{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T07:40:37Z","timestamp":1782459637777,"version":"3.54.5"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>The features of the hypertrophic cardiomyopathy (HCM) ECG make it a challenge for subcutaneous implantable cardioverter-defibrillator (S-ICD) screening. We aimed to investigate the causes of screening failure at rest and on exercise to inform optimal S-ICD ECG vector development.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              One hundred and thirty-one HCM patients (age, 50\u00b116 years; 92 males and 39 females) with \u22651 HCM risk factor for sudden death underwent S-ICD ECG screening at rest and on exercise. Fifty patients (38%) were ineligible for S-ICD because of screening failure in every lead vector: 33 (66%) failed in the supine position, 12 (24%) failed in the standing position, and 5 (10%) failed on exercise. In patients who could exercise and passed screening at rest, 31 (44%) had 1 vector safety, 16 (23%) had 2 vector safety, and 24 (33%) had 3 vector safety. Increased R:T wave ratio in the S-ICD screening ECG (odds ratio, 4.0; confidence interval, 3.0\u20135.3;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) was associated with screening failure, while R\/T ratio &lt;3 in aVF (odds ratio, 0.3; confidence interval, 0.12\u20130.69;\n              <jats:italic>P<\/jats:italic>\n              =0.006) and increasing age (odds ratio, 0.97; confidence interval, 0.95\u20130.99;\n              <jats:italic>P<\/jats:italic>\n              =0.03) was associated with reduced screening failure. European Society of Cardiology risk score was higher in those failing screening (risk score 5.5% [interquartile range, 3.2\u20138.7] in failed versus 4.5% [interquartile range, 2.9\u20137.4] in passed;\n              <jats:italic>P<\/jats:italic>\n              =0.04).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>HCM patients have a significant incidence of screening failure, which is determined primarily by the increased R:T ratio on the screening ECG and lead aVF. High-risk patients have an increased screening failure rate. Optimization of sensing algorithms is required to ensure that the highest risk HCM patients can benefit from S-ICD implantation.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circep.117.004801","type":"journal-article","created":{"date-parts":[[2017,4,14]],"date-time":"2017-04-14T01:05:21Z","timestamp":1492131921000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":42,"title":["Disease Severity and Exercise Testing Reduce Subcutaneous Implantable Cardioverter-Defibrillator Left Sternal ECG Screening Success in Hypertrophic Cardiomyopathy"],"prefix":"10.1161","volume":"10","author":[{"given":"Neil T.","family":"Srinivasan","sequence":"first","affiliation":[{"name":"From the Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew\u2019s Hospital, London, United Kingdom (N.T.S., M.B., R.P., P.M.E., P.D.L.); Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., K.H.P., K.Q., A.T., P.M.E., P.D.L.); and Department of Cardiology, St George\u2019s Hospital London, United Kingdom (M.T.-E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiran H.","family":"Patel","sequence":"additional","affiliation":[{"name":"From the Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew\u2019s Hospital, London, United Kingdom (N.T.S., M.B., R.P., P.M.E., P.D.L.); Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., K.H.P., K.Q., A.T., P.M.E., P.D.L.); and Department of Cardiology, St George\u2019s Hospital London, United Kingdom (M.T.-E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kashif","family":"Qamar","sequence":"additional","affiliation":[{"name":"From the Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew\u2019s Hospital, London, United Kingdom (N.T.S., M.B., R.P., P.M.E., P.D.L.); Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., K.H.P., K.Q., A.T., P.M.E., P.D.L.); and Department of Cardiology, St George\u2019s Hospital London, United Kingdom (M.T.-E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Taylor","sequence":"additional","affiliation":[{"name":"From the Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew\u2019s Hospital, London, United Kingdom (N.T.S., M.B., R.P., P.M.E., P.D.L.); Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., K.H.P., K.Q., A.T., P.M.E., P.D.L.); and Department of Cardiology, St George\u2019s Hospital London, United Kingdom (M.T.-E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Bac\u00e0","sequence":"additional","affiliation":[{"name":"From the Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew\u2019s Hospital, London, United Kingdom (N.T.S., M.B., R.P., P.M.E., P.D.L.); Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., K.H.P., K.Q., A.T., P.M.E., P.D.L.); and Department of Cardiology, St George\u2019s Hospital London, United Kingdom (M.T.-E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Provid\u00eancia","sequence":"additional","affiliation":[{"name":"From the Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew\u2019s Hospital, London, United Kingdom (N.T.S., M.B., R.P., P.M.E., P.D.L.); Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., K.H.P., K.Q., A.T., P.M.E., P.D.L.); and Department of Cardiology, St George\u2019s Hospital London, United Kingdom (M.T.-E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Tome-Esteban","sequence":"additional","affiliation":[{"name":"From the Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew\u2019s Hospital, London, United Kingdom (N.T.S., M.B., R.P., P.M.E., P.D.L.); Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., K.H.P., K.Q., A.T., P.M.E., P.D.L.); and Department of Cardiology, St George\u2019s Hospital London, United Kingdom (M.T.-E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Perry M.","family":"Elliott","sequence":"additional","affiliation":[{"name":"From the Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew\u2019s Hospital, London, United Kingdom (N.T.S., M.B., R.P., P.M.E., P.D.L.); Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., K.H.P., K.Q., A.T., P.M.E., P.D.L.); and Department of Cardiology, St George\u2019s Hospital London, United Kingdom (M.T.-E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pier D.","family":"Lambiase","sequence":"additional","affiliation":[{"name":"From the Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew\u2019s Hospital, London, United Kingdom (N.T.S., M.B., R.P., P.M.E., P.D.L.); Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., K.H.P., K.Q., A.T., P.M.E., P.D.L.); 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