Oğuzhan Ekrem TURAN, Mürsel ŞAHİN, Ali Nail KAYA, Armağan KAYA, Burcu KODAL

The prognostic value of T-peak T-end among patients with implantable cardiac defibrillator for secondary prevention

Aim: Cardiac death due to ventricular arrhyhtmias can occur in patients with ICD (implantable cardioverter defibrillator) for secondaryprevention. The aim of this study is to assess the prognostic value of electrocardiographic ventricular repolarization parameters inpatients with secondary prevention.Materials and Methods: Sixty five patients with ICD for secondary prevention after sustained ventricular tachycardia, ventricularfibrillation or sudden cardiac death were enrolled to the study retrospectively. Patients were divided into groups according tomortality during a follow up period of 4,5 years (48 patients alive and 17 dead). Heart rate, QT, QTc and T peak T end (Tp-e) durationwere measured from 12 derivations ECG electronically.Results: Mean age of the study population was 70.6±11.9 years. Ventricular repolarization parameters such as QT, QTc, Tp-e durationand Tp-e index values were found to be similar between deaths and live patient groups. Patients who died during the follow-up hadadvanced age (68.7±12.5 vs 76.8±10.3 years, p=0.009), lower left ventricular ejection fraction percentage (LVEF %) (37.6±13.3 vs26.9±9.2, p=0.003) and lower estimated glomerular filtration rate (81.2±22.5 vs 61±34.3 ml/min/m2, p=0.03). Arrhythmic deathpatients only had lower LVEF % than non-arrhythmic death patient’s group.Conclusions: In patients with ICD for secondary prevention QT, QTc, Tp-e duration and Tp-e index were not related to mortality

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1. The Antiarrhythmics Versus Implantable Defibrillators (AVID) Investigators. A comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med 1997;337:1576-83.
2. Kuck KH, Cappato R, Siebels J, et al. Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest: the Cardiac Arrest Study Hamburg (CASH). Circulation 2000;102:748-54.
3. Connolly SJ, Gent M, Robers RS, et al. Canadian Implantable Defibrillator Study (CIDS): a randomized trial of the implantable defibrillator against amiodarone. Circulation 2000;101:1297-1302.
4. Mirowski M, Reid PR, Mower MM, et al. Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings. N Engl J Med 1980;303:322.
5. Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/ AHA/ HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guidelines Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices). J Am Coll Cardiol 2008;51:1-62.
6. Masoudi FA, Ponirakis A, Yeh RW, et al. Cardiovascular care facts. A report from the National Cardiovascular Data Registry: 2011. J Am Coll Cardiol 2013;62:1931- 47.
7. Køber L, Thune, JJ, Nielsen JC, et al. Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure. N Engl J Med 2016:375;1221-30.
8. Boriani G, Berti E, Belotti LM, et al. RERAI (Registry of Emilia Romagnaon Arrhythmia Interventions) Investigators. Cardiac device therapy in patients with left ventricular dysfunction and heart failure: ‘real-world’ data on longterm outcomes (mortality, hospitalizations, days alive and out of hospital). Eur J Heart Fail 2016;18:693-702.
9. Yan GX, Antzelevitch C. Cellular basis for the normal T wave and the electrocardiographic manifestations of the long QT syndrome, Circulation 1998;98:1928-36.
10. Mitchell LB, Pineda EA, Titus JL, et al.Sudden death in patients with implantable cardioverter defibrillators. Journal of the American College of Cardiology, 2002;39:1323-8.
11. Hsia HH, Callans DJ, Marchlinski FE. Characterization of endocardial electrophysiological substrate in patients with nonischemic cardiomyopathy and monomorphic ventricular tachycardia.Circulation 2003;108:704-10.
12. Antzelevitch C, Di Diego JM, Argenziano M. TpeakTend as a predictor of ventricular arrhythmogenesis. Int J Cardiol 2017;249:75-6.
13. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.Eur Heart J. 2016;37:2129-200.
14. Morin DP, Saad MN, Shams OF, et al. Relationships between the T-peak to T-end interval, ventricular tachyarrhythmia, and death in left ventricular systolic dysfunction. Europace 2012;14:1172-9.
15. Scott PA, Rosengarten JA, Shahed A, et al. The relationship between left ventricular scar and ventricular repolarization in patients with coronary artery disease: insights from late gadolinium enhancement magnetic resonance imaging. Europace 2013;15:899-906.