QRS duration and prediction of mortality in patients undergoing risk stratification for ventricular arrhythmias

This study tested the hypothesis that prolonged QRS duration independently predicts long-term mortality in patients who underwent risk stratification and treatment for ventricular arrhythmias. Patients who underwent risk stratification by electrophysiologic study were identified. Electrophysiologic...

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Bibliographic Details
Published in:	The American journal of cardiology Vol. 92; no. 7; pp. 798 - 803
Main Authors:	Kalahasti, Vidyasagar, Nambi, Vijay, Martin, David O, Lam, Cathy T, Yamada, David, Wilkoff, Bruce L, Niebauer, Mark J, Jaeger, Fredrick J, Tchou, Patrick J, Chung, Mina K
Format:	Journal Article
Language:	English
Published:	New York, NY Elsevier Inc 01-10-2003 Elsevier Elsevier Limited
Subjects:	Aged Biological and medical sciences Cardiac arrhythmia Cardiac dysrhythmias Cardiology. Vascular system Coronary Artery Disease - complications Defibrillators, Implantable Electrophysiologic Techniques, Cardiac Female Health risk assessment Heart Humans Male Medical sciences Middle Aged Mortality Multivariate Analysis Patients Predictive Value of Tests Risk Assessment - methods Risk Factors Survival Analysis Ventricular Dysfunction, Left - complications Ventricular Fibrillation - complications Ventricular Fibrillation - diagnosis Ventricular Fibrillation - mortality Ventricular Fibrillation - therapy Human Prognosis Arrhythmia Mortality QRS interval Electrophysiology Cardiovascular disease Survival Excitability disorder Electrodiagnosis Follow up study Heart disease Electrocardiography Paroxysmal ventricular tachycardia
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Summary:	This study tested the hypothesis that prolonged QRS duration independently predicts long-term mortality in patients who underwent risk stratification and treatment for ventricular arrhythmias. Patients who underwent risk stratification by electrophysiologic study were identified. Electrophysiologic study results were defined as positive if sustained monomorphic ventricular tachycardia was induced. Mortality was the primary end point. Of 915 patients studied, mean left ventricular (LV) ejection fraction (EF) was 35.3 ± 15.7%, 608 (66.4%) had coronary artery disease, 233 (25.5%) had positive electrophysiologic study findings, 298 (32.6%) received implantable cardioverter-defibrillators, and 174 (19%) died (mean follow-up 35.0 ± 15.0 months). Cox regression analysis identified older age, coronary artery disease, digoxin use, absence of β blockers, lower LVEF, and prolonged QRS duration to be independent predictors of mortality. QRS duration ≥130 ms, present in 33.6% of patients, was associated with a twofold increase in mortality (hazard ratio 2.1, 95% confidence interval 1.5 to 2.8; p <0.0001). For every 10 ms increase in QRS duration, mortality rate increased 10%. In a subgroup of patients with coronary artery disease and LVEF ≤30%, prolonged QRS duration remained an independent predictor of mortality (hazard ratio 2.6, 95% confidence interval 1.6 to 4.2; p <0.0001). Thus, prolonged QRS duration is a strong independent marker of long-term mortality in patients who undergo risk stratification for ventricular arrhythmias. Whether QRS duration represents only a marker for mortality or if modification of this factor using resynchronization therapies will impact mortality merits further study.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0002-9149 1879-1913
DOI:	10.1016/S0002-9149(03)00886-5