European Heart Journal Advance Access originally published online on April 2, 2008
European Heart Journal 2008 29(13):1653-1661; doi:10.1093/eurheartj/ehn111
Paced ventricular electrogram fractionation predicts sudden cardiac death in hypertrophic cardiomyopathy
1 Department of Cardiology, Papworth Hospital, University of Cambridge, Cambridge CB23 3RE, UK
2 Department of Engineering, University of Cambridge, Cambridge CB2 1PZ, UK
3 Department of Medicine, University of Cambridge, Cambridge CB2 1PZ, UK
4 National Institute of Cardiology, 04-628 Warsaw, Poland
5 Department of Cardiology, Freeman Hospital, Newcastle NE7 7DN, UK
6 Department of Cardiology, Royal Brompton Hospital, London SW3 6NP, UK
7 Department of Medical Cardiology, Royal Infirmary, Glasgow G31 2ER, UK
8 Queen Elizabeth Hospital, Birmingham B15 2TH, UK
9 Department of Cardiology, Royal Victoria Hospital, Belfast BT12 6BA, UK
10 Department of Cardiology, Royal Hospital for Sick Children, Glasgow G3 8SJ, UK
11 Southampton General Hospital, Southampton SO16 6YD, UK
12 Département de Cardiologie, CHU Nancy Brabois, 54500 Vandoeuvre les Nancy, France
13 Division of Cardiovascular Biology, Department of Biochemistry and Physiological Laboratory, University of Cambridge, Tennis Court Road, Cambridge CB2 1QW, UK
Received 27 August 2007; revised 29 January 2008; accepted 22 February 2008; online publish-ahead-of-print 2 April 2008.
* Corresponding author. Tel: +44 1480 364350, Fax: +44 1480 364799, Email: ag{at}bioc.cam.ac.uk
See page 1600 for the editorial comment on this article (doi:10.1093/eurheartj/ehn238)
Aims: Paced electrogram fractionation analysis (PEFA) has been assessed for the prediction of sudden cardiac death (SCD) in a large-scale, prospective study of patients with hypertrophic cardiomyopathy (HCM).
Methods and results: We determined the positive predictive value (PPV) of PEFA in relation to other risk factors for SCD and outcomes in 179 patients with HCM and no prior history of cardiac arrest. Patients were followed over a mean 4.3 years (range: 1.1–6.3 years). Thirteen patients had SCD-equivalent events: four of these patients died suddenly, three were resuscitated from ventricular fibrillation (VF), and six had implantable cardioverter-defibrillator (ICD) discharges in response to VF. PEFA identified nine of these patients and another 14 non-VF patients yielding a censored PPV of between 0.19 and 0.59 that was greater than the PPV that was the formal stopping point of the trial (0.18). Eighty per cent of patients were followed for 4 years or more. The PPV for the identification of SCD in this group was 0.38 (0.17–0.59). The use of two or more conventional markers to predict SCD identified five patients with SCD-equivalent events in the 4-year follow-up group and 42 other patients without events yielding a PPV of 0.106 (confidence limits 0.02–0.15).
Conclusion: PEFA identifies HCM patients at risk of SCD with greater accuracy than non-invasive techniques and may have an important role in determining indications for ICD prescription.
Key Words: Heart arrest • Electrophysiology • Cardiomyopathy • Defibrillation
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