Circulation, Vol 89, 1681-1689, Copyright © 1994 by American Heart Association
SG Priori, C Napolitano, L Diehl and PJ Schwartz
BACKGROUND: QT interval dispersion, measured as interlead variability of
QT, is a marker of dispersion of ventricular repolarization and, hence, of
cardiac electrical instability. We tested the hypothesis that dispersion of
ventricular repolarization may be differently affected by interventions
destined to provide complete or incomplete protection against malignant
arrhythmias in patients with long QT syndrome (LQTS). Twenty-eight patients
affected by the Romano Ward form of LQTS entered the study and were divided
into three groups: LQTS patients before institution of therapy, patients
who did respond to beta-blocker therapy, and patients who continued to have
syncope and cardiac arrest despite beta-blockade and who underwent left
cardiac sympathetic denervation. A group of 15 healthy volunteers served as
control subjects. METHODS AND RESULTS: Dispersion of QT and QTc were
calculated using two indexes: the difference between the longest and the
shortest value measured in each of the 12 ECG leads (QTmax-QTmin,
QTcmax-QTcmin) and the relative dispersion of QT and QTc (standard
deviation of QT/QT average x100, standard deviation of QTc/QTc average
x100). Both indexes of dispersion of repolarization were higher in the LQTS
patients than in control subjects; also, patients not responding to
beta-blockers had a significantly higher dispersion of repolarization than
responders. A cutoff value of 100 milliseconds for QTmax-QTmin had an 80%
sensitivity and 82% specificity in discriminating between responders and
nonresponders. A cutoff value of 6 for QT relative dispersion yielded
similar results. The LQTS patients who did not respond to beta-blockade
underwent left cardiac sympathetic denervation and thereafter remained
asymptomatic (mean follow-up, 5 +/- 4 years). In this group, dispersion of
repolarization was significantly reduced by the surgical denervation to
values similar to that of the responders to beta-blockade. CONCLUSIONS:
These data indicate that QT dispersion is a useful clinical tool to predict
efficacy of antiadrenergic therapy in LQTS patients.
ARTICLES
Dispersion of the QT interval. A marker of therapeutic efficacy in the idiopathic long QT syndrome
Istituto di Clinica Medica Generale e Terapia Medica, Universita di Milano, Italy.
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