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CLINICAL RESEARCH: HEART RHYTHM DISORDERS

Tpeak-Tend and Tpeak-Tend Dispersion as Risk Factors for Ventricular Tachycardia/Ventricular Fibrillation in Patients With the Brugada Syndrome

Jesus Castro Hevia, MD^_*, Charles Antzelevitch, PhD, FACC^,_*, Francisco Tornés Bárzaga, MD^_*, Margarita Dorantes Sánchez, MD^_*, Francisco Dorticós Balea, PhD^_*, Roberto Zayas Molina, MD^_*, Miguel A. Quiñones Pérez, MD^_* and Yanela Fayad Rodríguez, MD^_*

^_* Arrhythmia Unit, Cardiovascular Surgery and Cardiology Institute, Havana, Cuba
Masonic Medical Research Laboratory, Utica, New York.

Manuscript received September 19, 2005; revised manuscript received November 14, 2005, accepted December 13, 2005.

^_* Reprint requests and correspondence: Dr. Charles Antzelevitch, Gordon K. Moe Scholar, Masonic Medical Research Laboratory, 2150 Bleecker Street, Utica, New York 13501-1787. (Email: ca{at}mmrl.edu).

OBJECTIVES: Our objective in this study was to evaluate Tpeak-Tend interval (Tp-e) and other electrocardiographic parameters as risk factors for recurrence of life-threatening cardiac events in patients with the Brugada syndrome (BS).

BACKGROUND: The Tp-e interval in the electrocardiogram (ECG) has been reported to predict life-threatening arrhythmias in the long QT syndrome.

METHODS: Twenty-nine patients with the ECG pattern of BS and 29 healthy age- and gender-matched controls were studied. The follow-up period was 42.65 ± 24.42 months (range 11 to 108 months).

RESULTS: Upon presentation, five patients had suffered aborted sudden death, five syncope, and two presyncope. Eleven patients with the ECG pattern of BS had a prolonged (>460 ms) QTc in V₂ but usually not in inferior or left leads. No patient had abnormally prolonged QT dispersion. Programmed electrical stimulation induced ventricular tachycardia/fibrillation in 5 out of 26 patients. Inducibility did not predict recurrence of events. Cardioverter-defibrillators were implanted in 14 patients (all symptomatic and two asymptomatic). During follow-up, nine symptomatic patients experienced recurrences. Previous cardiac events and a QTc >460 ms in V₂ were significant risk factors (p = 0.00002 and p = 0.03, respectively). Tp-e and Tp-e dispersion were significantly prolonged in patients with recurrences versus patients without events (104.4 and 35.6 ms vs. 87.4 and 23.2 ms; p = 0.006 and p = 0.03, respectively) or controls (90.7 and 17.9 ms; p = 0.02 and p = 0.001, respectively).

CONCLUSIONS: Our study demonstrates significant correlation between previous events, QTc >460 ms in V₂, Tp-e, and Tp-e dispersion and occurrence of life-threatening arrhythmic events, suggesting that these parameters may be useful in risk stratification of patients with the Brugada syndrome.

Abbreviations and Acronyms   AP = action potential   BS = Brugada syndrome   ECG = electrocardiogram   ICD = implantable cardioverter-defibrillator   LQTS = long QT syndrome   PES = programmed electrical stimulation   ROC = receiver-operating characteristic   TDR = transmural dispersion of repolarization   Tp-e = Tpeak-Tend interval   VF = ventricular fibrillation   VT = ventricular tachycardia

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