{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T19:25:00Z","timestamp":1777836300519,"version":"3.51.4"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"23","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,12,6]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Patients with hypertrophic cardiomyopathy (HCM) are at risk of ventricular arrhythmia (VA) attributed to abnormal electrical activation arising from myocardial fibrosis and myocyte disarray. We sought to quantify intra\u2010QRS peaks (QRSp) in high\u2010resolution ECGs as a measure of abnormal activation to predict late VA in patients with HCM.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Prospectively enrolled patients with HCM (n=143, age 53\u00b114\u2009years) with prophylactic implantable cardioverter\u2010defibrillators had 3\u2010minute, high\u2010resolution (1024\u2009Hz), digital 12\u2010lead ECGs recorded during intrinsic rhythm. For each precordial lead, QRSp was defined as the total number of peaks detected in the QRS complex that deviated from a smoothing filtered version of the QRS. The VA end point was appropriate implantable cardioverter\u2010defibrillator therapy during 5\u2010year prospective follow\u2010up. After 5\u2009years, 21 (16%) patients had VA. Patients who were VA positive had greater QRSp (6.0 [4.0\u20137.0] versus 4.0 [2.0\u20135.0];\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01) and lower left ventricular ejection fraction (57\u00b111 versus 62\u00b19;\n              <jats:italic>P<\/jats:italic>\n              =0.038) compared with patients who were VA negative, but had similar established HCM risk metrics. Receiver operating characteristic analysis revealed that QRSp discriminated VA (area under the curve=0.76;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), with a QRSp \u22654 achieving 91% sensitivity and 39% specificity. The annual VA rate was greater in patients with QRSp \u22654 versus QRSp &lt;4 (4.4% versus 0.98%;\n              <jats:italic>P<\/jats:italic>\n              =0.012). In multivariable Cox regression, age &lt;50\u2009years (hazard ratio [HR], 2.53;\n              <jats:italic>P<\/jats:italic>\n              =0.009) and QRSp (HR per QRS peak, 1.41;\n              <jats:italic>P<\/jats:italic>\n              =0.009) predicted VA after adjusting for established HCM risk metrics. In patients aged &lt;50\u2009years, the annual VA rate was 0.0% for QRSp &lt;4 compared with 6.9% for QRSp \u22654 (\n              <jats:italic>P<\/jats:italic>\n              =0.012).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">QRSp predicted VA in patients with HCM who were eligible for an implantable cardioverter\u2010defibrillator after adjusting for established HCM risk metrics, such that each additional QRS peak increases VA risk by 40%. QRSp &lt;4 was associated with a &lt;1% annual VA risk in all patients, and no VA risk among those aged &lt;50\u2009years. This novel ECG metric may improve patient selection for prophylactic implantable cardioverter\u2010defibrillator therapy by identifying those with low VA risk. These findings require further validation in a lower risk HCM cohort.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Registration<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT02560844.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.122.026025","type":"journal-article","created":{"date-parts":[[2022,11,29]],"date-time":"2022-11-29T11:10:45Z","timestamp":1669720245000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Automated Quantification of Abnormal QRS Peaks From High\u2010Resolution ECGs Predicts Late Ventricular Arrhythmias in Hypertrophic Cardiomyopathy: A 5\u2010Year Prospective Multicenter Study"],"prefix":"10.1161","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8185-1998","authenticated-orcid":false,"given":"Adrian M.","family":"Suszko","sequence":"first","affiliation":[{"name":"Division of Cardiology, Peter Munk Cardiac Center University Health Network Toronto Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5054-9136","authenticated-orcid":false,"given":"Praloy","family":"Chakraborty","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Peter Munk Cardiac Center University Health Network Toronto Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karthik","family":"Viswanathan","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Peter Munk Cardiac Center University Health Network Toronto Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott","family":"Barichello","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Peter Munk Cardiac Center University Health Network Toronto Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9602-2751","authenticated-orcid":false,"given":"John","family":"Sapp","sequence":"additional","affiliation":[{"name":"Division of Cardiology Queen Elizabeth II Health Sciences Center Halifax Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8469-4748","authenticated-orcid":false,"given":"Mario","family":"Talajic","sequence":"additional","affiliation":[{"name":"Montreal Heart Institute Montreal Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7790-541X","authenticated-orcid":false,"given":"Zachary","family":"Laksman","sequence":"additional","affiliation":[{"name":"Division of Cardiology St. Paul\u2019s Hospital Vancouver Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raymond","family":"Yee","sequence":"additional","affiliation":[{"name":"Division of Cardiology London Health Sciences Center London Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Woo","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Peter Munk Cardiac Center University Health Network Toronto Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danna","family":"Spears","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Peter Munk Cardiac Center University Health Network Toronto 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