Circulation. 1998;97:2491-2493
(Circulation. 1998;97:2491-2493.)
© 1998 American Heart Association, Inc.
Dispersion of Ventricular Repolarization
Reality? Illusion? Significance?
Philippe Coumel, MD, FESC;
Pierre Maison-Blanche, MD;
; Fabio Badilini, PhD
From the Hôpital Lariboisière, Paris, France.
Correspondence to Philippe Coumel, MD, FESC, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75015 Paris, France.
Key Words: Editorials • ventricles • electrophysiology
The QT interval
is considered to be a surrogate of cellular action potential duration.
However, it yields a limited view of the complex electrogenesis of the
ventricular repolarization (VR). Evidence of T-wave end
inequality among surface ECG traces back to Wilson et
al,1 and it was recently revived by the concept
of dispersion.2 Because of its apparent
simplicity, QT dispersion became fashionable, and a growing literature
is now devoted to its potential prognostic interest. The study by Zabel
et al3 seems timely to temper the enthusiasm. In
a prospectively collected cohort of patients, it offers evidence that
avoiding technical biases of measurement, QT dispersion is not a
prognostic marker. This contrasts with the confirmation that ejection
fraction, heart rate variability, and simply heart rate are indeed good
predictors of events. It suggests some reflections about the correct
and comprehensive use of a concept that still needs to be
validated.
Technical Considerations
Measurement of QT Duration
QT interval can be measured manually or with dedicated algorithms.
The performances of the 2 approaches were compared in a
remarkable study conducted by the late Jos
Willems.4 The aim was to assess the
diagnostic performances of computerized
systems.5 In view of the interobserver and
intraobserver variability in determining wave recognition points, an
elaborate reviewing scheme was devised to obtain a group estimate that
should define the "truth," ultimately serving as a standard for
computer measurement. Five experts defined individually the P- and
QRS-wave onset and offset and the T-wave offset. The database was
formed of 250 digitized (500 Hz) 12 . . . [Full Text of this Article]
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