Systematic multi-domain screening of lead-specific electrocardiographic features associated with sudden cardiac death

Background and objectives. Electrocardiogram (ECG) provides four-dimensional view to the electrical properties of the heart. We performed a comprehensive multi-domain screening to find the most significant lead-specific ECG features associated with sudden cardiac death (SCD). Methods We analyzed retrospective data from 21,176 consecutive patients undergoing coronary angiography in Tampere University Hospital between 2007 and 2018. 937 ECG variables provided by the 12SL algorithm were used for the analysis. From those, the significant lead-specific ECG variables were categorized into three subgroups: P-wave, QRS complex, and ST-segment/T-wave. The most significant (i.e., lowest P -value) independent lead-specific ECG variables were tested in multivariate analysis after filtering correlating variables with weaker associations with SCD. Results Among ventricular depolarization (QRS complex) variables, the strongest associations with SCD were observed for QRS intrinsicoid deflection (lead I) ( p = 4.6 × 10 −8 ), QRS peak-to-peak amplitude (lead aVR) ( p = 1.9 × 10 −5 ), and Q-wave amplitude (lead V1) ( p = 7.6 × 10 −6 ). Among repolarization (ST-segment and T-wave) variables, the strongest predictors of SCD were T-wave amplitude (lead aVR) ( p = 3.5 × 10 −7 ) and ST-segment end amplitude (lead aVL) ( p = 8.1 × 10 −5 ). The strongest associations with SCD among atrial depolarization (P-wave) variables were P-wave onset amplitude (lead V6) ( p = 3.1 × 10 −6 ), P′-wave amplitude (lead V2) ( p = 2.1 × 10 −5 ), and P-wave duration (lead V2) ( p = 2.4 × 10 −3 ). These variables remained significant in multivariate analysis alongside global ECG variables (e.g., heart rate, QRS duration, and LVH). Conclusion Systematic screening and utilizing the full prognostic potential of the 12‑lead ECG reveal several key elements of the electrical properties of the heart that associate with SCD.