LAUSR

BACKGROUND Myocardial scarring from infarction or non-ischemic fibrosis forms an arrhythmogenic substrate. The Selvester QRS-score has been developed to estimate myocardial scar from the 12-lead ECG. OBJECTIVE We aimed to assess the value of an automated version of the Selvester QRS-score for prediction of ICD therapy and death in patients undergoing primary prevention ICD implantation. METHODS Unselected patients undergoing primary prevention ICD implantation were included in this retrospective, observational, multicenter study. The QRS-score was calculated automatically from a digital standard pre-implant 12-lead ECG and was correlated to the occurrence of death, appropriate and inappropriate shocks during follow up. Analyses were performed in groups defined by QRS-duration <130ms vs. ≥130ms. RESULTS Overall, 1047 patients (83% male; median age 64 years) with ischemic (62%) or non-ischemic cardiomyopathy (38%) were included. The median QRS-duration was 123ms (IQR 111-157) and the median QRS-score was 5 (IQR 2-8). QRS-duration was <130ms in 59% and ≥130ms in 41%. During a median follow-up of 45 months (IQR 24-72), a QRS-score ≥5 was independently associated with a significantly higher risk of mortality (HR 1.67, 95%CI 1.05-2.66, p=0.031), appropriate (HR 1.83, 95%CI 1.07-3.14, p=0.028) and inappropriate shocks (HR 2.32, 95%CI 1.04-5.17, p=0.039) in patients with a QRS-duration ≥130ms. No association of the QRS-score and outcome was observed in patients with QRS-duration <130ms (p>0.05). CONCLUSION The automatically calculated Selvester QRS-score, an indicator of myocardial scar burden, predicts mortality, appropriate and inappropriate shocks in patients undergoing primary prevention ICD implantation with prolonged QRS-duration.