University of Oulu

Tikkanen, J. T., Kentta, T., Porthan, K., Anttonen, O., Eranti, A., Aro, A. L., Kerola, T., Rissanen, H. A., Knekt, P., Heliövaara, M., Holkeri, A., Haukilahti, A., Niiranen, T., Hernesniemi, J., Jula, A., Nieminen, M. S., Myerburg, R. J., Albert, C. M., Salomaa, V., … Junttila, M. J. (2022). Risk of sudden cardiac death associated with QRS, QTc, and JTc intervals in the general population. Heart Rhythm, S1547527122019403.

Risk of sudden cardiac death associated with QRS, QTc, and JTc intervals in the general population

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Author: Tikkanen, Jani T.1; Kenttä, Tuomas1; Porthan, Kimmo2;
Organizations: 1Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
2Department of Medicine, University of Helsinki and Minerva Foundation Institute for Medical Research, Helsinki, Finland
3Päijät-Häme Central Hospital, Lahti, Finland
4Division of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
5THL-Finnish Institute for Health and Welfare, Helsinki, Finland
6Department of Medicine, Turku University Hospital and University of Turku, Turku, Finland
7Tays Heart Hospital, Tampere University Hospital, Tampere, Finland
8Division of Cardiology, Miller School of Medicine, University of Miami, Miami, Florida
9Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
10Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.5 MB)
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Language: English
Published: Elsevier, 2022
Publish Date: 2022-06-08


Background: QRS duration and corrected QT (QTc) interval have been associated with sudden cardiac death (SCD), but no data are available on the significance of repolarization component (JTc interval) of the QTc interval as an independent risk marker in the general population.

Objective: In this study, we sought to quantify the risk of SCD associated with QRS, QTc, and JTc intervals.

Methods: This study was conducted using data from 3 population cohorts from different eras, comprising a total of 20,058 individuals. The follow-up period was limited to 10 years and age at baseline to 30–61 years. QRS duration and QT interval (Bazett’s) were measured from standard 12-lead electrocardiograms at baseline. JTc interval was defined as QTc interval — QRS duration. Cox proportional hazards models that controlled for confounding clinical factors identified at baseline were used to estimate the relative risk of SCD.

Results: During a mean period of 9.7 years, 207 SCDs occurred (1.1 per 1000 person-years). QRS duration was associated with a significantly increased risk of SCD in each cohort (pooled hazard ratio [HR] 1.030 per 1-ms increase; 95% confidence interval [CI] 1.017–1.043). The QTc interval had borderline to significant associations with SCD and varied among cohorts (pooled HR 1.007; 95% CI 1.001–1.012). JTc interval as a continuous variable was not associated with SCD (pooled HR 1.001; 95% CI 0.996–1.007).

Conclusions: Prolonged QRS durations and QTc intervals are associated with an increased risk of SCD. However, when the QTc interval is deconstructed into QRS and JTc intervals, the repolarization component (JTc) appears to have no independent prognostic value.

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Series: Heart rhythm
ISSN: 1547-5271
ISSN-E: 1556-3871
ISSN-L: 1547-5271
Volume: In press
DOI: 10.1016/j.hrthm.2022.04.016
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: This work was supported by grants from the Finnish Foundation for Cardiovascular Research (Drs Tikkanen, Porthan, Salomaa, and Junttila), Sigrid Juselius Foundation (Drs Tikkanen, Aro, and Junttila), Paavo Nurmi Foundation (Drs Tikkanen, Eranti, and Niiranen), Instrumentation Foundation (Dr Tikkanen), Finnish Medical Foundation (Drs Tikkanen, Aro, and Niiranen), Academy of Finland (Dr Junttila), and Orion Research Foundation (Drs Tikkanen and Porthan).
Copyright information: © 2022 Heart Rhythm Society. This is an open access article under the CC BY license (