Skip to main content
SpringerLink
Log in

Clinical Usefulness of QT Prolongation, QT Dispersion and T-Wave Alternans

  • Chapter
Cardiac Arrhythmias 1997

  • 86 Accesses

Abstract

The prognosis of postmyocardial infarction patients depends especially upon the interaction between ischemia, left ventricular dysfunction and electrical instability. Repolarization parameters (QT interval, QT dispersion and T-wave alternans analysis) are used for noninvasive evaluation of patients prone to ventricular arrhythmias after myocardial infarction. The publication of the results of the MADIT trial makes the development of new techniques for noninvasive risk stratification of arrhythmias even more important, because one of the major limitations to extrapolation of the results in daily clinical practice is the need for an invasive electrophysiological (EP) test to stratify the patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bazett HC (1920) An analysis of the time-relation of the electrocardiogram. Heart 7: 353–370

    Google Scholar 

  2. Schwartz PI, Wolf S (1978) QT interval prolongation as predictor of sudden death in patients with myocardial infarction. Circulation 57: 1074–1077

    Article  PubMed  CAS  Google Scholar 

  3. Haynes RE, Hallstrom AP, Cobb LA (1978) Repolarisation abnormalities in survivors of out-of-hospital ventricular fibrillation. Circulation 57: 654–658

    Article  PubMed  CAS  Google Scholar 

  4. Anhve S, Gilpin E, Madsen EB, Froelicher V, Henning H, Ross J Jr (1984) Prognostic importance of QTc interval at discharge after acute myocardial infarction: a multicenter study of 865 patients. Am Heart J 108: 395–400

    Article  Google Scholar 

  5. Algra A, Tijsen JGP, Roeland J, Pool J, Lubsen J (1991) QTc prolongation measured by standard 12-lead electrocardiography is an independent risk factor for sudden death due to cardiac arrest. Circulation 83: 1888–1894

    Article  PubMed  CAS  Google Scholar 

  6. Moller M (1981) QT interval in relation to ventricular arrhythmias and sudden cardiac death in post-myocardial infarction patients. Acta Med Scand 220: 73–77

    Google Scholar 

  7. Wheelam K, Mukharji J, Rude RE (1986) Sudden death and its relation to QT prolongation after acute myocardial infarction: 2 year follow-up. Am J Cardiol 57: 745–750

    Article  Google Scholar 

  8. Boudoulas H, Sohn YH, O’Neill WM, Brown R, Weissler AM (1982) The QT<QS2syndrome: a new mortality indicator in coronary artery disease. Am J Cardiol 50: 1229–1235

    Article  PubMed  CAS  Google Scholar 

  9. Pohjola-Sintonen S, Siltanen P, Haapakosi J (1986) The QTc interval on the discharge electrocardiogram for predicting survival after acute myocardial infarction. Am J Cardiol 57: 1066–1068

    Article  PubMed  CAS  Google Scholar 

  10. Marti V, Guindo J, Homs E, Vitiolas X, Bayés de Luna A (1992) Peaks of QTc lengthening in Holter recordings as a marker of life-threatening arrhythmias in postmyocardial infarction patients. Am Heart J 124: 234–235

    Article  PubMed  CAS  Google Scholar 

  11. Laguna P, Thakor NV, Caminal P, Jane R, Bayés de Luna A, Marti V, Guindo J (1990) New algorithm for QT interval analysis in 24-hour Holter ECG: performance and applications. Med & Biol Eng & Comput 28: 67–73

    Article  CAS  Google Scholar 

  12. Homs E, Marti V, Guindo J et al (1997) Automatic measurement of corrected QT interval in Holier recordings: comparison of its dynamic behaviour in postmyocardial infarction patients with and without life-threatening arrhythmias. Am Heart J (in press)

    Google Scholar 

  13. Algra A, Tijssen JGP, Roetlandt JRTC, Pool J, Lubsen J (1993) QT interval variables from 24-hour electrocardiography and the two year risk of sudden death. Br Heart J 70: 43–48

    Article  PubMed  CAS  Google Scholar 

  14. Day CP, McComb JM, Campbell RWF (1990) QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Br Heart J 63: 342–344

    Article  PubMed  CAS  Google Scholar 

  15. Perkiomaki JS, Koistinen J, Yli-Mayry S et al (1995) Dispersion of QT interval in patients with and without susceptibility to ventricular tachyarrhythmias after previous myocardial infarction. J Am Coll Cardiol 26: 174–179

    Article  PubMed  CAS  Google Scholar 

  16. Higham PD, Furniss SS, Campbell RW (1995) QT dispersion and components of the QT interval in ischemia and infarction. Br Heart J 73: 32–36

    Article  PubMed  CAS  Google Scholar 

  17. Barr CS, Naas A, Freeman M et al (1994) QT dispersion and sudden unexpected death in chronic heart failure. Lancet 343: 327–329

    Article  PubMed  CAS  Google Scholar 

  18. Zareba W, Moss AJ, le Cessie S (1994) Dispersion of ventricular repolarisation and arrhythmic cardiac death in coronary artery disease. Am J Cardiol 74: 550–553

    Article  PubMed  CAS  Google Scholar 

  19. Daliento L, Caneve F, Turrini P et al (1995) Clinical significance of high frequency, low amplitude electrocardiographic signals and QT dispersion in patients operated on for tetralogy of Fallot. Am J Cardiol 76: 408–411

    Article  PubMed  CAS  Google Scholar 

  20. Leitch J, Basta M, Dobson A (1995) QT dispersion does not predict early ventricular fibrillation after acute myocardial infarction. PACE 18: 45–48

    Article  PubMed  CAS  Google Scholar 

  21. Davey PP, Bateinan J, Mulligan C et al (1994) QT interval dispersion in chronic heart failure and left ventricular hypertrophy: relation to autonomic nervous system and Holter tape abnormalities. Br Heart J 71: 268–273

    Article  PubMed  CAS  Google Scholar 

  22. Fiol M, Marrugat J, Bergada et al (1995) QT dispersion and ventricular fibrillation in acute myocardial infarction. Lancet 346: 1424–1425

    Article  PubMed  CAS  Google Scholar 

  23. Zabel M, Portnoy S, Franz MR (1995) Electrocardiographic indexes of dispersion of ventricular repolarization: an isolated heart validation study. J Am Coll Cardiol 25: 746–752

    Article  PubMed  CAS  Google Scholar 

  24. Franz MR, Bargheer K, Raffenbeul W et al (1987) Monophasic action potential mapping in human subjects with normal electrocardiograms. Direct evidence for the genesis of the T wave. Circulation 75: 379–386

    Article  PubMed  CAS  Google Scholar 

  25. Kautzner J, Yi G, Camm J et al (1994) Short and long term reproducibility of QT, QTc and QT dispersion measurement in healthy subjects. PACE 17: 928–937

    Article  PubMed  CAS  Google Scholar 

  26. The European Agency for the Evaluation of Medicinal Products. Human Medecines Evaluation Unit. Committee for Proprietary Medicinal Products (CPMP) (1997) The assessment of the potential for QT interval prolongation by non-cardiovascular products (in press)

    Google Scholar 

  27. Schwartz P, Priory G (1996) Clinical utility of QT interval monitoring. In: Moss AJ, Stern S (eds) Non-invasive electrocardiology. Saunders, Philadelphia, pp 465–474

    Google Scholar 

  28. Day CP, McComb JM, Campbell RW (1992) QT dispersion in sinus beats and ventricular extrasystoles in normal hearts. Br Heart J 67: 39–41

    Article  PubMed  CAS  Google Scholar 

  29. Van de Loo A, Arendts W, Hohnloser SH (1994) Variability of QT dispersion measurements in the surface electrocardiogram in patients with acute myocardial infarction and in normal subjects. Am J Cardiol 74: 1113–1118

    Article  PubMed  Google Scholar 

  30. Hii JT, Wyse DG, Gillis AM et al (1992) Precordial QT interval dispersion as a marker of torsade de pointes. Disparate effects of class IA antiarrhythmic drugs and amiodarone. Circulation 86: 1376–1382

    Article  PubMed  CAS  Google Scholar 

  31. Shimizu W, Kamakura S, Ohe T et al (1994) Diagnostic value of recovery time measured by body surface mapping in patients with congenital long QT syndrome. Am J Cardiol 74: 780–785

    Article  PubMed  CAS  Google Scholar 

  32. Pye M, Quinn AC, Cobbe SM (1994) QT interval dispersion: A noninvasive marker of susceptibility to arrhythmia in patients with sustained ventricular arrhythmias. Br Heart J 71: 511–514

    Article  PubMed  CAS  Google Scholar 

  33. Uppal P, Sharma PP, Ahmed R et al (1994) QT dispersion in normal subjects and patients with myocardial infarction. J Am Coll Cardiol 23: 36A (abstr)

    Google Scholar 

  34. Hohnloser SH, Van De Loo A, Baedeker F (1995) Efficacy and proarrhythmic hazards of pharmacologic cardioversion of atrial fibrillaton. Prospective comparison of sotalol versus quinidine. J Am Coll Cardiol 26: 852–858

    Article  PubMed  CAS  Google Scholar 

  35. Wei K, Dorian P, Newman D et al (1995) Association between QT dispersion and autonomic dysfunction in patients with diabetes mellitus. J Am Coll Cardiol 26: 859–863

    Article  PubMed  CAS  Google Scholar 

  36. Buja G, Miorelli M, Turrini P et al (1993) Comparison of QT dispersion in hypertrophic cardiomyopathy between patients with and without ventricular arrhythmias and sudden death. Am J Cardiol 27: 973–976

    Article  Google Scholar 

  37. Dritsas A, Puri S, Davis G et al (1993) QT dispersion is increased in hypertrophic cardiomyopathy compared with secondary ventricular hypertrophy. Eur Heart J 14: 212 (abstr)

    Google Scholar 

  38. Kautzner J, Gang Y, Camm AJ et al (1994) Short-and long-term reproducibility of QT, QTc, and QT dispersion measurement in healthy subjects. PACE 17: 928–937

    Article  PubMed  CAS  Google Scholar 

  39. Linker NY, Colonna P, Keckwick CA et al (1992) Assessment of QT dispersion in symptomatic patients with the congenital long QT syndrome. Am J Cardiol 69: 634–638

    Article  PubMed  CAS  Google Scholar 

  40. Priori SG, Napolitano C, Diehl L et al (1995) Dispersion of the QT interval. A marker of therapeutic efficacy in the idiopathic long QT syndrome. Circulation 897: 1681–1689

    Google Scholar 

  41. Hnatkova K, Malik M, Kautzner J et al (1994) Adjustment of QT dispersion assessed from 12-lead electrocardiograms for different numbers of analysed electrocardiographic leads: comparison of stability of different methods. Br Heart J 72: 390–396

    Article  PubMed  CAS  Google Scholar 

  42. Day CP, James OF, Butler TJ et al (1993) QT prolongation and sudden cardiac death in patients with alcoholic liver disease. Lancet 341: 1423–1448

    Article  PubMed  CAS  Google Scholar 

  43. Jordaens L, Missault L, Pelleman G et al (1994) Comparison of athletes with life-threatening ventricular arrhythmias with two groups of healthy athletes and a group of normal control subjects. Am J Cardiol 74: 1124–1128

    Article  PubMed  CAS  Google Scholar 

  44. Verrier RL, Nearing BD (1995) T-wave alternans as a harbinger of ischemia-induced sudden cardiac death. In: Zipes DP, Jalife J (eds) Cardiac electrophysiology. From cell to bedside. WB Saunders Co, Philadelphia, pp

    Google Scholar 

  45. Fisch C (1988) In: Braunwald E (ed) Heart disease. A textbook of cardiovascular medicine.WB Saunders Co, Philadelphia, chp 7, pp 180–222

    Google Scholar 

  46. Nearing BD, Oesterle SN, Verrier RL (1994) Quantification of ischemia-induced vulnerability by precordial T-wave alternans analysis in dogs and human. Cardiovasc Res 28: 1440–1449

    Article  PubMed  CAS  Google Scholar 

  47. Adam DR, Smith JM, Axelrod S et al (1984) Fluctuations in T-wave morphology and susceptibility to ventricular fibrillation. J Electrocardiol 17: 209

    Article  PubMed  CAS  Google Scholar 

  48. Rosenbaum DS, Jackson LE, Smith JM (1994) Electrical alternans and vulnerability to ventricular arrhythmias. New Eng J Med 330: 235–241

    Article  PubMed  CAS  Google Scholar 

  49. Smith JM, Clancy EA, Valeri CR et al (1988) Electrical alternans and cardiac electrical instability. Circulation 7: 110

    Article  Google Scholar 

  50. Nearing BD, Huang AH, Verrier RL (1991) Dynamic tracking of cardiac vulnerability by complex demodulation of the T wave. Science 252: 437–440

    Article  PubMed  CAS  Google Scholar 

  51. Nearing BD, Verrier RL (1993) Personal computer system for tracking cardiac vulnerability by complex demodulation of the T-wave. J Appl Physiol 74: 2606–2612

    PubMed  CAS  Google Scholar 

  52. Zareba W, Badilini F, Moss AJ (1994) Automatic detection of spatial and dynamic heterogeneity of repolarization. J Electrocardiol (Suppl) 27: 66–72

    Article  Google Scholar 

  53. Verrier RL, Zareba W, Nearing BD (1996) T-wave alternans monitoring to assess risk for ventricular tachycardia and fibrillation. In: Moss AJ, Stern S (eds) Non-invasive electrocardiology. Clinical aspects of Holter Monitoring. WB Saunders Co, London

    Google Scholar 

  54. Verrier RL, Nearing BD (1994) Electrophysiological basis for T-wave alternans as an index of vulnerability to ventricular fibrillation. J Cardiovasc Electrophysiol 5: 445–461

    Article  PubMed  CAS  Google Scholar 

  55. Rozanski JJ, Kleinfeld M (1982) Alternans of the ST segment and T-wave: a sign of electrical instability in Prinzmetal’s angina. PACE 5: 359–365

    Article  PubMed  CAS  Google Scholar 

  56. Salerno JA, Previtali M, Panciroli C et al (1986) Ventricular arrhythmias during acute myocardial ischemia in man: the role of R-ST-T alternans and the prevention of ischaemic sudden death by medical treatment. Eur Heart J 7: 63–66

    Article  PubMed  Google Scholar 

  57. Turitto G, El-Sheriff N (1988) Alternans of the ST segment in variant angina: incidence, time course and relation to ventricular arrhythmias during ambulatory electrocardiographic recordings. Chest 93: 587–591

    Article  PubMed  CAS  Google Scholar 

  58. Zareba W, Moss AJ, le Cessie E et al (1994) T-wave alternans in idiopathic QT syndrome. J Am Coll Cardiol 23: 1541–1546

    Article  PubMed  CAS  Google Scholar 

  59. Rosenbaum DS, Albrecht P, Cohen RJ (1996) Predicting cardiac death from T-wave alternans of the surface electrocardiograms: promise and pitfalls. J Cardiovasc Electrophysiol 7: 1095–1111

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departament de Cardiologia, Hospital de Sant Pau, Barcelona, Spain

    X. Viñolas, A. Cabrera & A. Bayés de Luna

Authors
  1. X. Viñolas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Cabrera
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Bayés de Luna
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Divisione di Cardiologia, Ospedale Umberto I, Via Circonvallazione 50, I-30174, Venezia Mestre, Italy

    Antonio Raviele MD

Rights and permissions

Reprints and permissions

Copyright information

© 1998 Springer-Verlag Italia

About this chapter

Cite this chapter

Viñolas, X., Cabrera, A., de Luna, A.B. (1998). Clinical Usefulness of QT Prolongation, QT Dispersion and T-Wave Alternans. In: Raviele, A. (eds) Cardiac Arrhythmias 1997. Springer, Milano. https://doi.org/10.1007/978-88-470-2288-1_26

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-2288-1_26

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2290-4

  • Online ISBN: 978-88-470-2288-1

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation