Intracardiac QT integral on far-field ICD electrogram predicts sustained ventricular tachyarrhythmias in ICD patients

Prediction of sustained ventricular tachycardia (VT)/ventricular fibrillation (VF) could help to guide preventive interventions in at-risk patients. The QRST integral (∫QT) reflects intrinsic repolarization properties.

The objective of this study was to determine whether intracardiac ∫QT predicts VT/VF in the next few months in patients with implantable cardioverter defibrillators (ICDs).

Far-field (FF) and near-field (NF) right ventricular intracardiac electrograms (EGMs) were recorded via telemetry in 46 patients with structural heart disease and ICDs implanted for secondary prevention of sudden cardiac death. Epochs of 4.9 ± 0.4 minutes during sinus rhythm (mean heart rate 70.9 ± 15.2 beats/min) and ventricular pacing at 105 beats/min were analyzed. Mean ∫QT was calculated on FF and NF EGMs as the algebraic sum of areas under the QRST curve and adjusted by mean heart rate. Patients were followed up for at least 3 months. True VT/VF events treated by the ICD served as the end point.

During a mean follow-up of 4.6 months, 22 patients (48%) were treated for VT/VF. Unadjusted and adjusted by heart rate, FF EGM ∫QT in sinus rhythm was a significant predictor of VT/VF (unadjusted ∫QT hazard ratio 1.007; 95% confidence interval 1.002 to 1.0013; P = .007; adjusted ∫QT hazard ratio 1.68; 95% confidence interval 1.19 to 2.36; P = .002). The highest quartile of intracardiac ∫QT predicted VT/VF (log-rank test P = .042) and identified patients at risk with a specificity of 86% and positive predictive value of 73%.

Increased intracardiac FF EGM ∫QT predicts VT/VF in patients with structural heart disease and secondary prevention ICDs.