Sinus rhythm QRS amplitude and fractionation in patients with nonischemic cardiomyopathy to identify ventricular tachycardia substrate and location,Heart Rhythm

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Sinus rhythm QRS amplitude and fractionation in patients with nonischemic cardiomyopathy to identify ventricular tachycardia substrate and location
Heart Rhythm ( IF 5.6 ) Pub Date : 2021-09-30 , DOI: 10.1016/j.hrthm.2021.09.028
Martín R Arceluz ₁ , Ioan Liuba ₁ , Cory M Tschabrunn ₁ , David S Frankel ₁ , Pasquale Santangeli ₁ , Gregory E Supple ₁ , Robert D Schaller ₁ , Fermin C Garcia ₁ , David J Callans ₁ , Gustavo S Guandalini ₁ , Katie Walsh ₁ , Saman Nazarian ₁ , Erica S Zado ₁ , Francis E Marchlinski ₁

Affiliation

Background

Ventricular tachycardia (VT) substrate in left ventricular (LV) nonischemic cardiomyopathy (NICM) consists of fibrosis with surviving myocardium.

Objective

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.

Methods

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).

Results

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.

Conclusion

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.

中文翻译：

非缺血性心肌病患者的窦性心律 QRS 波幅和分割以识别室性心动过速的底物和位置

背景

左心室 (LV) 非缺血性心肌病 (NICM) 中的室性心动过速 (VT) 基质由存活心肌的纤维化组成。

客观的

本研究的目的是确定在 LV NICM 和持续 VT 患者中，窦性心律期间 QRS 波幅和 QRSf 降低是否可以识别异常间隔 (S-NICM) 和/或游离壁 (FW- NICM) VT 底物。

方法

我们将 NICM 和 VT 患者（第 1 组）与电解剖标测间隔（S-NICM；n = 21）或游离壁（FW-NICM；n = 20）VT 底物与 38 名患者参考队列（第 2 组）心脏磁共振成像 (cMRI) 和 NICM，但没有 VT 转诊为一级预防植入式心脏复律除颤器（26 [68.4%] 晚期钆增强）。

结果

第 1 组在 II 导联 (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) 和 V ₂ (1.09 ± 0.52 vs 1.38 ± 0.55, P = .001) 比第 2 组。aVF 导联中的 QRS <0.55 mV 可识别 VT 和伴随基质，灵敏度为 70%，特异性为 71%。大多数第 1 组和第 2 组患者在≥2 个连续导联中具有 12 导联心电图 QRS 分割 (QRSf)（78% 对 63.2%，P = .14）。识别相应区域电解剖或 cMRI 异常的≥2 个 QRSf 导联的敏感性和特异性分别为：下位导联为 76% 和 50%，侧导联为 44% 和 87%，前路导联为 21% 和 89%。