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

Roten, Laurent; Derval, Nicolas; Maury, Philippe; Mahida, Saagar; Pascale, Patrizio; Leenhardt, Antoine; Jesel, Laurence; Deisenhofer, Isabel; Kautzner, Josef; Probst, Vincent; Rollin, Anne; Ruidavets, Jean-Bernard; Ferrières, Jean; Sacher, Frédéric; Heg, Dik; Scherr, Daniel; Komatsu, Yuki; Daly, Matthew; Denis, Arnaud; Shah, Ashok; ... (2016). Benign vs malignant inferolateral early repolarization: Focus on the T wave. Heart rhythm, 13(4), pp. 894-902. Elsevier 10.1016/j.hrthm.2015.11.020

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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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