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Controlled Clinical Trial
. 2022 May 3;24(5):774-783.
doi: 10.1093/europace/euab260.

Q waves are the strongest electrocardiographic variable associated with primary prophylactic implantable cardioverter-defibrillator benefit: a prospective multicentre study

Ari Pelli  1 , M Juhani Junttila  1   2 , Tuomas V Kenttä  1 , Simon Schlögl  3 , Markus Zabel  3   4 , Marek Malik  5   6 , Tobias Reichlin  7 , Rik Willems  8 , Marc A Vos  9 , Markus Harden  10 , Tim Friede  4   10 , Christian Sticherling  7 , Heikki V Huikuri  1 ; EU-CERT-ICD Study Investigators
Collaborators, Affiliations
Controlled Clinical Trial

Q waves are the strongest electrocardiographic variable associated with primary prophylactic implantable cardioverter-defibrillator benefit: a prospective multicentre study

Ari Pelli et al. Europace. .

Abstract

Aim: 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.

Methods and results: 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.

Conclusion: 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.

Keywords: Appropriate shock; Benefit; Electrocardiogram; Heart failure; Implantable cardioverter-defibrillator; Mortality; Primary prevention; Q wave; QT interval.

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Figures

Figure 1
Figure 1
Flow chart of study data. ECG, electrocardiogram; VT, ventricular tachycardia; WP7, Work Package 7.
Figure 2
Figure 2
Mortality among subjects with and without Q waves in ICD and control populations. ICD, implantable cardioverter-defibrillator.
See this image and copyright information in PMC

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