QRS Prolongation is Associated With High Defibrillation Thresholds During Cardioverter-Defibrillator Implantations in Patients With Hypertrophic Cardiomyopathy

Takayuki Nagai; Takashi Kurita; Kazuhiro Satomi; Takashi Noda; Hideo Okamura; Wataru Shimizu; Kazuhiro Suyama; Naohiko Aihara; Junjiro Kobayashi; Shiro Kamakura

doi:10.1253/circj.CJ-08-0744

Arrhythmia/Electrophysiology

QRS Prolongation is Associated With High Defibrillation Thresholds During Cardioverter-Defibrillator Implantations in Patients With Hypertrophic Cardiomyopathy

Takayuki Nagai, Takashi Kurita, Kazuhiro Satomi, Takashi Noda, Hideo Okamura, Wataru Shimizu, Kazuhiro Suyama, Naohiko Aihara, Junjiro Kobayashi, Shiro Kamakura

Author information

Takayuki Nagai
Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center
Takashi Kurita
Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center
Kazuhiro Satomi
Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center
Takashi Noda
Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center
Hideo Okamura
Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center
Wataru Shimizu
Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center
Kazuhiro Suyama
Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center
Naohiko Aihara
Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center
Junjiro Kobayashi
Department of Cardiovascular Surgery, National Cardiovascular Center
Shiro Kamakura
Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center

Keywords: Defibrillation threshold, Hypertrophic cardiomyopathy, Implantable cardioverter defibrillator, QRS prolongation

JOURNAL FREE ACCESS

2009 Volume 73 Issue 6 Pages 1028-1032

DOI https://doi.org/10.1253/circj.CJ-08-0744

View "Advance Publication" version (April 10, 2009).

Details

Abstract

Background: Although high defibrillation threshold (DFT) is a major and unavoidable clinical problem after implantation of an implantable cardioverter defibrillator (ICD), little is known about the cause and management of a high DFT in patients with hypertrophic cardiomyopathy (HCM). The purpose of this study was to assess the predictors of a high DFT in patients with HCM. Methods and Results: Twenty-three patients with non-dilated HCM who underwent ICD implantation were included. The DFT at the time of the device implantation was measured in all patients. The patients were divided into 2 groups, a high DFT group (DFT ≥15J, n=13) and a low DFT group (DFT <15J, n=10); and their baseline characteristics were compared. The QRS duration was longer in the high than in the low DFT group (128 ±31 vs 103 ±12 ms, respectively; P=0.02). QRS duration, left ventricular (LV) end-systolic diameter, and LV ejection fraction were significant predictors of DFT in univariate analysis. However, in multivariate analysis, the only factor significantly associated with DFT was QRS duration (P=0.002). Conclusions: QRS duration is the most consistent predictor of a high DFT in HCM patients undergoing ICD implantation. (Circ J 2009; 73: 1028-1032)

Corresponding author

Register with J-STAGE for free!