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The Spatial Ventricular Gradient Is Associated With Inducibility of Ventricular Arrhythmias During Electrophysiology Study.
- Source :
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Heart rhythm [Heart Rhythm] 2024 May 06. Date of Electronic Publication: 2024 May 06. - Publication Year :
- 2024
- Publisher :
- Ahead of Print
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Abstract
- Background: Myocardial electrical heterogeneity is critical for normal cardiac electromechanical function, but abnormal or excessive electrical heterogeneity is proarrhythmic. The spatial ventricular gradient (SVG), a vectorcardiographic measure of electrical heterogeneity, has been associated with arrhythmic events during long-term follow-up, but its relationship with short-term inducibility of ventricular arrhythmias (VAs) is unclear.<br />Objective: This study was designed to determine associations between SVG and inducible VAs during electrophysiology study.<br />Methods: A retrospective study was conducted of adults without prior sustained VA, cardiac arrest, or implantable cardioverter-defibrillator who underwent ventricular stimulation for evaluation of syncope and nonsustained ventricular tachycardia or for risk stratification before primary prevention implantable cardioverter-defibrillator implantation. The 12-lead electrocardiograms were converted into vectorcardiograms, and SVG magnitude (SVGmag) and direction (azimuth and elevation) were calculated. Odds of inducible VA were regressed by logistic models.<br />Results: Of 143 patients (median age, 69 years; 80% male; median left ventricular ejection fraction [LVEF], 47%; 52% myocardial infarction), 34 (23.8%) had inducible VAs. Inducible patients had lower median LVEF (38% vs 50%; P < .0001), smaller SVGmag (29.5 vs 39.4 mV·ms; P = .0099), and smaller cosine SVG azimuth (cosSVGaz; 0.64 vs 0.89; P = .0007). When LVEF, SVGmag, and cosSVGaz were dichotomized at their medians, there was a 39-fold increase in adjusted odds (P = .002) between patients with all low LVEF, SVGmag, and cosSVGaz (65% inducible) compared with patients with all high LVEF, SVGmag, and cosSVGaz (4% [n = 1] inducible). After multivariable adjustment, SVGmag, cosSVGaz, and sex but not LVEF or other characteristics remained associated with inducible VAs.<br />Conclusion: Assessment of electrical heterogeneity by SVG, which reflects abnormal electrophysiologic substrate, adds to LVEF and identifies patients at high and low risk of inducible VA at electrophysiology study.<br />Competing Interests: Disclosures D.B.K. and J.W.W. previously served on an advisory board for HeartcoR Solutions. T.R.M.: consulting/speaking for Abbott and Biosense; research support from LuxMed. A.L.: speaking for Abbott and Biosense. A.D.: consulting/speaking for Abbott, Biosense, and Biotronik; research support from Abbott, Biosense, and Medtronic. All other authors report no conflicts of interest.<br /> (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
Details
- Language :
- English
- ISSN :
- 1556-3871
- Database :
- MEDLINE
- Journal :
- Heart rhythm
- Publication Type :
- Academic Journal
- Accession number :
- 38718942
- Full Text :
- https://doi.org/10.1016/j.hrthm.2024.05.005