Electrocardiographic indexes of dispersion of ventricular repolarization: an isolated heart validation study

Division of Clinical Pharmacology, Georgetown University, Washington, D.C.

OBJECTIVES. This study tested the correlation of QT and JT dispersion and other potentially useful electrocardiographic (ECG) indexes with dispersion of repolarization and recovery time. BACKGROUND. Dispersion of ventricular repolarization is currently being assessed noninvasively from the surface ECG by means of QT and JT dispersion, although their correlation with dispersion of repolarization as measured directly from the myocardium is not well established. METHODS. Multiple monophasic action potentials were recorded simultaneously with a 12-lead ECG from isolated Langendorff-perfused rabbit hearts. The QT and JT dispersion was compared with the dispersion of monophasic action potential duration at 90% repolarization (APD90) and with dispersion of recovery time. As new ECG indexes, total T wave area, T wave area after the peak (late T wave area) and T peak to T end interval were also tested. RESULTS. The QT and JT dispersion showed a significant correlation with the dispersion of APD90 and the dispersion of recovery time (r values between 0.58 and 0.64, respectively, p < 0.001). However, total T wave area showed better correlation, respectively, with dispersion of APD90 and recovery time (r = 0.79 and r = 0.82, p < 0.0001), as did late T wave area (r = 0.81 and r = 0.81, p < 0.0001) and T peak to T end interval (r = 0.81 and r = 0.82, p < 0.0001). CONCLUSIONS. The JT and QT dispersion correlate significantly with dispersion of APD90 and recovery time. The ECG assessment of dispersion of repolarization can be improved by three new ECG dispersion indexes: T peak to T end interval, total T wave area and late T wave area. These new indexes should be tested clinically.

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