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Background and objectives <p>Selection for implantable cardioverter-defibrillator (ICD) therapy based on left ventricular ejection fraction (LVEF) may miss at-risk patients with LVEF &gt; 35%. We tested whether a simple electrocardiogram (ECG) burden adds discriminatory power for appropriate ICD therapy beyond clinical factors and LVEF.</p> Methods <p>Single-center retrospective cohort of 236 ICD recipients.&#xa0;Six routinely reported ECG abnormalities (heart rate &gt; 75&#xa0;bpm; QRS duration &gt; 110&#xa0;ms; obtuse QRS–T angle; delayed transition zone; prolonged QTc; prolonged Tp–Te)&#xa0;were prespecified, summed to form an ECG burden (0–6), and categorized as 0–1, 2–3, or ≥ 4 abnormalities. Logistic regression estimated odds ratios (OR) with 95% CIs for appropriate ICD therapy. Multivariable models included LVEF category (≤ 35% vs &gt; 35%), ischemic vs non-ischemic cardiomyopathy, ICD indication (secondary vs primary prevention), and ECG burden category. Discrimination of the clinical + LVEF model with and without ECG burden was assessed using the AUC (C-statistic) and the DeLong test.</p> Results <p>Mean age was 62.1 ± 16.2&#xa0;years; 71% were male; 61% had ischemic cardiomyopathy; 72% underwent primary-prevention ICD implantation; and mean follow-up was 7.6 ± 2.9&#xa0;years. Appropriate ICD therapy was delivered to 26/236 (11.0%) patients. A high ECG burden (≥ 4 abnormalities) was associated with appropriate ICD therapy after adjustment (OR 3.6, 95% CI 1.8–7.2; <i>p</i> &lt; 0.001). Adding ECG burden to a clinical + LVEF model modestly improved discrimination in this cohort, with the AUC (C-statistic) from 0.67 to 0.72 (DeLong <i>p</i> = 0.01). Kaplan–Meier curves showed graded separation across ECG-burden categories (log-rank <i>p</i> &lt; 0.001). Among patients with LVEF &gt; 35%, therapy was observed more frequently in the high-burden group than in the low-burden group.</p> Conclusions <p>In this single-center retrospective cohort of ICD recipients, a higher ECG abnormality burden was associated with a higher risk of appropriate ICD therapy and modestly improved discrimination when added to a clinical + LVEF model. These findings are hypothesis-generating and warrant prospective, multicenter external validation using standardized ECG measurements before any clinical application.</p>

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Electrocardiographic predictors of ventricular arrhythmic events in ICD recipients: signal beyond the left ventricular ejection fraction threshold

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月6日

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  • Maysan Almegbel,
  • Abdulmohsen Almusaad,
  • Ali Mahmoud Alzammam,
  • Razan Alzayer,
  • Muneera AlTaweel

摘要

Background and objectives

Selection for implantable cardioverter-defibrillator (ICD) therapy based on left ventricular ejection fraction (LVEF) may miss at-risk patients with LVEF > 35%. We tested whether a simple electrocardiogram (ECG) burden adds discriminatory power for appropriate ICD therapy beyond clinical factors and LVEF.

Methods

Single-center retrospective cohort of 236 ICD recipients. Six routinely reported ECG abnormalities (heart rate > 75 bpm; QRS duration > 110 ms; obtuse QRS–T angle; delayed transition zone; prolonged QTc; prolonged Tp–Te) were prespecified, summed to form an ECG burden (0–6), and categorized as 0–1, 2–3, or ≥ 4 abnormalities. Logistic regression estimated odds ratios (OR) with 95% CIs for appropriate ICD therapy. Multivariable models included LVEF category (≤ 35% vs > 35%), ischemic vs non-ischemic cardiomyopathy, ICD indication (secondary vs primary prevention), and ECG burden category. Discrimination of the clinical + LVEF model with and without ECG burden was assessed using the AUC (C-statistic) and the DeLong test.

Results

Mean age was 62.1 ± 16.2 years; 71% were male; 61% had ischemic cardiomyopathy; 72% underwent primary-prevention ICD implantation; and mean follow-up was 7.6 ± 2.9 years. Appropriate ICD therapy was delivered to 26/236 (11.0%) patients. A high ECG burden (≥ 4 abnormalities) was associated with appropriate ICD therapy after adjustment (OR 3.6, 95% CI 1.8–7.2; p < 0.001). Adding ECG burden to a clinical + LVEF model modestly improved discrimination in this cohort, with the AUC (C-statistic) from 0.67 to 0.72 (DeLong p = 0.01). Kaplan–Meier curves showed graded separation across ECG-burden categories (log-rank p < 0.001). Among patients with LVEF > 35%, therapy was observed more frequently in the high-burden group than in the low-burden group.

Conclusions

In this single-center retrospective cohort of ICD recipients, a higher ECG abnormality burden was associated with a higher risk of appropriate ICD therapy and modestly improved discrimination when added to a clinical + LVEF model. These findings are hypothesis-generating and warrant prospective, multicenter external validation using standardized ECG measurements before any clinical application.