Dispersion of repolarization in canine ventricle and the electrocardiographic T wave: Tp-e interval does not reflect transmural dispersion

Opthof, Tobias; Coronel, Ruben; Wilms‐Schopman, Francien J.G.; Plotnikov, Alexei N.; Shlapakova, Iryna N.; Danilo, Peter; Rosen, Michael R.; Janse, Michiel J.

doi:10.1016/j.hrthm.2006.11.022

Cited by 249 publications

(139 citation statements)

References 36 publications

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“…Heterogenity of ventricular repolarisation facilitates transmural early after depolarization propagation and also can cause intramural conduction blocks that predispose to re-entrant tachyarrhythmias [11]. Measurement of QTd, JTd, and Tp-e interval from surface ECG provides an index of repolarisation dispersion [12,13]. Our findings of increase in QTc dispersion and Tp-e interval after CRT are consistent with previous experimental and clinical studies [14,15].…”

Section: Discussionsupporting

confidence: 86%

Increase in QTC Dispersion Predicts Arrhythmic Events in Patients With Cardiac Resynchronization Therapy

Kocas¹,

Abacı

Kılıçkesmez

et al. 2014

Russ J Cardiol

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Aim. Benefits of CRT on mortality and morbidity in patients with severe CHF are clear but the effect of CRT on sudden cardiac death is more controversial. It has been suggested that CRT may catalyze arrhythmogenicity by reversing the normal depolarization pattern. The purpose of this study was to examine the effect of CRT on dispersion of repolarization as assessed by ECG. We also sought to determine the value of dispersion of repolarization ECG parameters in predicting the occurrence of major arrhythmic events (MAE) in follow-up. Material and methods. A total of 48 patients with end-stage heart failure and QRS duration >120 ms underwent CRT. QT dispersion (QTd), T peak t end interval (Tpe) and T peak t end dispersion (Tpe dispersion) were measured before and immediately after CRT implantation. All patients were followed at least 12 months for ventricular tachycardia or fibrillation that were treated with antitachicardia pace or cardioversion. Results. Over 16±7.1 months, 14 patients had a MAE. Compared to baseline, after CRT, QTc dispersion (84.66±37.7 vs 100.36±47.4, p=0.04) and Tpe interval (104.1±20.4 vs 122.03±33, p=0.02) increased significantly. Increase in QTD (∆QTD) (31.66±39.5 vs 5.57±5.59, p=0.03), and QTc dispersion (∆QTc dispersion) (40.19±46.6 vs 4.39±14.35, p=0.04) from baseline was signifcantly higher in MAE group. In multiple regression analyses, ∆QTc dispersion predicted MAE (p=0.045, CI: 1.000-1.033). Цель. Преимущества сердечной ресинхронизирующей терапии (CRT) в сни-жении смертности и заболеваемости больных с тяжелой ХСН ясны, но дейст-вие CRT при внезапной сердечной смерти является более спорным. Было высказано предположение, что CRT может катализировать аритмогенность, реверсируя нормальную деполяризационную структуру. Целью данного исследования было изучить влияние CRT на дисперсию реполяризации, при оценке ЭКГ. Мы также стремились определить значение дисперсии реполяри-зации параметров ЭКГ в прогнозировании возникновения крупных аритмиче-ских событий (MAE) в последующем. Материал и методы. Всего 48 пациентов с терминальной стадией сердеч-ной недостаточности и длительностью комплекса QRS >120 мс прошли CRT. Дисперсия QT (QTd), T пик t end интервал (Tpe) и T пик t end дисперсии (Tpe дисперсии) были измерены до и сразу после CRT имплантации. Все паци-енты находились под наблюдением, по крайней мере, 12 месяцев, желудоч-ковая тахикардия или аритмия лечились кардиостимуляцией или кардио-версией. Conclusion. Immediately after CRT implantationРезультаты. Более 16±7.1 месяцев у 14 пациентов были MAE. По сравнению с исходными данными, после CRT, QTc дисперсия (84.66±на 37,7 против 100.36±47.4, p=0,04) и Tpe интервал (104.1±20.4 против 122.03±33, p=0.02) значительно увеличились. Увеличение QTD (t QTd) (31.66±39.5 против 5.57±5.59, p=0,03), и QTc дисперсии (t QTc дисперсии) (40.19±против 46.6 4.39±14.35, p=0,04) от исходного уровня были значительно выше в группе с MAE. При множественном регрессионном анализе ∆QTc дисперсия предска-зывала развитие MAE (р=0,045 (CI): 1.000-1.033). Заключение. Сразу по...

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Section: Discussionsupporting

confidence: 86%

Increase in QTC Dispersion Predicts Arrhythmic Events in Patients With Cardiac Resynchronization Therapy

Kocas¹,

Abacı

Kılıçkesmez

et al. 2014

Russ J Cardiol

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“…Even if T pe does not only reflect transmural dispersion but may include also other ventricular heterogeneities (e.g. apico-basal) [48], [49], it is still a marker of VRD that can be quantified from the ECG.…”

Section: ) Dispersion Of Repolarization Reflected On Ecg Intervalsmentioning

confidence: 99%

“…The T pe interval reflects differences in the time for completion of repolarization at different ventricular regions. While some studies postulate that T pe measures transmural dispersion of repolarization [48], other studies claim that T pe includes additional heterogeneities, such as apico-basal ones [49].…”

Section: ) Repolarization Dispersion By T-peak To T-end Interval Dynmentioning

confidence: 99%

Techniques for Ventricular Repolarization Instability Assessment From the ECG

2016

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Abstract-Instabilities in ventricular repolarization have been documented to be tightly linked to arrhythmia vulnerability. Translation of the information contained in the repolarization phase of the ECG into valuable clinical decision-making tools remains challenging. This work aims at providing an overview of the last advances in the proposal and quantification of ECG-derived indices that describe repolarization properties and whose alterations are related with threatening arrhythmogenic conditions. A review of the state-of-the-art is provided, spanning from the electrophysiological basis of ventricular repolarization to its characterization on the surface ECG through a set of temporal and spatial risk markers.Index Terms-Electrophysiological basis of the ECG, ECG waves, ECG intervals, repolarization instabilities, spatial and temporal ventricular repolarization dispersion, cardiac arrhythmias, biophysical modeling of the ECG, ECG signal processing, repolarization risk markers, T wave alternans, QT variability.

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“…While Tpeak-Tend intervals measured in these limb leads may provide an index of TDR, they are more likely to reflect global dispersion, including apico-basal and interventricular dispersion of repoalrization. 4,15 A large increase in TDR is likely to be arrhythmogenic because the dispersion of repolarization and refractoriness occurs over a very short distance (the width of the ventricular wall), creating a steep repolarization gradient. 16,17 It is the steepness of the repolarization gradient rather than the total magnitude of dispersion that determines its arrhythmogenic potential.…”

mentioning

confidence: 99%

Does Tpeak–Tend provide an index of transmural dispersion of repolarization?

Antzelevitch¹,

Sicouri²,

Diego³

et al. 2007

Heart Rhythm

261

212

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Differences in the time course of repolarization of the three predominant myocardial cell types have been shown to contribute to the inscription of the T wave of the electrocardiogram (ECG). Voltage gradients developing as a result of the different time course of repolarization of phases 2 and 3 in the three cell types give rise to opposing voltage gradients on either side of the M region, which are in part responsible for the inscription of the T wave. 1 In the case of an upright T wave, the epicardial response is the earliest to repolarize and the M cell action potential is the latest. In the coronary-perfused wedge preparation, repolarization of the epicardial action potential coincides with the peak of the T wave and repolarization of the M cells is coincident with the end of the T wave, so that the interval from the peak to the end of the T wave provides a measure of transmural dispersion of repolarization (TDR).Based on these early studies, the Tpeak-Tend interval in precordial ECG leads was suggested to provide an index of transmural dispersion of repolarization. 2 More recent studies have also provided guidelines for the estimation of transmural dispersion of repolarization in the case of more complex T waves, including negative, biphasic and triphasic T waves. 3 In such cases, the interval from the nadir of the first component of the T wave to the end of the T wave was shown to provide an electrocardiographic approximation of TDR.While these relationships are relatively straight forward in the coronary-perfused wedge preparation, extrapolation to the surface ECG recorded in vivo must be approached with great caution and will require careful validation. The Tpeak-Tend interval is unlikely to provide an absolute measure of transmural dispersion in vivo, as elegantly demonstrated by Xia and coworkers 4 . However, changes in this parameter are thought to be capable of reflecting changes in spatial dispersion of repolarization, particularly TDR, and thus may be prognostic of arrhythmic risk under a variety of conditions. 5-10 Takenaka et al. recently demonstrated exercise-induced accentuation of the Tpeak-Tend interval in LQT1 patients, but not LQT2. 9

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Dispersion of repolarization in canine ventricle and the electrocardiographic T wave: Tp-e interval does not reflect transmural dispersion

Cited by 249 publications

References 36 publications

Increase in QTC Dispersion Predicts Arrhythmic Events in Patients With Cardiac Resynchronization Therapy

Increase in QTC Dispersion Predicts Arrhythmic Events in Patients With Cardiac Resynchronization Therapy

Techniques for Ventricular Repolarization Instability Assessment From the ECG

Does Tpeak–Tend provide an index of transmural dispersion of repolarization?

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