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Delayed QRS transition in the precordial leads of an electrocardiogram as a predictor of sudden cardiac death in the general population.

Abstract：

BACKGROUND:QRS transition zone is related to the electrical axis of the heart in the horizontal plane and is easily determined from the precordial leads of a standard 12-lead ECG. However, whether delayed QRS transition, or clockwise rotation of the heart, carries prognostic implications and predicts sudden cardiac death (SCD) is unclear. OBJECTIVE:The purpose of this study was to study whether delayed transition is associated with mortality and SCD. METHODS:We evaluated 12-lead ECGs of 10,815 Finnish middle-aged subjects from the general population (52% men, mean age 44 ± 8.5 years) and followed them for 30 ± 11 years. Main end-points were mortality and SCD. RESULTS:Delayed QRS transition at lead V4 or later occurred in 1770 subjects (16.4%) and markedly delayed transition at lead V5 or later in 146 subjects (1.3%). Delayed transition zone was associated with older age, male gender, higher body mass index, hypertension, baseline cardiovascular disease, leftward shift of the frontal QRS axis, wider QRS-T angle, and ECG left ventricular hypertrophy. After adjusting for several clinical and ECG variables, delayed transition was associated with overall mortality (hazard ratio [HR] 1.15, 95% confidence interval [CI] 1.07-1.22, P < .001) and SCD (HR 1.23, 95% CI 1.03-1.47, P = .029). Markedly delayed transition at V5 or later predicted significantly SCD (HR 1.89, 95% CI 1.18-3.03, P = .008) and all-cause mortality (HR 1.30, 95% CI 1.07-1.58, P = .01). However, further adjustments for repolarization abnormalities attenuated this effect. CONCLUSION:Delayed QRS transition in the precordial leads of an ECG seems to be a novel ECG risk marker for SCD. In particular, markedly delayed transition was associated with significantly increased risk of SCD, independent of confounding factors.

journal_name

Heart Rhythm

journal_title

Heart rhythm

authors

Aro AL,Eranti A,Anttonen O,Kerola T,Rissanen HA,Knekt P,Porthan K,Tikkanen JT,Junttila MJ,Huikuri HV

doi

10.1016/j.hrthm.2014.08.014

subject

Has Abstract

pub_date

2014-12-01 00:00:00

pages

2254-60

issue

eissn

1547-5271

issn

1556-3871

pii

S1547-5271(14)00868-6

journal_volume

pub_type

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Delayed QRS transition in the precordial leads of an electrocardiogram as a predictor of sudden cardiac death in the general population.