Interlead heterogeneity of R‐ and T‐wave morphology in standard 12‐lead ECGs predicts sustained ventricular tachycardia/fibrillation and arrhythmic death in patients with cardiomyopathy

Abstract

Interlead RWH and TWH in 12-lead ECGs predict sustained ventricular arrhythmia, appropriate ICD therapies, and arrhythmic death or cardiac arrest in cardiomyopathy patients independent of LVEF and other standard variables.

Vagus Nerve Stimulation Provides Multiyear Improvements in Autonomic Function and Cardiac Electrical Stability in the ANTHEM-HF Study

“…29 RWH and TWH predicted cardiac mortality and sudden cardiac death based on resting 12-lead ECGs in the 5600-subject Health Survey 2000 30 as well as ventricular fibrillation and appropriate implantable cardioverter defibrillator discharge in patients with ischemic and nonischemic cardiomyopathy undergoing electrophysiological study. 19 In the current investigation, we observed parallel reductions in TWA (Fig. 2) and RWH and TWH levels (Fig.…”

“…Cutpoints for abnormality of RWH (> 160 mV) and TWH (> 80 mV) were applied. 19 Heart Rate Turbulence HRT onset, which calculates the initial brief acceleration in sinus rate after a premature ventricular contraction, and HRT slope, which measures the subsequent heart rate deceleration, were evaluated as continuous variables. HRT onset of 0% and HRT slope of 2.5 ms per RR interval have been determined to be abnormal.…”

The role of baseline and post‐procedural frontal plane QRS‐T angles for cardiac risk assessment in patients with acute STEMI

“…Normally, the directions of the myocardial depolarization axis and repolarization axis is in the similar orientation. Therefore, f(QRS-T) angle often tend to be a narrow angle (<45°) (Gungor et al, 2017;Raposeiras-Roubin et al, 2014;Tan et al, 2017). A wider f(QRS-T) angle is associated with discordance between ventricular depolarization phase and repolarization phase and it was found to be associated with poor outcomes in different populations (Pavri et al, 2008;Raposeiras-Roubin et al, 2014).…”

Marked exercise‐induced T‐wave heterogeneity in symptomatic diabetic patients with nonflow‐limiting coronary artery stenosis

“…The increase in TWH was substantial (49%) from rest to ETT (49 ± 5 to 73 ± 8 μV, p = .003). The level achieved approaches the 80- μV cut-point associated with elevated risk for ventricular tachyarrhythmias and arrhythmic death (Tan et al, 2017). By comparison, nondiabetic control subjects with comparable degrees of nonflow- limiting coronary artery stenosis but with FFR >0.8 exhibited no significant ETT- induced change in TWH (rest: 49 ± 8 μV; ETT: 37 ± 4 μV, p = .18) at an equivalent rate- pressure product.…”

“…These findings are consistent with the observations that myocardial ischemia results in marked dispersion of action potential duration (Dilly & Lab, 1987) and nonuniformities of recovery of excitability (Han & Moe, 1964), changes highly conductive to malignant cardiac arrhythmias. Recently, the utility of TWH has been tested clinically and has been shown capable of detecting arrhythmia risk in diverse conditions including decompensated heart failure (Nearing et al, 2012), ischemic and nonischemic cardiomyopathies (Tan et al, 2017), and in a population survey (Kenttä et al, 2016). It is germane that in both the experimental and clinical settings, TWH provides early signs of myocardial electrophysiologic dysfunction preceding the development of TWA and arrhythmias (Nearing & Verrier, 2003, 2015; Nearing et al, 2012; Verrier & Huikuri, 2017).…”