Sinus Rhythm QRS Amplitude and Fractionation in Patients with Non-Ischemic Cardiomyopathy to Identify Ventricular Tachycardia Substrate and Location.

医学 内科学 心脏病学 缺血性心肌病 QRS波群 室性心动过速 心肌病 窦性心律 心力衰竭 射血分数 心房颤动
作者
Martín Arceluz,Ioan Liuba,Cory M. Tschabrunn,David S. Frankel,Pasquale Santangeli,Gregory E. Supple,Robert D. Schaller,Fermin C. Garcia,David J. Callans,Gustavo S. Guandalini,Katie Walsh,Saman Nazarian,Erica S. Zado,Francis E. Marchlinski
出处
期刊:Heart Rhythm [Elsevier]
被引量:2
标识
DOI:10.1016/j.hrthm.2021.09.028
摘要

Ventricular tachycardia (VT) substrate in left ventricular (LV) nonischemic cardiomyopathy (NICM) consists of fibrosis with surviving myocardium.The purpose of this study was to determine whether, in patients with LV NICM and sustained VT, reduced QRS amplitude and QRSf during sinus rhythm can identify the presence and location of abnormal septal (S-NICM) and/or free-wall (FW-NICM) VT substrate.We compared patients with NICM and VT (group 1) with electroanatomic mapping septal (S-NICM; n = 21) or free-wall (FW-NICM; n = 20) VT substrate to a 38-patient reference cohort (group 2) with cardiac magnetic resonance imaging (cMRI) and NICM but no VT referred for primary prevention implantable cardioverter-defibrillator (26 [68.4%] with late gadolinium enhancement).Group 1 had lower QRS amplitude in leads II (0.60 ± 0.22 vs 0.86 ± 0.35, P <.001), aVR (0.60 ± 0.24 vs 0.75 ± 0.31, P = .002), aVF (0.48 ± 0.20 vs 0.70 ± 0.28, P <.001), and V2 (1.09 ± 0.52 vs 1.38 ± 0.55, P = .001) than group 2. QRS <0.55 mV in lead aVF identified VT and accompanying substrate with sensitivity 70% and specificity 71%. Most group 1 and group 2 patients had 12-lead ECG QRS fractionation (QRSf) in ≥2 contiguous leads (78% vs 63.2%, P = .14). Sensitivity and specificity for ≥2 QRSf leads identifying respective regional electroanatomic or cMRI abnormalities were 76% and 50% for inferior, 44% and 87% for lateral, and 21% and 89% for anterior leads.In LV NICM, low frontal plane QRS (<0.55 mV in aVF) is associated with VT substrate. Although multilead QRS fractionation is associated with the presence and location of VT substrate, it is frequently identified in patients without VT with cMRI abnormalities.
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