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Ventricular Repolarization and the Identification of the Sudden Death Candidate

Hype or Hope?

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Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

In 1940 Wiggers described disparity in repolarization times across the ventricles as a marker of susceptibility for ventricular arrhythmias (1). This observation was followed by many attempts to quantify those differences and to determine their prognostic significance. Several techniques were used to measure duration and disparity of repolarization such as body surface mapping (2,3), endocardial monophasic action potential recordings (4), and epicardial (5–7) recordings. This was followed by endeavors to obtain that information from the 12-lead electrocardiogram by measuring the QT interval. This brought the suggestion and hope that measuring the QT interval in different ECG leads looking for QT dispersion could be of help to identify cardiac patients at increased risk of dying suddenly (8–14). However, the idea could not be confirmed in prospective studies by Zabel et al. (15) in patients after a myocardial infarction and by Brendorp et al. (16) in patients with heart failure.

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References

  1. Wiggers CJ. The mechanism and nature of ventricular fibrillation. Am Heart J 1940;20:399–412.

    Article  Google Scholar 

  2. Mirvis DM. Spatial variation of QT intervals in normal persons and patients with acute myocardial infarction. Am Coll Cardiol 1985;5:625–631.

    Article  CAS  Google Scholar 

  3. De Ambroggi L, Bertoni T, Locati E, Stramba-Badiale M, Schwartz PJ. Mapping of body surface potentials in patients with the idiopathic long QT syndrome. Circulation 1986;74:1334–1345.

    Article  PubMed  Google Scholar 

  4. Franz MR, Bragheer K, Rafflenbeul W, Haverich A, Lichtlen PR. Monophasis action potential mapping human subjects with normal electrocardiograms: direct evidence for the genisis of the T wave. Circulation 1987;75:379–386.

    Article  PubMed  CAS  Google Scholar 

  5. Cowan JC, Hilton CJ, Griffiths CJ, et al. Sequence of epicardial repolarization and configuration of the T wave. Brit Heart J 1988;60:424–433.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  6. Misier AR, Opthof T, van Hemel NM, et al. Dispersion of refractoriness in noninfarcted myocardium of patients with ventricular tachycardia or ventricular fibrillation after myocardial infarction. Circulation 1995;91:2566–2572.

    Article  PubMed  CAS  Google Scholar 

  7. Zabel M, Portnoy S, Franz MR. Electrocardiographic indexes of dispersion of ventricular repolarization: an isolated heart validation study. J Amer Coll Cardiol 1995;25:746–752.

    Article  CAS  Google Scholar 

  8. Day CP, McComb JM, Campbell RW. QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Brit Heart J 1990;63:342–344.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  9. Hii JT, Wyse DG, Gillis AM, Duff HJ, Solylo MA, Mitchell LB. Precordial QT interval dispersion as a marker of torsade de pointes. Disparate effects of class la antiarrhythmic drugs and amiodarone. Circulation 1992;86:1376–1382.

    Article  PubMed  CAS  Google Scholar 

  10. Priori SG, Napolitano C, Diehl L, Schwartz PJ. Dispersion of the QT interval. A marker of therapeutic efficacy in the idiopathic long QT syndrome. Circulation 1994;89:1681–1689.

    Article  PubMed  CAS  Google Scholar 

  11. Barr CS, Naas A, Freeman M, Lang CC, Struthers AD. QT dispersion and sudden unexpected death in chronic heart failure. Lancet 1994;343:327–329.

    Article  PubMed  CAS  Google Scholar 

  12. Zareba W, Moss AJ, Le Cessie S. Dispersion of ventricular repolarization and arrhythmic cardiac death in coronary artery disease. Am J Cardiol 1994;74:550–553.

    Article  PubMed  CAS  Google Scholar 

  13. de Bruyne MC, Hoes AW, Kors JA, Hofman A, van Bemmel JH, Grobbe DE. QTc dispersion predicts cardiac mortality in the elderly: the Rotterdam study. Circulation 1998;97:467–172.

    Article  PubMed  Google Scholar 

  14. Okin PM, Devereux RB, Howard BV, Fabsitz RR, Lee ET, Welty TK. Assessment of QT dispersion for prediction of all-cause and cardiovascular mortality in American Indians: the Strong Heart Study. Circulation 2000;101:61–66.

    Article  PubMed  CAS  Google Scholar 

  15. Zabel M, Klingenheben T, Frantz MR, Hohnloser SH. Assessment of QT dispersion for prediction of mortality of arrhythmic events after myocardial infarction: results of a prospective, long-term follow-up study. Circulation 1998;97:2543–2550.

    Article  PubMed  CAS  Google Scholar 

  16. Brendorp B, Elming H, Jung L, et al. QT dispersion has no prognostic information for patients with advanced congestive heart failure and reduced left ventricular systolic function. Circulation 2001;103:831–835.

    Article  PubMed  CAS  Google Scholar 

  17. Merri M, Benhorn J, Alberti M, et al. Electrocardiographic quantitation of ventricular repolarization. Circulation 1989;80:1301–1308.

    Article  PubMed  CAS  Google Scholar 

  18. Surawicz, B. Electrophysiologic basis of ECG and cardiac arrhythmias. Williams & Wilkins, Malvern, 1995. p. 192.

    Google Scholar 

  19. Willems JL, Abreu-Lima C, Arnaud P, et al. The diagnostic performance of computer programs for the interpretations of electrocardiograms. N Engl J Med 1991;325:1767–1773.

    Article  PubMed  CAS  Google Scholar 

  20. Malik M, Batchvarov VN. Measurement, interpretation and clinical potential of QT dispersion. Am J Cardiol 2000;36:1749–1766.

    Article  CAS  Google Scholar 

  21. Xue Q, Reddy S. Computerized QT analysis algorithms. J. Electrocardiol 1997;30(Suppl): 181–186.

    Article  Google Scholar 

  22. Van Opstal JM, Schoenmakers M, Verduyn SC, et al. Chronic amiodarone evokes no torsade de pointes arrhythmias despite QT lengthening in an animal model of acquired long-QT syndrome. Circulation 2001;104:2722–2730.

    Article  PubMed  Google Scholar 

  23. Antzelevitch C, Sicouri S, Litovsky SH, et al. Heterogeneity within the ventricular wall: Electrophysi-ology and pharmacology of epicardial, endocardial, and M cells. Circ Res 1991;69:1427–1449.

    Article  PubMed  CAS  Google Scholar 

  24. Zipes DP, Wellens HJJ. Sudden cardiac death. Circulation 1998;98:2334–2351.

    Article  PubMed  CAS  Google Scholar 

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Wellens, H.J., Zipes, D.P. (2003). Ventricular Repolarization and the Identification of the Sudden Death Candidate. In: Gussak, I., Antzelevitch, C., Hammill, S.C., Shen, WK., Bjerregaard, P. (eds) Cardiac Repolarization. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-362-0_1

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  • DOI: https://doi.org/10.1007/978-1-59259-362-0_1

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61737-336-7

  • Online ISBN: 978-1-59259-362-0

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