Fragmented surface ECG was a poor predictor of appropriate therapies in patients with Chagas' cardiomyopathy and ICD implantation (Fragmented ECG in CHAgas' Cardiomyopathy Study).

Abstract

BACKGROUND:

Main causes of death in chronic Chagas' cardiomyopathy (CChC) are progressive congestive heart failure and sudden cardiac death. Implantable cardioverter defibrillators (ICD) have been proved an effective therapy to prevent sudden death in patients with CChC. Identification of predictors of sudden death remains a challenge.

OBJECTIVE:

To determine whether surface fragmented ECG (fQRS) helps identifying patients with CChC and ICDs at higher risk of presenting appropriate ICD therapies.

METHODS:

Multicenter retrospective study. All patients with CChC and ICDs were analyzed. Clinical demographics, surface ECG, and ICD therapies were collected.

RESULTS:

A total of 98 patients were analyzed. Another four cases were excluded due to pacing dependency. Mean age was 55.5 ± 10.4 years, male gender 65%, heart failure New York Heart Association class I 47% and II 38%. Mean left ventricular ejection fraction (LVEF) 39.6 ± 11.8%. The indication for ICD was secondary prevention in 70% of patients. fQRS was found in 56 patients (59.6%). Location of fragmentation was inferior (57.1%), lateral (35.7%), and anterior (44.6%). Rsr pattern was the more prevalent (57.1%). Predictors of appropriate therapy in the multivariate model were: increased age (P = 0.01), secondary prevention indication (P = 0.01), ventricular pacing >50% of the time (P = 0.004), and LVEF <30% (P = 0.01). The presence of fQRS did not identify patients at higher risk of presenting appropriate therapies delivered by the ICD (P = 0.87); regardless of QRS interval duration.

CONCLUSIONS:

fQRS is highly prevalent among patients with CChC. It has been found a poor predictor of appropriate therapies delivered by the ICD in this population.

• Authors: Adrian Baranchuk, Francisco Femenia, Juan Cruz López-Diez, Claudio Muratore, Mariana Valentino, Enrique Retyk, Nestor Galizio, Darío Di Toro, Karina Alonso, Wilma M Hopman, Rodrigo Miranda, FECHA Study Investigators
• Journal: Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc (Ann Noninvasive Electrocardiol) Vol. 19 Issue 1 Pg. 43-9 (Jan 2014) ISSN: 1542-474X [Electronic] United States
• PMID: 24460805 (Publication Type: Journal Article, Multicenter Study)
• Copyright: ©2013 Wiley Periodicals, Inc.

Topics

• Arrhythmias, Cardiac (complications, diagnosis)
• Brugada Syndrome
• Cardiac Conduction System Disease
• Chagas Cardiomyopathy (complications, surgery)
• Death, Sudden, Cardiac (prevention & control)
• Defibrillators, Implantable
• Electrocardiography (methods, statistics & numerical data)
• Female
• Heart Conduction System (abnormalities)
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Risk Factors
• Treatment Outcome