AIM: The association of standard 12-lead electrocardiogram (ECG) markers with benefits of the primary prophylactic implantable cardioverter-defibrillator (ICD) has not been determined in the contemporary era. We analysed traditional and novel ECG variables in a large prospective, controlled primary prophylactic ICD population to assess the predictive value of ECG in terms of ICD benefit. METHODS AND RESULTS: Electrocardiograms from 1477 ICD patients and 700 control patients (EU-CERT-ICD; non-randomized, controlled, prospective multicentre study; ClinicalTrials.gov Identifier: NCT02064192), who met ICD implantation criteria but did not receive the device, were analysed. The primary outcome was all-cause mortality. In ICD patients, the co-primary outcome of first appropriate shock was used. Mean follow-up time was 2.4 ± 1.1 years to death and 2.3 ± 1.2 years to the first appropriate shock. Pathological Q waves were associated with decreased mortality in ICD patients [hazard ratio (HR) 0.54, 95% confidence interval (CI) 0.35-0.84; P < 0.01] and patients with pathological Q waves had significantly more benefit from ICD (HR 0.44, 95% CI 0.21-0.93; P = 0.03). QTc interval increase taken as a continuous variable was associated with both mortality and appropriate shock incidence, but commonly used cut-off values, were not statistically significantly associated with either of the outcomes. CONCLUSION: Pathological Q waves were a strong ECG predictor of ICD benefit in primary prophylactic ICD patients. Excess mortality among Q wave patients seems to be due to arrhythmic death which can be prevented by ICD.

Biocenter Oulu University of Oulu Oulu Finland

Department of Cardiovascular Sciences University of Leuven and University Hospitals Leuven Leuven Belgium

Department of Internal Medicine and Cardiology Masaryk University Brno Czech Republic

Department of Medical Statistics University Medical Center Göttingen Göttingen Germany

Division of Cardiology University Hospital Basel Basel Switzerland

Division of Cardiology University Medical Center Göttingen Heart Center Göttingen Germany

DZHK partner site Göttingen Göttingen Germany

Medical Physiology University Medical Center Utrecht Utrecht Netherlands

National Heart and Lung Institute Imperial College London UK

Research Unit of Internal Medicine Medical Research Center Oulu Oulu University Hospital and University of Oulu PO Box 5000 FIN 90014 Oulu Finland

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ClinicalTrials.gov
NCT02064192