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

Malik, Marek; Huikuri, Heikki V.; Lombardi, Federico; Schmidt, Georg; Verrier, Richard L.; Zabel, Markus

doi:10.1016/j.hrthm.2019.01.015

Cited by 23 publications

(19 citation statements)

References 9 publications

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“…Some researchers believe that T peak –T end is not associated with TDR but with the interventricular dispersion of repolarization . Indeed, we cannot verify whether the “interventricular” dispersion of repolarization contributes to T peak –T end in wedge preparation models, which do not have two ventricles.…”

Section: Discussionmentioning

confidence: 73%

“…Some researchers believe that T peak -T end is not associated with TDR but with the interventricular dispersion of repolarization. 16,17 Indeed, we cannot verify whether the "interventricular" dispersion of repolarization contributes to T peak -T end in wedge preparation models, which do not F I G U R E 4 A, Sequential illustration of endocardial and epicardial AP and ECG every 2 minutes following exposure to the provocative agents during steady-state endocardial stimulation at a cycle length of 1000 msec. B, Superimposed ECGs.…”

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confidence: 99%

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Experimental verification of the value of the T_peak–T_end interval in ventricular arrhythmia inducibility in an early repolarization syndrome model

Yoon

Hong

Cho

et al. 2019

Cardiovasc electrophysiol

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Introduction In patients with early repolarization patterns on ECG, many researchers have studied to find predictors of fatal arrhythmia. However, there are no satisfying clinical predictors. We evaluated the value of the Tpeak–Tend interval on pseudo‐ECG in canine myocardial wedge preparation models of early repolarization syndrome. Methods and Results Transmural pseudo‐ECG and endocardial/epicardial action potentials were recorded from coronary‐perfused canine left ventricular wedge preparations (n = 34). The Ito agonist NS5806 (8‐10 µM), the calcium channel blocker verapamil (3 µM) and acetylcholine (2‐3 µM) were used to mimic the disease model. A ventricular arrhythmia induction test was performed. QTpeak, QTend, Tpeak–Tend, and Tpeak–Tend/QTend were measured at 15 to 20 minutes after the provocative agent infusion. Polymorphic ventricular tachycardias (pVT) developed in 23 of the 34 preparations (67%). The maximal values of Tpeak–Tend and Tpeak–Tend/QTend were recorded just before pVT induction. At baseline, without the provocative agents, Tpeak–Tend and Tpeak–Tend/QTend were not different between pVT‐induced and pVT‐noninduced preparations. The Tpeak–Tend of the pVT‐induced preparations was longer than that of non‐induced preparations (58 ± 26.8 msec vs 33 ± 6.8 msec, P < .001). The Tpeak–Tend/QTend of pVT‐ induced preparations was larger than that of noninduced preparations (0.220 ± 0.1017 vs 0.128 ± 0.0312, P < .001). The transmural and epicardial dispersion of repolarization of pVT‐induced preparations were larger than those of pVT‐noninduced preparations. The transmural dispersion of repolarization showed a positive correlation with Tpeak–Tend. Conclusion Tpeak–Tend predicted malignant ventricular arrhythmias in early repolarization syndrome models. Tpeak–Tend reflects the repolarization heterogeneity of ventricular myocardium.

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Section: Discussionmentioning

confidence: 73%

mentioning

confidence: 99%

Experimental verification of the value of the T_peak–T_end interval in ventricular arrhythmia inducibility in an early repolarization syndrome model

Yoon

Hong

Cho

et al. 2019

Cardiovasc electrophysiol

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“…TpTe parameter subsequently became the subject of clinical research, but its results remain controversial ( Lellouche et al, 2007 ; Letsas et al, 2009 ; Smetana et al, 2011 ; Morin et al, 2012 ; Porthan et al, 2013 ; Rosenthal et al, 2015 ). At present, even the very concept of association between TpTe and TDR is being questioned ( Srinivasan et al, 2019 ), which only adds further doubts to its clinical validity ( Malik et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

No Association Between T-peak to T-end Interval on the Resting ECG and Long-Term Incidence of Ventricular Arrhythmias Triggering ICD Interventions

et al. 2020

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Background and Objectives Potential of using the T-peak to T-end (TpTe) interval as an electrocardiographic parameter reflecting the transmural dispersion of ventricular repolarization (TDR) to identify patients (pts.) with higher risk of malignant ventricular arrhythmias (MVA) for better selection of candidates for implantable cardioverter-defibrillator (ICD) in primary prevention (PP) of sudden cardiac death (SCD) remains controversial. The primary objective of this study was to investigate the relationship between the TpTe interval in patient’s preimplantation resting 12-lead electrocardiogram (ECG) and the incidence of MVA resulting in appropriate ICD intervention (AI). The secondary objective was to assess its relationship to overall mortality. Methods A total of 243 consecutive pts. with severe left ventricular (LV) systolic dysfunction after myocardial infarction (MI) with a single-chamber ICD for PP of SCD from one implantation center were included. Excluded were all pts. with any other disease that could interfere with the indication of ICD implantation. Primarily investigated intervals were measured manually in accordance with accepted methodology. Data on ICD interventions were acquired from device interrogation during regular outpatient visits. Survival data were collected from the databases of health insurance and regulatory authorities. Results We did not find a significant relationship between the duration of the TpTe interval and the incidence of MVA (71.5 ms in pts. with MVA vs. 70 ms in pts. without MVA; p = 0.408). Similar results were obtained for the corrected TpTe interval (TpTec) and the ratio of TpTe to QT interval (76.3 ms vs. 76.5 ms; p = 0.539 and 0.178 vs. 0.181; p = 0.547, respectively). There was also no significant difference between the duration of TpTe, TpTec and TpTe/QT ratio in pts. groups by overall mortality (71.5 ms in the deceased group vs. 70 ms in the survivors group; HR 1.01; 95% CI, 0.99–1.02; p = 0.715, 76.3 ms vs. 76.5 ms; HR 1.01; 95% CI, 0.99–1.02; p = 0.208 and 0.178 vs. 0.186; p = 0.116, respectively). Conclusion This study suggests no significant association of overall or MVA-free survival with ECG parameters reflecting TDR (TpTe, TpTec) in patients with systolic dysfunction after MI and ICD implanted for primary prevention.

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“…While some researchers have suggested that the Tp‐e interval can be used as a myocardial repolarization index, 15 some recently published articles state that the Tp‐e interval does not fully show the ventricular repolarization dispersion and that the Tp‐e interval cannot be used as a ventricular repolarization index 16 . Nevertheless, many studies have shown that significant increases in the Tp‐e interval are closely related to malignant ventricular arrhythmias 11 …”

Section: Introductionmentioning

confidence: 99%

Variation of Tpeak‐end, corrected Tpeak‐end, QT, and corrected QT intervals, Tpeak‐end/QT, Tpeak‐end/corrected QT ratios and heart rate variability according to decades in the healthy male subjects aged between 30 and 79 years

Cosgun

Oren

2020

Journal of Arrhythmia

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This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractBackground: Heart rate variability (HRV) is a predictor of cardiac autonomic functions. Ventricular repolarization markers can indicate ventricular arrhythmias. We aimed to evaluate variations of HRV and these repolarization markers in five healthy male groups between age 30 and 79 years according to decades. Materials and Methods:The study group consisted of 500 healthy male subjects between October 2018 and May 2019. The male subjects were divided into five categories according to their ages. Then, electrocardiograms (ECG), transthoracic echocardiograms (TTE), and treadmill exercise test (TET) were performed. T-wave peak-end (Tp-e) interval was defined as the time between the peak point and end of T-wave. Tp-e, corrected Tp-e (cTp-e), QT, and corrected QT (QTc) were measured from the resting ECGs and HRV temporal parameters (SDNN, SDNN Index, SDANN Index, RMSSD, sNN50, and pNN50), and HRV frequency parameters (VLF, LF, HF, and LF/HF) were obtained from 24-hour Holter monitorization recordings. One-way ANOVA test was used for the differences between the groups. Pearson correlation test was used to determine the correlations between the values of all groups. Results:Considering the repolarization parameters, there are significant differences in five groups in terms of Tp-e interval, but not Tp-e/QT and Tp-e/QTc ratios.Considering the HRV parameters, there were statistically significant differences between the five male healthy groups in terms of HRV temporal parameters and there are no significant differences in terms of HRV frequency parameters. Conclusion:As the age increases, basal Tp-e interval increases and HRV temporal parameters decrease significantly in the male subjects aged between 30 and 79 years, but HRV frequency parameters do not change. K E Y W O R D Shealthy male subjects, heart rate variability, Tp-e interval, Tp-e/QT ratio, Tp-e/QTc ratio, variation according to decades | 509 COSGUN aNd OREN

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

Cited by 23 publications

References 9 publications

Experimental verification of the value of the T_peak–T_end interval in ventricular arrhythmia inducibility in an early repolarization syndrome model

Experimental verification of the value of the T_peak–T_end interval in ventricular arrhythmia inducibility in an early repolarization syndrome model

No Association Between T-peak to T-end Interval on the Resting ECG and Long-Term Incidence of Ventricular Arrhythmias Triggering ICD Interventions

Variation of Tpeak‐end, corrected Tpeak‐end, QT, and corrected QT intervals, Tpeak‐end/QT, Tpeak‐end/corrected QT ratios and heart rate variability according to decades in the healthy male subjects aged between 30 and 79 years

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

Cited by 23 publications

References 9 publications

Experimental verification of the value of the Tpeak–Tend interval in ventricular arrhythmia inducibility in an early repolarization syndrome model

Experimental verification of the value of the Tpeak–Tend interval in ventricular arrhythmia inducibility in an early repolarization syndrome model

No Association Between T-peak to T-end Interval on the Resting ECG and Long-Term Incidence of Ventricular Arrhythmias Triggering ICD Interventions

Variation of Tpeak‐end, corrected Tpeak‐end, QT, and corrected QT intervals, Tpeak‐end/QT, Tpeak‐end/corrected QT ratios and heart rate variability according to decades in the healthy male subjects aged between 30 and 79 years

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Experimental verification of the value of the T_peak–T_end interval in ventricular arrhythmia inducibility in an early repolarization syndrome model

Experimental verification of the value of the T_peak–T_end interval in ventricular arrhythmia inducibility in an early repolarization syndrome model