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Role of Electrocardiographic Tpeak-Tend for the Prediction of Ventricular Arrhythmic Events in the Brugada Syndrome

      Some previous studies have proposed the electrocardiographic Tpeak-Tend (TpTe) as a possible predictor of ventricular arrhythmic events in patients with Brugada syndrome (BrS). We sought to analyze the association between the parameters of repolarization dispersion (TpTe, TpTe/QT, TpTe dispersion, QTc, and QTd) and ventricular fibrillation/sudden cardiac death in a large cohort of patients with type 1 BrS. A total of 448 consecutive patients with BrS (men 61%, age 45 ± 16 years) with spontaneous (n = 96, 21%) or drug-induced (n = 352, 79%) type 1 electrocardiogram were retrospectively included. At the time of the diagnosis or during a mean follow-up of 93 ± 47 months (median 88 months), 43 patients (9%) documented ventricular arrhythmias. No significant difference was observed in TpTe, TpTe/QT, maximum TpTe, and TpTe dispersion between asymptomatic patients and those with syncope and malignant arrhythmias. TpTe/QT ratio did not also significantly differ between patients with ventricular fibrillation/sudden cardiac death and those asymptomatic ones. In conclusion, TpTe was not significantly prolonged in those patients with type 1 BrS presenting with unexplained syncope or malignant arrhythmic events during follow-up.
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      References

        • Brugada P.
        • Brugada J.
        Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome: a multicenter report.
        J Am Coll Cardiol. 1992; 20: 1391-1396
        • Priori S.G.
        • Napolitano C.
        • Gasparini M.
        • Pappone C.
        • Della Bella P.
        • Brignole M.
        • Giordano U.
        • Giovannini T.
        • Menozzi C.
        • Bloise R.
        • Crotti L.
        • Terreni L.
        • Schwartz P.J.
        Clinical and genetic heterogeneity of right bundle branch block and ST-segment elevation syndrome: a prospective evaluation of 52 families.
        Circulation. 2000; 102: 2509-2515
        • Eckardt L.
        • Probst V.
        • Smits J.P.
        • Bahr E.S.
        • Wolpert C.
        • Schimpf R.
        • Wichter T.
        • Boisseau P.
        • Heinecke A.
        • Breithardt G.
        • Borggrefe M.
        • LeMarec H.
        • Bocker D.
        • Wilde A.A.
        Long-term prognosis of individuals with right precordial ST-segment-elevation Brugada syndrome.
        Circulation. 2005; 111: 257-263
        • Brugada J.
        • Brugada R.
        • Brugada P.
        Determinants of sudden cardiac death in individuals with the electrocardiographic pattern of Brugada syndrome and no previous cardiac arrest.
        Circulation. 2003; 108: 3092-3096
        • Antzelevitch C.
        • Brugada P.
        • Borggrefe M.
        • Brugada J.
        • Brugada R.
        • Corrado D.
        • Gussak I.
        • LeMarec H.
        • Nademanee K.
        • Perez Riera A.R.
        • Shimizu W.
        • Schulze-Bahr E.
        • Tan H.
        • Wilde A.
        Brugada syndrome. Report of the Second Consensus Conference. Endorsed by the Heart Rhythm Society and the European Heart Rhythm Association.
        Circulation. 2005; 111: 659-670
        • Lambiase P.D.
        Tpeak-Tend interval and Tpeak-Tend/QT ratio as markers of ventricular tachycardia inducibility in subjects with Brugada ECG phenotype.
        Europace. 2010; 12: 158-159
        • Castro Hevia J.
        • Antzelevitch C.
        • Tornes Barzaga F.
        • Dorantes Sanchez M.
        • Dorticos Balea F.
        • Zayas Molina R.
        • Quinones Perez M.A.
        • Fayad Rodriguez Y.
        Tpeak-Tend and Tpeak-Tend dispersion as risk factors for ventricular tachycardia/ventricular fibrillation in patients with the Brugada syndrome.
        J Am Coll Cardiol. 2006; 47: 1828-1834
        • Wang J.F.
        • Shan Q.J.
        • Yang B.
        • Chen M.L.
        • Zou J.G.
        • Chen C.
        • Xu D.J.
        • Cao K.J.
        Tpeak-Tend interval and risk of cardiac events in patients with Brugada syndrome.
        Zhonghua Xin Xue Guan Bing Za Zhi. 2007; 35: 629-632
        • Letsas K.P.
        • Weber R.
        • Astheimer K.
        • Kalusche D.
        • Arentz T.
        Tpeak-Tend interval and Tpeak Tend/QT ratio as markers of ventricular tachycardia inducibility in subjects with Brugada ECG phenotype.
        Europace. 2010; 12: 271-274
        • Maury P.
        • Sacher F.
        • Gourraud J.B.
        • Pasquié J.L.
        • Raczka F.
        • Bongard V.
        • Duparc A.
        • Mondoly P.
        • Sadron M.
        • Chatel S.
        • Derval N.
        • Denis A.
        • Cardin C.
        • Davy J.M.
        • Hocini M.
        • Jais P.
        • Jesel L.
        • Carrié D.
        • Galinier M.
        • Haissaguerre M.
        • Probst V.
        • Rollin A.
        Increased Tpeak-Tend interval is highly and independently related to arrhythmic events in Brugada syndrome.
        Heart Rhythm. 2015; 12: 2469-2476
        • Zumhagen S.
        • Zeidler E.M.
        • Stallmeyer B.
        • Ernsting M.
        • Eckardt L.
        • Schulze-Bahr E.
        Tpeak-Tend interval and Tpeak-Tend/QT ratio in patients with Brugada syndrome.
        Europace. 2016; 18: 1866-1872
        • Rivard L.
        • Roux A.
        • Nault I.
        • Champagne J.
        • Roux J.F.
        • Tadros R.
        • Talajic M.
        • Cadrin-Tourigny J.
        • Shohoudi A.
        • Mondesert B.
        • Roy D.
        • Macle L.
        • Andrade J.
        • Dyrda K.
        • Dubuc M.
        • Guerra P.G.
        • Sarrazin J.F.
        • Thibault B.
        • Khairy P.
        Predictors of ventricular arrhythmias and sudden death in a Quebec cohort with Brugada syndrome.
        Can J Cardiol. 2016; 32 (e1-e7): 1355
        • Junttila M.J.
        • Brugada P.
        • Hong K.
        • Lizotte E.
        • De Zutter M.
        • Sarkozy A.
        • Brugada J.
        • Benito B.
        • Perkiomaki J.S.
        • Makikallio T.H.
        • Huikuri H.V.
        • Brugada R.
        Differences in 12-lead electrocardiogram between symptomatic and asymptomatic Brugada syndrome patients.
        J Cardiovasc Electrophysiol. 2008; 19: 380-383
        • Morita H.
        • Kusano K.F.
        • Miura D.
        • Nagase S.
        • Nakamura K.
        • Morita S.T.
        • Ohe T.
        • Zipes D.P.
        • Wu J.
        Fragmented QRS as a marker of conduction abnormality and a predictor of prognosis of Brugada syndrome.
        Circulation. 2008; 118: 1697-1704
        • Panikkath R.
        • Reinier K.
        • Uy-Evanado A.
        • Teodorescu C.
        • Hattenhauer J.
        • Mariani R.
        • Gunson K.
        • Jui J.
        • Chugh S.S.
        Prolonged Tpeak-to-Tend interval on the resting ECG is associated with increased risk of sudden cardiac death.
        Circ Arrhythm Electrophysiol. 2011; 4: 441-447
        • Gupta P.
        • Patel C.
        • Patel H.
        • Narayanaswamy S.
        • Malhotra B.
        • Green J.T.
        • Yan G.X.
        Tp-e/QT ratio as an index of arrhythmogenesis.
        J Electrocardiol. 2008; 41: 567-574
        • Opthof T.
        • Coronel R.
        • Wilms-Schopman F.J.G.
        • Plotnikov A.N.
        • Shlapakova I.N.
        • Danilo P.
        • Rosen M.R.
        • Janse M.J.
        Dispersion of repolarization in canine ventricle and the electrocardiographic T wave: Tp-e interval does not reflect transmural dispersion.
        Heart Rhythm. 2007; 4: 341-348
        • Antzelevitch C.
        Transmural dispersion of repolarization and the T wave.
        Cardiovasc Res. 2001; 50: 426-431
        • Yagishita D.
        • Chui R.W.
        • Yamakawa K.
        • Rajendran P.S.
        • Ajijola O.A.
        • Nakamura K.
        • So E.L.
        • Mahajan A.
        • Shivkumar K.
        • Vaseghi M.
        Sympathetic nerve stimulation, not circulating norepinephrine, modulates T-peak to T-end interval by increasing global dispersion of repolarization.
        Circ Arrhythm Electrophysiol. 2015; 8: 174-185
        • Shinohara T.
        • Kondo H.
        • Otsubo T.
        • Fukui A.
        • Yufu K.
        • Nakagawa M.
        • Takahashi N.
        Exaggerated reactivity of parasympathetic nerves is involved in ventricular fibrillation in J-wave syndrome.
        J Cardiovasc Electrophysiol. 2017; 28: 321-326
        • Bachmann T.N.
        • Skov M.W.
        • Rasmussen P.V.
        • Graff C.
        • Pietersen A.
        • Lind B.
        • Struijk J.J.
        • Olesen M.S.
        • Haunsø S.
        • Køber L.
        • Svendsen J.H.
        • Holst A.G.
        • Nielsen J.B.
        Electrocardiographic Tpeak-Tend interval and risk of cardiovascular morbidity and mortality: results from the Copenhagen ECG study.
        Heart Rhythm. 2016; 13: 915-924
        • Sieira J.
        • Conte G.
        • Ciconte G.
        • de Asmundis C.
        • Chierchia G.B.
        • Baltogiannis G.
        • Di Giovanni G.
        • Saitoh Y.
        • Irfan G.
        • Casado-Arroyo R.
        • Julia J.
        • La Meir M.
        • Wellens F.
        • Wauters K.
        • Van Malderen S.
        • Pappaert G.
        • Brugada P.
        Prognostic value of programmed electrical stimulation in Brugada syndrome.
        Circ Arrhythm Electrophysiol. 2015; 8: 777-784