Differences in the upslope of the precordial body surface ECG T wave reflect right to left dispersion of repolarization in the intact human heart

Neil T Srinivasan; Michele Orini; Rui Providencia; Ron Simon; Martin Lowe; Oliver R Segal; Anthony W Chow; Richard J Schilling; Ross J Hunter; Peter Taggart; Pier D Lambiase

doi:10.1016/j.hrthm.2018.12.006

Differences in the upslope of the precordial body surface ECG T wave reflect right to left dispersion of repolarization in the intact human heart

Heart Rhythm. 2019 Jun;16(6):943-951. doi: 10.1016/j.hrthm.2018.12.006. Epub 2018 Dec 12.

Authors

Affiliations

¹ Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom.
² Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom; Department of Mechanical Engineering, University College London, London, United Kingdom.
³ Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom.
⁴ Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom. Electronic address: p.lambiase@ucl.ac.uk.

Abstract

Background: The relationship between the surface electrocardiogram (ECG) T wave to intracardiac repolarization is poorly understood.

Objective: The purpose of this study was to examine the association between intracardiac ventricular repolarization and the T wave on the body surface ECG (SECG_TW).

Methods: Ten patients with a normal heart (age 35 ± 15 years; 6 men) were studied. Decapolar electrophysiological catheters were placed in the right ventricle (RV) and lateral left ventricle (LV) to record in an apicobasal orientation and in the lateral LV branch of the coronary sinus (CS) for transmural recording. Each catheter (CS, LV, RV) was sequentially paced using an S1-S2 restitution protocol. Intracardiac repolarization time and apicobasal, RV-LV, and transmural repolarization dispersion were correlated with the SECG_TW, and a total of 23,946 T waves analyzed.

Results: RV endocardial repolarization occurred on the upslope of lead V₁, V₂, and V₃ SECG_TW, with sensitivity of 0.89, 0.91, and 0.84 and specificity of 0.67, 0.68, and 0.65, respectively. LV basal endocardial, epicardial, and mid-endocardial repolarization occurred on the upslope of leads V₆ and I, with sensitivity of 0.79 and 0.8 and specificity of 0.66 and 0.67, respectively. Differences between the end of the upslope in V₁, V₂, and V₃ vs V₆ strongly correlated with right to left dispersion of repolarization (intraclass correlation coefficient 0.81, 0.83, and 0.85, respectively; P <.001). Poor association between the T wave and apicobasal and transmural dispersion of repolarization was seen.

Conclusion: The precordial SECG_TW reflects regional repolarization differences between right and left heart. These findings have important implications for accurately identifying biomarkers of arrhythmogenic risk in disease.

Keywords: Body surface electrocardiogram; Dispersion of repolarization; Surface electrocardiogram; T wave; T-wave genesis; Tpeak-Tend; Ventricular repolarization.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Arrhythmias, Cardiac* / diagnosis
Arrhythmias, Cardiac* / physiopathology
Body Surface Potential Mapping / methods*
Cardiac Electrophysiology
Electrophysiologic Techniques, Cardiac / methods*
Heart Conduction System / physiology*
Heart Ventricles*
Humans
Male
Risk Assessment / methods
Risk Assessment / standards

Abstract

Publication types

MeSH terms

Grants and funding