Korean Circ J.  2023 Sep;53(9):621-631. 10.4070/kcj.2022.0353.

Efficiency of MVP ECG Risk Score for Prediction of Long-Term Atrial Fibrillation in Patients With ICD for Heart Failure With Reduced Ejection Fraction

• Pay L
• Yumurtaş A
• Tezen O
• Çetin T
• Eren S
• Çinier G
• Hayıroğlu M
• Tekkeşin A

• KMID: 2545956
• DOI: http://doi.org/10.4070/kcj.2022.0353

Abstract

Background and Objectives
The morphology-voltage-P-wave duration (MVP) electrocardiography (ECG) risk score is a newly defined scoring system that has recently been used for atrial fibrillation (AF) prediction. The aim of this study was to evaluate the ability of the MVP ECG risk score to predict AF in patients with an implantable cardioverter defibrillator (ICD) and heart failure with reduced ejection fraction in long-term follow-up.
Methods
The study used a single-center, and retrospective design. The study included 328 patients who underwent ICD implantation in our hospital between January 2010 and April 2021, diagnosed with heart failure. The patients were divided into low, intermediate and high-risk categories according to the MVP ECG risk scores. The long-term development of atrial fibrillation was compared among these 3 groups.
Results
The low-risk group included 191 patients, the intermediate-risk group 114 patients, and the high-risk group 23 patients. The long-term AF development rate was 12.0% in the low-risk group, 21.9% in the intermediate risk group, and 78.3% in the high-risk group. Patients in the high-risk group were found to have 5.2 times higher rates of long-term AF occurrence compared to low-risk group.
Conclusions
The MVP ECG risk score, which is an inexpensive, simple and easily accessible tool, was found to be a significant predictor of the development of AF in the long-term follow-up of patients with an ICD with heart failure with reduced ejection fraction. This risk score may be used to identify patients who require close follow-up for development and management of AF.

Keyword

Atrial fibrillation; Heart failure; Implantable cardioverter defibrillator

Figure

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  Figure 1 Evaluation of P wave variables on a sample ECG. The P wave voltage is measured from lead 1. P wave duration is measured from leads 2, 3, and aVF.aVF = augmented vector foot; ECG = electrocardiography.

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  Figure 2 ROC analysis showing that the MVP ECG risk score is 3 with an optimal cut-off value of 3 with 66% sensitivity and 65% specificity to predict long-term atrial fibrillation.CI = confidence interval; ECG = electrocardiography; MVP = morphology-voltage-P-wave duration; ROC = receiver operating characteristics.

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  Figure 3 AF free survival according to MVP ECG risk score group.AF = atrial fibrillation; ECG = electrocardiography; MVP = morphology-voltage-P-wave duration.

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