The utilization of twelve-lead electrocardiography for predicting sudden cardiac death after heart transplantation

Abstract

Background: Sudden cardiac death (SCD) occurs commonly after heart transplantation (HTX). The utilization of surface electrocardiography (ECG) to assess post-HTX SCD has not been investigated thoroughly. This study aimed to investigate the specific changes in surface ECG in HTX patients with SCD.

Methods: A total of 227 HTX patients (age 48 ± 14 y/o, mean donor age 34 ± 14 y/o, 173 males) were followed up regularly at the outpatient clinic. Twelve-lead ECG's were recorded during 1-2 monthly visits. Serial ECG parameters and relevant clinical data were collected and analyzed.

Results: During the follow-up period of 96 ± 51 months, SCD occurred in 28 (12.3%) patients. The baseline ECG parameters were comparable between patients with and without SCD. Important ECG trends of rising rest heart rates and prolongation of corrected QT (QTc) and JT (JTc) intervals were observed prior to development of SCD. After adjustment for other clinical variables, the independent predictors for SCD were older donor age (p = 0.014, OR 1.05, 95% CI 1.01-1.09), faster heart rate (p = 0.006, OR 1.06, 95% CI 1.02-1.1) and longer JTc interval (p = 0.015, OR 1.03, 95% CI 1.01-1.06). SCD occurred in 71.4% patients presenting with all three risk predictors.

Conclusions: Besides older donor age, important ECG signs, including prolongation of the JTc interval and increased heart rate during post HTX follow up, could predict SCD.

Keywords: CAV; ECG; Electrocardiography; HTX; Heart rate; Heart transplantation; LBBB; LV; LVEF; RBBB; SCD; Sudden death; cardiac allograft vasculopathy; electrocardiography; heart transplantation; left bundle branch block; left ventricular; left ventricular ejection fraction; right bundle branch block; sudden cardiac death.