Complex T-wave morphology in body surface potential mapping in prediction of arrhythmic events in patients with acute myocardial infarction and cardiac dysfunction.
OBJECTIVE
Heterogeneous ventricular repolarization is associated with sudden cardiac death after myocardial infarction (MI). This prospective study investigated repolarization disparity with parameters based on T-wave morphology in body surface potential mapping (BSPM) in the assessment of arrhythmia risk in patients with a recent MI and cardiac dysfunction.


RESULTS
Patients (n = 158) had 120-lead BSPM and 12-lead electrocardiogram (ECG) registered soon after acute MI. Principal component analysis (PCA) of the T-wave and T-wave vector loop descriptors were applied to compute parameters describing T-wave morphology and its variation. The study endpoints were arrhythmic events and all-cause mortality. During a mean follow-up of 50 months, 30 patients (19%) died and 16 (10%) had an arrhythmic event. Most of the parameters differed significantly between patients with and without arrhythmic events. In univariate analysis, T-wave vector loop length (TLL) and PCA parameter PCA(3) in BSPM and TLL in ECG were significant predictors of arrhythmic events. In multivariate analysis including several clinical variables, these parameters also showed an independent prediction, with parameters in BSPM performing somewhat better. None of the parameters predicted all-cause mortality.


CONCLUSIONS
Complex T-wave morphology in BSPM is a marker of arrhythmia propensity in patients with a recent MI and cardiac dysfunction.
Korhonen
Petri
P
Division of Cardiology, Helsinki University Hospital, PL 340, 00029 HUS Helsinki, Finland. korhonen.petri@kolumbus.fi
Husa
Terhi
T
Konttila
Teijo
T
Tierala
Ilkka
I
Mäkijärvi
Markku
M
Väänänen
Heikki
H
Toivonen
Lauri
L
D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000453:epidemiology* / Q000503:physiopathology; D018780:Body Surface Potential Mapping; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000503:physiopathology