (p<0.001) associated with follow-up deaths despite ICD protection with HR of 1.339 (95% CI 1.165 to 1.540) but was only univariably associated with appropriate ICD shocks. Non-planarity of the T wave loop was the only ECG-derived index significantly (p<0.001) associated with appropriate ICD shocks with multivariable Cox regression HR of 1.364 (1.180 to 1.576) but was not associated with follow-up mortality. Conclusions: The analysed data suggest that QRS and T wave non-planarity might offer distinction between patients who are at greater risk of death despite ICD protection and those who are likely to use the defibrillator protection.

AB - Objective: To test the hypothesis that in recipients of primary prophylactic implantable cardioverter-defibrillators (ICDs), the non-planarity of ECG vector loops predicts (a) deaths despite ICD protection and (b) appropriate ICD shocks. Methods: Digital pre-implant ECGs were collected in 1948 ICD recipients: 21.4% females, median age 65 years, 61.5% ischaemic heart disease (IHD). QRS and T wave three-dimensional loops were constructed using singular value decomposition that allowed to measure the vector loop planarity. The non-planarity, that is, the twist of the three-dimensional loops out of a single plane, was related to all-cause mortality (n=294; 15.3% females; 68.7% IHD) and appropriate ICD shocks (n=162; 10.5% females; 87.7% IHD) during 5-year follow-up after device implantation. Using multivariable Cox regression, the predictive power of QRS and T wave non-planarity was compared with that of age, heart rate, left ventricular ejection fraction, QRS duration, spatial QRS-T angle, QTc interval and T-peak to T-end interval. Results: QRS non-planarity was significantly (p<0.001) associated with follow-up deaths despite ICD protection with HR of 1.339 (95% CI 1.165 to 1.540) but was only univariably associated with appropriate ICD shocks. Non-planarity of the T wave loop was the only ECG-derived index significantly (p<0.001) associated with appropriate ICD shocks with multivariable Cox regression HR of 1.364 (1.180 to 1.576) but was not associated with follow-up mortality. Conclusions: The analysed data suggest that QRS and T wave non-planarity might offer distinction between patients who are at greater risk of death despite ICD protection and those who are likely to use the defibrillator protection.

KW - Biomarkers

KW - Defibrillators, Implantable

KW - Electrocardiography

UR - http://www.scopus.com/inward/record.url?scp=85172309894&partnerID=8YFLogxK

U2 - 10.1136/heartjnl-2023-322878

DO - 10.1136/heartjnl-2023-322878

M3 - Article

C2 - 37714697

AN - SCOPUS:85172309894

SN - 1355-6037

JO - Heart

JF - Heart

M1 - 322878

ER -

Hnatkova K, Andršová I, Novotný T, Vanderberk B, Sprenkeler D, Junttila J et al. QRS complex and T wave planarity for the efficacy prediction of automatic implantable defibrillators. Heart. 2023;322878. doi: 10.1136/heartjnl-2023-322878