Disease Severity and Exercise Testing Reduce Subcutaneous Implantable Cardioverter-Defibrillator Left Sternal ECG Screening Success in Hypertrophic Cardiomyopathy.
Background: The features of the hypertrophic cardiomyopathy (HCM) ECG make it a challenge for subcutaneous implantable cardioverter-defibrillator (S-ICD) screening. We aimed to investigate the causes of screening failure at rest and on exercise to inform optimal S-ICD ECG vector development.Methods...
| Publicado en: | Circulation: Arrhythmia & Electrophysiology Vol. 10; no. 4; pp. 1 - 11 |
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| Autores principales: | , , , , , , , , |
| Formato: | Journal Article |
| Publicado: |
Lippincott Williams & Wilkins
Apr2017
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=122581988&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 122581988 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 19413149 6CUA jtl: Circulation: Arrhythmia & Electrophysiology issn: 19413149 maglogo: N pubinfo: dt: Apr2017 vid: 10 iid: 4 pid: 433 pub: Lippincott Williams & Wilkins place: Baltimore, Maryland artinfo: ui: 122581988 122581988 NLM28408651 10.1161/CIRCEP.117.004801 NLM28408651 122581988 ppf: 1 ppct: 10 formats: tig: atl: Disease Severity and Exercise Testing Reduce Subcutaneous Implantable Cardioverter-Defibrillator Left Sternal ECG Screening Success in Hypertrophic Cardiomyopathy. aug: au: Srinivasan, Neil T. Patel, Kiran H. Qamar, Kashif Taylor, Amy Bacà, Marco Providência, Rui Tome-Esteban, Maria Elliott, Perry M. Lambiase, Pier D. affil: Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew’s Hospital, London, United Kingdom. sug: subj: Cardiomyopathy, Hypertrophic Therapy Cardioversion Equipment and Supplies Death, Sudden, Cardiac Prevention and Control Decision Support Techniques Electrocardiography Defibrillators, Implantable Exercise Test Cardiomyopathy, Hypertrophic Diagnosis Female Predictive Value of Tests Heart Rate Risk Factors Adult Reproducibility of Results Algorithms Aged Death, Sudden, Cardiac Etiology Supine Position Cardiomyopathy, Hypertrophic Physiopathology Patient Positioning Male Logistic Regression Patient Selection Cardioversion Adverse Effects Severity of Illness Indices Middle Age Chi Square Test Action Potentials Odds Ratio Multivariate Analysis Cardiomyopathy, Hypertrophic Mortality Exercise of Self-Care Agency Scale Adult: 19-44 years Aged: 65+ years Middle Aged: 45-64 years Female Male ab: Background: The features of the hypertrophic cardiomyopathy (HCM) ECG make it a challenge for subcutaneous implantable cardioverter-defibrillator (S-ICD) screening. We aimed to investigate the causes of screening failure at rest and on exercise to inform optimal S-ICD ECG vector development.Methods and Results: One hundred and thirty-one HCM patients (age, 50±16 years; 92 males and 39 females) with ≥1 HCM risk factor for sudden death underwent S-ICD ECG screening at rest and on exercise. Fifty patients (38%) were ineligible for S-ICD because of screening failure in every lead vector: 33 (66%) failed in the supine position, 12 (24%) failed in the standing position, and 5 (10%) failed on exercise. In patients who could exercise and passed screening at rest, 31 (44%) had 1 vector safety, 16 (23%) had 2 vector safety, and 24 (33%) had 3 vector safety. Increased R:T wave ratio in the S-ICD screening ECG (odds ratio, 4.0; confidence interval, 3.0-5.3; P<0.001) was associated with screening failure, while R/T ratio <3 in aVF (odds ratio, 0.3; confidence interval, 0.12-0.69; P=0.006) and increasing age (odds ratio, 0.97; confidence interval, 0.95-0.99; P=0.03) was associated with reduced screening failure. European Society of Cardiology risk score was higher in those failing screening (risk score 5.5% [interquartile range, 3.2-8.7] in failed versus 4.5% [interquartile range, 2.9-7.4] in passed; P=0.04).Conclusions: HCM patients have a significant incidence of screening failure, which is determined primarily by the increased R:T ratio on the screening ECG and lead aVF. High-risk patients have an increased screening failure rate. Optimization of sensing algorithms is required to ensure that the highest risk HCM patients can benefit from S-ICD implantation. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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