Abstract
OBJECTIVE--Recent studies have suggested that QT interlead variability (dispersion) on the surface electrocardiogram may have potential as a measure of recovery time dispersion. To test this hypothesis further QT dispersion occurring in sinus beats was compared with that in ventricular extrasystoles. DESIGN--Simultaneous electrocardiograms were recorded at 50 mm/s during sinus rhythm in a drug free state while ventricular extrastimuli were introduced by programmed right ventricular stimulation at different coupling intervals. QT dispersion, defined as the difference between the maximum and minimum QT, was calculated separately for the extrasystoles and preceding and following sinus complexes. To correct for the influence of the number of measurable leads on QT dispersion, an "adjusted" QT dispersion calculated as QT dispersion/square root of the number of measurable leads, was used to compare sinus complexes and extrasystoles. PATIENTS--Nine patients were studied who were undergoing electrophysiological study for investigation of palpitation and were found to have electrically normal ventricles. RESULTS--At all coupling intervals tested "adjusted" QT dispersion was significantly greater in the ventricular extrasystoles than in either the preceding or following sinus complexes. For the coupling interval 350 ms, the 95% confidence intervals for the difference between means was 52 to 78 ms (preceding sinus complex) and 56 to 82 ms (following sinus complex) (p less than 0.00001). There was no correlation between the coupling interval and the magnitude of the "adjusted" QT dispersion. CONCLUSION--These results accord fully with expected differences in ventricular recovery time dispersion and offer further support for the hypothesis that QT dispersion reflects regional variation in ventricular recovery. If substantiated by invasive studies, these findings have wide implications for both the usefulness and the method of QT measurement.
Full text
PDF


Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Cowan J. C., Hilton C. J., Griffiths C. J., Tansuphaswadikul S., Bourke J. P., Murray A., Campbell R. W. Sequence of epicardial repolarisation and configuration of the T wave. Br Heart J. 1988 Nov;60(5):424–433. doi: 10.1136/hrt.60.5.424. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cowan J. C., Yusoff K., Moore M., Amos P. A., Gold A. E., Bourke J. P., Tansuphaswadikul S., Campbell R. W. Importance of lead selection in QT interval measurement. Am J Cardiol. 1988 Jan 1;61(1):83–87. doi: 10.1016/0002-9149(88)91309-4. [DOI] [PubMed] [Google Scholar]
- Day C. P., McComb J. M., Campbell R. W. QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Br Heart J. 1990 Jun;63(6):342–344. doi: 10.1136/hrt.63.6.342. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Day C. P., McComb J. M., Matthews J., Campbell R. W. Reduction in QT dispersion by sotalol following myocardial infarction. Eur Heart J. 1991 Mar;12(3):423–427. doi: 10.1093/oxfordjournals.eurheartj.a059911. [DOI] [PubMed] [Google Scholar]
- Edvardsson N., Hirsch I., Emanuelsson H., Pontén J., Olsson S. B. Sotalol-induced delayed ventricular repolarization in man. Eur Heart J. 1980 Oct;1(5):335–343. doi: 10.1093/eurheartj/1.5.335. [DOI] [PubMed] [Google Scholar]
- Franz M. R., Bargheer K., Rafflenbeul W., Haverich A., Lichtlen P. R. Monophasic action potential mapping in human subjects with normal electrocardiograms: direct evidence for the genesis of the T wave. Circulation. 1987 Feb;75(2):379–386. doi: 10.1161/01.cir.75.2.379. [DOI] [PubMed] [Google Scholar]
- Fraser A. G., Ikram S. Torsade de pointes with prenylamine: do we still need the drug? Lancet. 1986 Sep 6;2(8506):572–572. doi: 10.1016/s0140-6736(86)90135-2. [DOI] [PubMed] [Google Scholar]
- Krikler D. M. A fresh look at cardiac arrhythmias Pathogenesis and presentation. Lancet. 1974 May 11;1(7863):913–918. doi: 10.1016/s0140-6736(74)90360-2. [DOI] [PubMed] [Google Scholar]
- Kuo C. S., Amlie J. P., Munakata K., Reddy C. P., Surawicz B. Dispersion of monophasic action potential durations and activation times during atrial pacing, ventricular pacing, and ventricular premature stimulation in canine ventricles. Cardiovasc Res. 1983 Mar;17(3):152–161. doi: 10.1093/cvr/17.3.152. [DOI] [PubMed] [Google Scholar]
- Lown B., Klein M. D., Hershberg P. I. Coronary and precoronary care. Am J Med. 1969 May;46(5):705–724. doi: 10.1016/0002-9343(69)90022-9. [DOI] [PubMed] [Google Scholar]
- Mirvis D. M. Spatial variation of QT intervals in normal persons and patients with acute myocardial infarction. J Am Coll Cardiol. 1985 Mar;5(3):625–631. doi: 10.1016/s0735-1097(85)80387-9. [DOI] [PubMed] [Google Scholar]
- Schwartz P. J., Periti M., Malliani A. The long Q-T syndrome. Am Heart J. 1975 Mar;89(3):378–390. doi: 10.1016/0002-8703(75)90089-7. [DOI] [PubMed] [Google Scholar]
- Spach M. S., Barr R. C. Ventricular intramural and epicardial potential distributions during ventricular activation and repolarization in the intact dog. Circ Res. 1975 Aug;37(2):243–257. doi: 10.1161/01.res.37.2.243. [DOI] [PubMed] [Google Scholar]
- Waller A. D. A Demonstration on Man of Electromotive Changes accompanying the Heart's Beat. J Physiol. 1887 Oct;8(5):229–234. doi: 10.1113/jphysiol.1887.sp000257. [DOI] [PMC free article] [PubMed] [Google Scholar]
