Engstrom, Nathan, Letson, Hayley, Ng, Kevin, and Dobson, Geoffrey (2024) Ventriculo-arterial (VA) coupling and fQRS as new selection criteria for primary prevention ICD placement. Intensive Care Medicine Experimental, 12. 62.

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Abstract

For decades, left ventricular ejection fraction (LVEF < 35%) has been a mainstay for identifying heart failure (HF) patients most likely to benefit from an implantable cardioverter defibrillator (ICD). However, LVEF is a poor predictor of sudden cardiac death (SCD) and ignores 50% of HF patients with mildly reduced and preserved LVEF. The current international guidelines for primary prophylaxis ICD therapy are inadequate. Instead of LVEF, which is not a good measure of LV contractility or hemodynamic characterization, we hypothesize ventriculo-arterial (VA) coupling combined with fragmented QRS (fQRS) will improve risk stratification and patient suitability for an ICD. Quantifying cardiac and aortic mechanics, and predicting active arrhythmogenic substrate, from varying fQRS morphologies, may help to stratify ischemic and non-ischemic patients with different functional capacities and predisposition for lethal arrhythmias. We propose HF patients with a low physiological reserve may not benefit from ICD therapy, whereas those patients with higher reserves and extensive arrhythmogenic substrate may benefit. Our hypothesis combining VA coupling with fQRS changes has the potential to widen HF patient participation (low and high LVEF) and advance personalized medicine for HF patients at high risk of SCD.

Item ID:	83075
Item Type:	Article (Scholarly Work)
ISSN:	2197-425X
Keywords:	Fragmented QRS, Heart failure, Ventriculo-arterial coupling, Implantable cardiac defibrillator, Left ventricular ejection fraction, Sudden cardiac death, Arrhythmias
Funders:	Townsville Hospital and Health Service Study, Education and Research (SERTA)
Projects and Grants:	SERTA research grant 2020_12
Date Deposited:	12 Jul 2024 03:52
FoR Codes:	32 BIOMEDICAL AND CLINICAL SCIENCES > 3201 Cardiovascular medicine and haematology > 320101 Cardiology (incl. cardiovascular diseases) @ 100%
SEO Codes:	20 HEALTH > 2001 Clinical health > 200101 Diagnosis of human diseases and conditions @ 100%
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