QT Dispersion and T-Wave Alternans of Early Repolarization Electrocardiogram
Abstract
Background. It has been well known that early repolarization is only normal ECG variant without significant clinical consequences. However, recent studies show variable results of its relation to ventricular arrhythmias occurence. This study is aimed to seek corellation between early repolarization with more established ventricular arrhythmia marker.Methods. Corellation of early repolarization with QT dispersion and T wave alternans (TWA) in comparation with normal ECG pattern was conducted in a cross secional study. QT interval was measured using tangential methods. QT dispersion is defined as difference of longest and shortest QT interval in 12-lead ECG. TWA is determined by means of time domain modified moving average (MMA).
Results. Twenty six subjects with early repolarization and 36 subjects with normal ECG participated in this study. Median age was 30 (20-49) years. Maximum TWA are 29. 5 (9 – 81) vs. 27 (5–81) (p= 0.493), and QT dispersion 20.4 (2.8–47.2) vs. 13.2 (2.4–46.0) ms (p=0.053) in early repolarization and normal ECG group respectively.
Conclusion. No significant different of QT dispersion and TWA between subjects with early repolarization as compare to that with normal ECG.
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References
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Haissaguerre M, Derval N, Sacher F, et al. Sudden car-diac arrest associated with early repolarization. N Engl J Med 2008;358:2016 –23.
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Klatsky AL, Oehm R, Cooper RA, Udaltsova N, Armstrong MA. The early repolarization normal variant electrocardiogram: correlates and consequences. Am J Med 2003;115:171–7.
Otto CM, Tauxe RV, Cobb LA, et al. Ventricular fibrillation causes sudden death in Southeast Asian immigrants. Ann Intern Med 1984;101:45–7.
Tikkanen JT, Anttonen O, Junttila MJ, et al. Long-term out-come associated with early repolarization on electrocardiography. N Engl J Med 2009;361:2529 –37.
Malik M, Batchvarov VN. Measurement, interpretation and clinical potential of QT dispersion. J Am Coll Cardiol 2000;36:1749-66
Hostetler B, Xue J, Young B, Kaiser W, Findeis M. Detect short run of TWA event with time-domain algorithm.Computers in cardiology 2005;5:483-486.
Wasserburger RH, Alt WJ. The Normal RS-T segment elevation variant. Am J Cardiol 1961;8:184-192.
Garcia TB, Holtz NE.12 Sadapan ECG.Art of Interpretation. Jones & Bartlett Learning, 2001.p 3-403
Walker ML, Rosenbaum DS. Repolarization alternans: implica-tions for the mechanism and prevention of sudden cardiac death. Cardiovasc Research 2003;57:599-614
American diabetes association, standards of medical care in diabetes-2009 position statement. Diabetes care. 2009;32 (suppl 1):S14
Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the joint national committee on prevention, detection, evalu-ation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003;289(19):2560-72
Thygesen K, Alpert JS, White HD. Universal definition of myocardial infarction. European Heart Journal 2007;28, 2525–2538
Goyle KK,Walling AD.Diagnosing pericarditis. Am Fam Physi-cian 2002;66:1695-702
Tikkanen JT, Anttonen O, Junttila MJ, et al. Long-term out-come associated with early repolarization on electrocardiography. N Engl J Med 2009;361:2529 –37.
Nam GB, Kim YH, Anzelevitch C. Augmentation of J waves and electrical storm in patients with early repolarization. N Eng J Med 2008;358:2078-2079.
Vijgen JM, Julka B, Rosenbaum D. Arrhythmogenic T wave alternans is primarily a disturbance of early repolarization. J Am Coll Cardiol 1995;25:107A-108A.
Han J, Moe GK. Nonuniform recovery of excitability in ven-tricular muscle. Circ Res 1964;14:44.
Kuo CS, Munakata K, Reddy P, Surawicz B. Characteristics and possible mechanism of ventricular arrhythmia dependent on the dispersion of action potential durations. Circ 1983;67:1356-67.
De Bruyne MC, Hoes AW, Kors JA, Hofman A, van Bemmel JH, et al. QTc dispersion predicts cardiac mortality in the eldely. The Rotterdam study. Circ 1998;97:467-72.
Gehi AK, Stein RH, Metz LD, Gomes JA. Microvolt T-wave alternans for the risk stratification of ventricular tachyarrhythmic events: a meta-analysis. J Am Coll Cardiol 2005;46(1):2275-2284
Kirchoff P, Eckardt L, Rolf S, Esperer, HD, Paul M,et al. T wave alternans does not assess arrhythmic risk in patients with brugada syndrome. A.N.E 2004;9(2):162-165.
Ikeda T, Sakurada H, Sakabe K. Assessment of noninvasive markers in identifying patients at risk in Brugada syndrome: In-sights into risk stratification. J Am Coll Cardiol 2001;37:1628-1634.
Abe A, Ikeda T, Tsukada T, Ishiguro H, Miwa Y, et al. Circadian variation of late potentials in idiopathic ventricular fibrillation associated with J waves: Insights into alternative pathophysiology and risk stratification. Heart Rhythm 2010;7:675–682
T-wave alternans. GE healthcare 2008:1-51
Pastore JM, Rosenbaum DS. Role of structural barriers in the mechanism of alternans-induced reentry. Circ Res 2000;87:1157-1163.
Verrier RL, Klingenheben T, Malik M, El-sherif N, Exner D, Hohnloser SH, et al. Microvolt T-wave alternans. J Am Coll Cardiol 2011;58(13):1309-1324
Divaleris P, Pantazis A, Giafalos E, Gaifalos J, Toutouzas P,et al. Assessment of ventricular repolarization alterations in subjects with early repolarization. Int J Cardiol 2004;96:273-279.
Haissaguerre M, Derval N, Sacher F, et al. Sudden car-diac arrest associated with early repolarization. N Engl J Med 2008;358:2016 –23.
Shipley R, Hallaran W. The four sadapan electrocardiogram in 200 normal men and women. Am Heart J 1936;11:325– 45.
Klatsky AL, Oehm R, Cooper RA, Udaltsova N, Armstrong MA. The early repolarization normal variant electrocardiogram: correlates and consequences. Am J Med 2003;115:171–7.
Otto CM, Tauxe RV, Cobb LA, et al. Ventricular fibrillation causes sudden death in Southeast Asian immigrants. Ann Intern Med 1984;101:45–7.
Tikkanen JT, Anttonen O, Junttila MJ, et al. Long-term out-come associated with early repolarization on electrocardiography. N Engl J Med 2009;361:2529 –37.
Malik M, Batchvarov VN. Measurement, interpretation and clinical potential of QT dispersion. J Am Coll Cardiol 2000;36:1749-66
Hostetler B, Xue J, Young B, Kaiser W, Findeis M. Detect short run of TWA event with time-domain algorithm.Computers in cardiology 2005;5:483-486.
Wasserburger RH, Alt WJ. The Normal RS-T segment elevation variant. Am J Cardiol 1961;8:184-192.
Garcia TB, Holtz NE.12 Sadapan ECG.Art of Interpretation. Jones & Bartlett Learning, 2001.p 3-403
Walker ML, Rosenbaum DS. Repolarization alternans: implica-tions for the mechanism and prevention of sudden cardiac death. Cardiovasc Research 2003;57:599-614
American diabetes association, standards of medical care in diabetes-2009 position statement. Diabetes care. 2009;32 (suppl 1):S14
Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the joint national committee on prevention, detection, evalu-ation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003;289(19):2560-72
Thygesen K, Alpert JS, White HD. Universal definition of myocardial infarction. European Heart Journal 2007;28, 2525–2538
Goyle KK,Walling AD.Diagnosing pericarditis. Am Fam Physi-cian 2002;66:1695-702
Tikkanen JT, Anttonen O, Junttila MJ, et al. Long-term out-come associated with early repolarization on electrocardiography. N Engl J Med 2009;361:2529 –37.
Nam GB, Kim YH, Anzelevitch C. Augmentation of J waves and electrical storm in patients with early repolarization. N Eng J Med 2008;358:2078-2079.
Vijgen JM, Julka B, Rosenbaum D. Arrhythmogenic T wave alternans is primarily a disturbance of early repolarization. J Am Coll Cardiol 1995;25:107A-108A.
Han J, Moe GK. Nonuniform recovery of excitability in ven-tricular muscle. Circ Res 1964;14:44.
Kuo CS, Munakata K, Reddy P, Surawicz B. Characteristics and possible mechanism of ventricular arrhythmia dependent on the dispersion of action potential durations. Circ 1983;67:1356-67.
De Bruyne MC, Hoes AW, Kors JA, Hofman A, van Bemmel JH, et al. QTc dispersion predicts cardiac mortality in the eldely. The Rotterdam study. Circ 1998;97:467-72.
Gehi AK, Stein RH, Metz LD, Gomes JA. Microvolt T-wave alternans for the risk stratification of ventricular tachyarrhythmic events: a meta-analysis. J Am Coll Cardiol 2005;46(1):2275-2284
Kirchoff P, Eckardt L, Rolf S, Esperer, HD, Paul M,et al. T wave alternans does not assess arrhythmic risk in patients with brugada syndrome. A.N.E 2004;9(2):162-165.
Ikeda T, Sakurada H, Sakabe K. Assessment of noninvasive markers in identifying patients at risk in Brugada syndrome: In-sights into risk stratification. J Am Coll Cardiol 2001;37:1628-1634.
Abe A, Ikeda T, Tsukada T, Ishiguro H, Miwa Y, et al. Circadian variation of late potentials in idiopathic ventricular fibrillation associated with J waves: Insights into alternative pathophysiology and risk stratification. Heart Rhythm 2010;7:675–682
T-wave alternans. GE healthcare 2008:1-51
Pastore JM, Rosenbaum DS. Role of structural barriers in the mechanism of alternans-induced reentry. Circ Res 2000;87:1157-1163.
Verrier RL, Klingenheben T, Malik M, El-sherif N, Exner D, Hohnloser SH, et al. Microvolt T-wave alternans. J Am Coll Cardiol 2011;58(13):1309-1324
Divaleris P, Pantazis A, Giafalos E, Gaifalos J, Toutouzas P,et al. Assessment of ventricular repolarization alterations in subjects with early repolarization. Int J Cardiol 2004;96:273-279.
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How to Cite
Octavianus, R., Yuniadi, Y., & Setianto, B. (1). QT Dispersion and T-Wave Alternans of Early Repolarization Electrocardiogram. Indonesian Journal of Cardiology, 33(2), 83-90. https://doi.org/10.30701/ijc.v33i2.66
Section
Clinical Research
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