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Multicenter Study
. 2015 Dec;12(12):2469-76.
doi: 10.1016/j.hrthm.2015.07.029. Epub 2015 Jul 21.

Increased Tpeak-Tend interval is highly and independently related to arrhythmic events in Brugada syndrome

Philippe Maury  1 , Frederic Sacher  2 , Jean-Baptiste Gourraud  3 , Jean-Luc Pasquié  4 , Franck Raczka  4 , Vanina Bongard  5 , Alexandre Duparc  5 , Pierre Mondoly  5 , Marie Sadron  5 , Stephanie Chatel  3 , Nicolas Derval  2 , Arnaud Denis  2 , Christelle Cardin  5 , Jean-Marc Davy  4 , Meleze Hocini  2 , Pierre Jaïs  2 , Laurence Jesel  2 , Didier Carrié  5 , Michel Galinier  5 , Michel Haïssaguerre  2 , Vincent Probst  3 , Anne Rollin  5
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Free article
Multicenter Study

Increased Tpeak-Tend interval is highly and independently related to arrhythmic events in Brugada syndrome

Philippe Maury et al. Heart Rhythm. 2015 Dec.
Free article

Abstract

Background: Risk stratification in Brugada syndrome (BS) remains controversial. The time interval between the peak and the end of the T wave (Tpe interval), a marker of transmural dispersion of repolarization, has been linked to malignant ventricular arrhythmias in various settings but leads to discordant results in BS.

Objective: We study the correlation of the Tpe interval with arrhythmic events in a large cohort of patients with BS.

Methods: A total of 325 consecutive patients with BS (mean age 47±13 years, 259 men-80%) with spontaneous (n=143, 44%) or drug-induced (n=182, 56%) type 1 electrocardiogram were retrospectively included. 235 were asymptomatic (70%), 80 presented with unexplained syncope (22%), and 10 presented with sudden death (SD) or appropriate implantable cardioverter-defibrillator therapy (AT) (8%) at diagnosis or over a mean follow-up of 48 ± 34 months. The Tpe interval was calculated as the difference between the QT interval and the QT peak interval as measured in each of the precordial leads.

Results: The Tpe interval from lead V1 to lead V4, maximum value of the Tpe interval (max Tpe), and Tpe dispersion in all precordial leads were significantly higher in patients with SD/AT or in patients with syncope than in asymptomatic patients (P < .001). A max Tpe of ≥100 ms was present in 47 of 226 asymptomatic patients (21%), in 48 of 73 patients with syncope (66%), and in 22 of 26 patients with SD/AT (85%) (P < .0001). In multivariate analysis, a max Tpe of ≥100 ms was independently related to arrhythmic events (odds ratio 9.61; 95% confidence interval 3.13-29.41; P < .0001).

Conclusion: The Tpe interval in the precordial leads is highly related to malignant ventricular arrhythmias in this large cohort of patients with BS. This simple electrocardiographic parameter could be used to refine risk stratification.

Keywords: Brugada syndrome; QT interval; Sudden death; Transmural dispersion of repolarization.

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