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. 2010 Nov-Dec;43(6):548-52.
doi: 10.1016/j.jelectrocard.2010.07.013. Epub 2010 Sep 15.

Ventricular arrhythmia is predicted by sum absolute QRST integralbut not by QRS width

Larisa G Tereshchenko  1 , Alan Cheng, Barry J Fetics, Joseph E Marine, David D Spragg, Sunil Sinha, Hugh Calkins, Gordon F Tomaselli, Ronald D Berger
Affiliations

Ventricular arrhythmia is predicted by sum absolute QRST integralbut not by QRS width

Larisa G Tereshchenko et al. J Electrocardiol. 2010 Nov-Dec.

Abstract

Background: There is a controversy regarding the association between QRS width and ventricular arrhythmias (VAs). We hypothesized that predictive value of the QRS width could be improved if QRS width were considered in the context of the sum magnitude of the absolute QRST integral in 3 orthogonal leads sum absolute QRST integral (SAI QRST). We explored correlations between QRS width, SAI QRST, and VA in primary prevention implantable cardioverter-defibrillator (ICD) patients with structural heart disease.

Methods: Baseline orthogonal electrocardiograms were recorded at rest in 355 patients with implanted primary prevention ICDs (mean age, 59.5 ± 12.4 years; 279 male [79%]). Patients were observed prospectively at least 6 months; appropriate ICD therapies because of sustained VA served as end points. The sum magnitude of the absolute QRST integral in 3 orthogonal leads (SAI QRST) was calculated.

Results: During a mean follow-up of 18 months, 48 patients had sustained VA and received appropriate ICD therapies. There was no difference in baseline QRS width between patients with and those without arrhythmia (114.9 ± 32.8 vs 108.9 ± 24.7 milliseconds; P = .230). SAI QRST was significantly lower in patients with VA at follow-up than in patients without VA (102.6 ± 27.6 vs 112.0 ± 31.9 mV·ms; P = 0.034). Patients with SAI QRST (≤145 mV·ms) had a 3-fold higher risk of ventricular tachycardia (VT)/ventricular fibrillation (VF) (hazard ratio [HR], 3.25; 95% confidence interval [CI], 1.59-6.75; P = .001). In the univariate analysis, QRS width did not predict VT/VF. In the bivariate Cox regression model, every 1 millisecond of incremental QRS widening with a simultaneous 1 mV·ms SAI QRST decrease raised the risk of VT/VF by 2% (HR, 1.02; 95% CI, 1.01-1.03; P = .005).

Conclusion: QRS widening is associated with ventricular tachyarrhythmia only if accompanied by low SAI QRST.

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Figures

Figure 1
Figure 1
Boxplot of baseline SAI QRST and QRS width in patients with and without VT/VF at follow-up. Median (white horizontal line crossing the box) and interquartile range [IQR] (box) of SAI QRST (A) and QRS width (B). Whiskers specify the adjacent values, defined as the most extreme values within 1.5 IQR of the nearer quartile.
Figure 2
Figure 2
Correlation between QRS width and SAI QRST. Linear regression fitted line of SAI QRST on QRS width (dashed line) with 95% CI (gray zone).
Figure 3
Figure 3
Kaplan-Meier curves for freedom from ventricular arrhythmia events in patients with low, intermediate, and high SAI QRST, adjusted by QRS width.
See this image and copyright information in PMC

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