ArticleBMC cardiovascular disorders2026
Electrocardiographic predictors of ventricular arrhythmic events in ICD recipients: signal beyond the left ventricular ejection fraction threshold.
Article in BMC cardiovascular disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
objectivesSelection for implantable cardioverter-defibrillator (ICD) therapy based on left ventricular ejection fraction (LVEF) may miss at-risk patients with LVEF > 35%. We tested whether a simple electrocardiogram (ECG) burden adds discriminatory power for appropriate ICD therapy beyond clinical factors and LVEF.
methodsSingle-center retrospective cohort of 236 ICD recipients. Six routinely reported ECG abnormalities (heart rate > 75 bpm; QRS duration > 110 ms; obtuse QRS–T angle; delayed transition zone; prolonged QTc; prolonged Tp–Te) were prespecified, summed to form an ECG burden (0–6), and categorized as 0–1, 2–3, or ≥ 4 abnormalities. Logistic regression estimated odds ratios (OR) with 95% CIs for appropriate ICD therapy. Multivariable models included LVEF category (≤ 35% vs > 35%), ischemic vs non-ischemic cardiomyopathy, ICD indication (secondary vs primary prevention), and ECG burden category. Discrimination of the clinical + LVEF model with and without ECG burden was assessed using the AUC (C-statistic) and the DeLong test.
resultsMean age was 62.1 ± 16.2 years; 71% were male; 61% had ischemic cardiomyopathy; 72% underwent primary-prevention ICD implantation; and mean follow-up was 7.6 ± 2.9 years. Appropriate ICD therapy was delivered to 26/236 (11.0%) patients. A high ECG burden (≥ 4 abnormalities) was associated with appropriate ICD therapy after adjustment (OR 3.6, 95% CI 1.8–7.2; p < 0.001). Adding ECG burden to a clinical + LVEF model modestly improved discrimination in this cohort, with the AUC (C-statistic) from 0.67 to 0.72 (DeLong p = 0.01). Kaplan–Meier curves showed graded separation across ECG-burden categories (log-rank p < 0.001). Among patients with LVEF > 35%, therapy was observed more frequently in the high-burden group than in the low-burden group.
conclusionsIn this single-center retrospective cohort of ICD recipients, a higher ECG abnormality burden was associated with a higher risk of appropriate ICD therapy and modestly improved discrimination when added to a clinical + LVEF model. These findings are hypothesis-generating and warrant prospective, multicenter external validation using standardized ECG measurements before any clinical application.
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