ArticleHeart rhythm2021
Competing risks in patients with primary prevention implantable cardioverter-defibrillators: Global Electrical Heterogeneity and Clinical Outcomes study.
Article in Heart rhythm, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03210883 (Global Electrical Heterogeneity and Clinical Outcomes), which is not on this map. Cited by 12 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Global Electrical Heterogeneity and Clinical Outcomes
Who cites it
12 citing papers in PubMed, 18 citations in OpenAlex.
- Anticholinergic medications and out-of-hospital sudden cardiac arrest: a new piece to the puzzle?European heart journal · 2025Article
- Larger spatial ventricular gradient magnitude is associated with higher rates of response to cardiac resynchronization therapy.Heart rhythm O2 · 2025Article
- Electrical Heterogeneity in Hispanic Background Subpopulations: The HCHS/SOL.JACC. Advances · 2024Article
- Latent profiles of global electrical heterogeneity: the Hispanic Community Health Study/Study of Latinos.European heart journal. Digital health · 2024Article
- Competing risks of monomorphic vs. non-monomorphic ventricular arrhythmias in primary prevention implantable cardioverter-defibrillator recipients: Global Electrical Heterogeneity and Clinical Outcomes (GEHCO) study.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024Article
- Electrocardiographic risk stratification in patients with a primary prophylactic implantable cardioverter defibrillator: can future arrhythmias correlating with sudden cardiac death be predicted?Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024Article
- The spatial ventricular gradient is associated with adverse outcomes in acute pulmonary embolism.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2023Article
- Genetic architecture of spatial electrical biomarkers for cardiac arrhythmia and relationship with cardiovascular disease.Nature communications · 2023Article
- The Spatial Ventricular Gradient Is an Independent Predictor of Anthracycline-Associated Cardiotoxicity.JACC. Advances · 2023Article
- The role of metabolic syndrome in sudden cardiac death risk: Recent evidence and future directions.European journal of clinical investigation · 2022Review
- Detection and removal of pacing artifacts prior to automated analysis of 12-lead ECG.Computers in biology and medicine · 2021Article
- Reproducibility of global electrical heterogeneity measurements on 12-lead ECG: The Multi-Ethnic Study of Atherosclerosis.Journal of electrocardiologyArticle
Corrections and comments
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Authors and funding
14 authors at 6 institutions in 1 country.
Funding
Abstract
backgroundGlobal electrical heterogeneity (GEH) is associated with sudden cardiac death in the general population. Its utility in patients with systolic heart failure who are candidates for primary prevention (PP) implantable cardioverter-defibrillators (ICDs) is unclear.
objectiveThe purpose of this study was to investigate whether GEH is associated with sustained ventricular tachycardia/ventricular fibrillation leading to appropriate ICD therapies in patients with heart failure and PP ICDs.
methodsWe conducted a multicenter retrospective cohort study. GEH was measured by spatial ventricular gradient (SVG) direction (azimuth and elevation) and magnitude, QRS-T angle, and sum absolute QRST integral on preimplant 12-lead electrocardiograms. Survival analysis using cause-specific hazard functions compared the strength of associations with 2 competing outcomes: sustained ventricular tachycardia/ventricular fibrillation leading to appropriate ICD therapies and all-cause death without appropriate ICD therapies.
resultsWe analyzed 2668 patients (mean age 63 ± 12 years; 624 (23%) female; 78% white; 43% nonischemic cardiomyopathy; left ventricular ejection fraction 28% ± 11% from 6 academic medical centers). After adjustment for demographic, clinical, device, and traditional electrocardiographic characteristics, SVG elevation (hazard ratio [HR] per 1SD 1.14; 95% confidence interval [CI] 1.04-1.25; P = .004), SVG azimuth (HR per 1SD 1.12; 95% CI 1.01-1.24; P = .039), SVG magnitude (HR per 1SD 0.75; 95% CI 0.66-0.85; P < .0001), and QRS-T angle (HR per 1SD 1.21; 95% CI 1.08-1.36; P = .001) were associated with appropriate ICD therapies. Sum absolute QRST integral had different associations in infarct-related cardiomyopathy (HR 1.29; 95% CI 1.04-1.60) and nonischemic cardiomyopathy (HR 0.78; 95% CI 0.62-0.96) (P
conclusionIn patients with PP ICDs, GEH is independently associated with appropriate ICD therapies. The SVG vector points in distinctly different directions in patients with 2 competing outcomes.
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