Benign vs malignant inferolateral early repolarization: Focus on the T wave

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• 作者：Laurent Roten ; MD^* ; ^&dagger ; ; ^{laurent.roten@insel.ch" class="auth_mail" title="E-mail the corresponding author} ; Nicolas Derval ; MD^* ; Philippe Maury ; MD^&Dagger ; ; Saagar Mahida ; MD^* ; Patrizio Pascale ; MD^* ; Antoine Leenhardt ; MD^§ ; ; Laurence Jesel ; MD^║ ; Isabel Deisenhofer ; MD^¶ ; ; Josef Kautzner ; MD ; PhD^# ; Vincent Probst ; MD^** ; Anne Rollin ; MD^&Dagger ; ; Jean-Bernard Ruidavets ; MD^&Dagger ; ; Jean Ferriè ; res ; MD^&dagger ; &dagger ; ; Fré ; dé ; ric Sacher ; MD^* ; Dik Heg ; MD ; PhD^&Dagger ; &Dagger ; ; Daniel Scherr ; MD ; FHRS^* ; Yuki Komatsu ; MD^* ; Matthew Daly ; MD^* ; Arnaud Denis ; MD^* ; Ashok Shah ; MD^* ; Mé ; lè ; ze Hocini ; MD^* ; Pierre Jaï ; s ; MD^* ; Michel Haï ; ssaguerre ; MD^*
• 关键词：CI ; confidence interval ; ECG ; electrocardiogram ; ER ; early repolarization ; OR ; odds ratio ; VF ; ventricular fibrillation
• 刊名：Heart Rhythm
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：13
• 期：4
• 页码：894-902
• 全文大小：1871 K

文摘

Inferolateral early repolarization (ER) is highly prevalent and is associated with idiopathic ventricular fibrillation (VF).

Objective

The purpose of this study was to evaluate the potential role of T-wave parameters to differentiate between malignant and benign ER.

Methods

We compared the ECGs of patients with ER and VF (n = 92) with control subjects with asymptomatic ER (n = 247). We assessed J-wave amplitude, QTc interval, T-wave/R-wave (T/R) ratio in leads II and V5, and presence of low-amplitude T waves (T-wave amplitude <0.1 mV and <10% of R-wave amplitude in lead I, II, or V₄–V₆).

Results

Compared to controls, the VF group had longer QTc intervals (388 ms vs 377 ms, P = .001), higher J-wave amplitudes (0.23 mV vs 0.17 mV, P <.001), higher prevalence of low-amplitude T waves (29% vs 3%, P <.001), and lower T/R ratio (0.18 vs 0.30, P <.001). Logistic regression analysis demonstrated that QTc interval (odds ratio [OR] per 10 ms: 1.15, 95% confidence interval [CI} 1.02–1.30), maximal J-wave amplitude (OR per 0.1 mV: 1.68, 95% CI 1.23–2.31), lower T/R ratio (OR per 0.1 unit: 0.62, 95% CI 0.47–0.81), presence of low-amplitude T waves (OR 3.53, 95% CI 1.26–9.88). and presence of J waves in the inferior leads (OR 2.58, 95% CI 1.18–5.65) were associated with malignant ER.

Conclusion

Patients with malignant ER have a higher prevalence of low-amplitude T waves, lower T/R ratio (lead II or V₅), and longer QTc interval. The combination of these parameters with J-wave amplitude and distribution of J waves may allow for improved identification of malignant ER.