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Sudden cardiac death in adults with congenital heart disease: does QRS-complex fragmentation discriminate in
Jim T Vehmeijer1, Zeliha Koyak1, Jouke P Bokma1
1Department of Cardiology, Heart Center, Academic Medical Center-University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Insights
Fragmented QRS-complexes (fQRS) are a significant independent predictor of sudden cardiac death (SCD) in adult congenital heart disease (ACHD) patients. This finding may aid in identifying high-risk individuals for SCD prevention strategies.
Area of Science:
- Cardiology
- Electrophysiology
- Congenital Heart Disease
Background:
- Sudden cardiac death (SCD) is a major cause of mortality in adult congenital heart disease (ACHD) patients.
- Identifying high-risk ACHD patients for SCD remains a clinical challenge.
- Fragmented QRS-complexes (fQRS) are a known marker for SCD in acquired heart disease, but their role in ACHD is understudied.
Purpose of the Study:
- To investigate the prognostic value of fQRS for predicting SCD in a large cohort of ACHD patients.
- To determine if fQRS is an independent risk factor for SCD in this population.
Main Methods:
- A multicenter cohort study included 25,790 ACHD patients, analyzing 147 tachyarrhythmic SCD cases and 266 matched controls.
- fQRS was defined based on discontinuous deflections in QRS complexes on ECG.
- Conditional logistic regression models were used to assess the association between fQRS and SCD, adjusting for relevant clinical factors.
Main Results:
- fQRS was present in 51% of SCD cases versus 34% of controls (OR 2.0, P=0.003).
- Multivariable analysis confirmed fQRS as an independent predictor of SCD (OR 1.9, P=0.01).
- In tetralogy of Fallot (ToF) patients, fQRS was significantly more prevalent in SCD cases (71%) than controls (43%, OR 2.8, P=0.03).
Conclusions:
- fQRS is independently associated with SCD in ACHD patients.
- fQRS may serve as a valuable tool in risk stratification for primary SCD prevention in ACHD.
- Further research can explore the integration of fQRS into clinical decision-making for ACHD management.
Aims:
Sudden cardiac death (SCD) causes a large portion of all mortality in adult congenital heart disease (ACHD) patients. However, identification of high-risk patients remains challenging. Fragmented QRS-complexes (fQRS) are a marker for SCD in patients with acquired heart disease but data in ACHD patients are lacking. We therefore aim to evaluate the prognostic value of fQRS for SCD in ACHD patients.
Methods And Results:
From a multicentre cohort of 25 790 ACHD patients, we included tachyarrhythmic SCD cases (n = 147), and controls (n = 266) matched by age, gender, congenital defect and (surgical) intervention. fQRS was defined as ≥1 discontinuous deflection in narrow QRS-complexes, and ≥2 in wide QRS-complexes (>120 ms), in two contiguous ECG leads. We calculated odds ratios (OR) using univariable and multivariable conditional logistic regression models correcting for impaired systemic ventricular function, heart failure and QRS duration >120 ms. ECGs of 147 SCD cases (65% male, median age of death 34 years) and of 266 controls were assessed. fQRS was present in 51% of cases and 34% of controls (OR 2.0, P = 0.003). In multivariable analysis, fQRS was independently associated with SCD (OR 1.9, P = 0.01). The most common diagnose of SCD cases was tetralogy of Fallot (ToF, 34 cases). In ToF, fQRS was present in 71% of cases vs. 43% of controls (OR for SCD 2.8, P = 0.03).
Conclusions:
fQRS was independently associated with SCD in ACHD patients in a cohort of SCD patients and matched controls. fQRS may therefore contribute to the decision when evaluating ACHD patients for primary prevention of SCD.