Laurent Roten1, Nicolas Derval2, Philippe Maury3, Saagar Mahida2, Patrizio Pascale2, Antoine Leenhardt4, Laurence Jesel5, Isabel Deisenhofer6, Josef Kautzner7, Vincent Probst8, Anne Rollin3, Jean-Bernard Ruidavets3, Jean Ferrières9, Frédéric Sacher2, Dik Heg10, Daniel Scherr2, Yuki Komatsu2, Matthew Daly2, Arnaud Denis2, Ashok Shah2, Mélèze Hocini2, Pierre Jaïs2, Michel Haïssaguerre2. 1. CHU de Bordeaux/IHU Institut de Rythmologie et Modélisation Cardiaque, Université Bordeaux/Inserm U1045, Bordeaux, France; Department of Cardiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland. Electronic address: laurent.roten@insel.ch. 2. CHU de Bordeaux/IHU Institut de Rythmologie et Modélisation Cardiaque, Université Bordeaux/Inserm U1045, Bordeaux, France. 3. Centre Hospitalier Universitaire de Toulouse, Toulouse, France. 4. Département de Cardiologie et Centre de Référence des Maladies Cardiaques Héréditaires, AP-HP, Hôpital Bichat, Université Paris Diderot, Sorbonne Paris Cité, Paris, France. 5. Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France. 6. Deutsches Herzzentrum München, München, Germany. 7. Institute for Clinical and Experimental Medicine, Prague, Czech Republic. 8. L׳institut du thorax, service de cardiologie du CHU de Nantes, Nantes, France. 9. Department of Cardiology, Toulouse University School of Medicine, Toulouse, France. 10. CTU Bern, Department of Clinical Research, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
Abstract
BACKGROUND: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.
RCT Entities:
BACKGROUND: 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.
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