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. 2025 Jun 9;17(6):e85629.
doi: 10.7759/cureus.85629. eCollection 2025 Jun.

Electrocardiographic T-wave Abnormalities and Premature Ventricular Contraction Burden in Patients With Palpitations: A Regional Study From Northeast India

Rajeev Bharadwaj  1 , Suman Kalita  1 , Rudrakshya Sahu  2 , Saif Ahmad  3   4 , Durlav Banskota  1 , Suraj Mungase  5
Affiliations

Electrocardiographic T-wave Abnormalities and Premature Ventricular Contraction Burden in Patients With Palpitations: A Regional Study From Northeast India

Rajeev Bharadwaj et al. Cureus. .

Abstract

Background: Premature ventricular contractions (PVCs), often presenting as palpitations, are common in cardiology outpatient settings. While a high PVC burden is linked to adverse cardiac outcomes, its detection typically requires 24-hour Holter monitoring - an investigation not always feasible in resource-limited settings. Electrocardiographic (ECG) markers of ventricular repolarization, represented by T-wave abnormalities, such as Tp-Te interval, Tp-Te/QT ratio, and QTc dispersion, may serve as accessible surrogate indicators of PVC burden.

Objective: To evaluate the correlation between surface ECG-derived repolarization markers and PVC burden and determine which parameters best predict higher PVC burden in patients presenting with palpitations.

Methodology: A total of 87 adult patients with palpitations referred to a tertiary care cardiology clinic in Northeast India underwent 12-lead ECG and 24-hour Holter monitoring. Patients were stratified into two groups based on PVC burden (<1% vs. >1%). ECG parameters, including T-wave axis angle, frontal QRS-T (fQRS-T) angle, Tp-Te interval, Tp-Te dispersion, Tp-Te/QT ratio, and QTc dispersion, were compared. Statistical analysis included Welch's t-test and Spearman's correlation.

Results: Tp-Te interval (r = 0.5), Tp-Te/QT ratio (r = 0.4), and QTc dispersion (r = 0.3) demonstrated significant positive correlations with total PVC burden. These parameters were also significantly higher in the >1% PVC burden group (P < 0.05). No significant correlation was observed with T-wave axis or fQRS-T angle.

Conclusions: Among surface ECG markers studied, Tp-Te interval, Tp-Te/QT ratio, and QTc dispersion showed the strongest correlation with PVC burden in patients presenting with palpitations. These accessible and non-invasive markers may help identify patients at risk of higher PVC loads who may benefit from further evaluation, especially in settings where Holter monitoring is limited.

Keywords: ecg; holter; pvc burden; repolarization abnormalities; tp -te interval.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. All India Institute of Medical Sciences, Guwahati issued approval AIIMSG/IEC/M2/P10/2023. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Heat map showing the correlation of parameters.
*P < 0.05 was considered statistically significant. Values represent Spearman's correlation coefficient.
Figure 2
Figure 2. ROC curve analysis of ECG parameters: (A) Tp-Te dispersion, (B) QTc dispersion, (C) Tp-Te interval, (D) Tp-Te/QT ratio, (E) fQRS-T angle, and (F) QTc interval.
ROC, receiver operating characteristic; AUC, area under the curve; fQRS-T, frontal QRS-T; ECG, electrocardiographic
See this image and copyright information in PMC

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