Relationship between ventricular repolarization parameters and the
inducibility of ventricular arrhythmias during electrophysiological
study in patients with coronary artery disease
Abstract
INTRODUCTION: Malignant ventricular arrhythmias (MVA) are often the main
cause of sudden cardiac death (SCD), especially in patients with
pre-existing coronary artery disease (CAD). The identification of
factors associated with SCD in this clinical setting is important and
might help physicians in identifying this high risk group of patients.
We evaluated the association between 12-lead ECG ventricular
repolarization parameters and the induction of MVA on the
electrophysiological study (EPS). METHODS AND RESULTS: 177 patients
[mean age 65±10.1yo, 83.6% male, mean LV ejection fraction (LVEF)
37.5±13.6%] were analyzed. For each 10ms increment in the QT
interval, an increase of 7% in MVA inducibility was observed. The QT
cut-off point of 452 ms had and accuracy of 0.611 for predicting MVA
(p=0.011). Male gender (OR=4.18, p=0.012), LVEF < 35%
(OR=2.32, p=0.013), amiodarone use (OR=2.01, p=0.038) and prolonged QT
(OR=1.07, p=0.023) were independent factors associated with MVA. QT
> 452ms in patients with ventricular dysfunction was
associated with significant increased risk of MVA (OR=5.44, p=0.0004).
In patients with LVEF ≥ 35%, QT dispersion (QTd) was significantly
higher in those with inducible MVA. QTd > 20ms had an
accuracy of 0.638 in predicting MVA, with 81.3% negative predictive
value (95% CI 63-92.1%). CONCLUSION: QT interval was an independent
factor associated with MVA in patients with CAD. The combination of
ventricular dysfunction and prolonged QT interval was associated with a
5-fold increase of MVA induction. Male gender, amiodarone use and
decreased LVEF were also associated with increased risk of inducibility
of MVA on the EPS.