Conundrum of the Tpeak‐Tend interval

Rationale and design of the EU‐CERT‐ICD prospective study: comparative effectiveness of prophylactic ICD implantation

“…In addition to the described prospective study, a retrospective registry 17 and meta-analyses in primary prophylactic ICD patients were set up 18,19 (Figure 1). Over the course of the project, several original papers [20][21][22][23][24][25][26][27] and editorials [28][29][30][31][32][33] have been published from the various work packages. At the outset of the project, its primary objectives were as follows:…”

European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population

“…The Tpeak‐end interval, measured from the peak to the end of the T‐wave, thought to reflect heterogeneity of repolarization in the heart, has been associated with arrhythmic risk in various populations 40 . However, considerable controversy remains as to how it should be measured and applied 41 …”

Is the Tpeak-Tend interval as a measure of repolarization heterogeneity dead or just seriously wounded?

“…A literature review including superficial meta-analyses [5] might suggest that repolarization heterogeneity represented by Tpe interval has been proven by studies showing the association of prolonged Tpe with proarrhythmia and other risks. However, as already discussed [6], detailed comparisons of such studies report important differences in several crucial aspects including patient characteristics, methods of ECG measurement, heart rate correction, and outcome events. Simply stated, what one groups calls a prolonged Tpe is frequently rather different from the understanding and publications on Tpe prolongation by another group.…”

“…While identification of the end of the T wave is frequently problematic in pathological ECGs, it is believed that localization of the T-wave peak can be made with much greater certainty. However, this belief is unjustified [6]. When these measurement problems are combined with the variety of reported heart rate corrections (often used without sufficient justification) and when such data are subjected to the standard bias of publishing only positive results, a misleading picture of the importance of the Tpe interval might emerge.…”