title: A novel ECG-index for prediction of ventricular arrhythmias in patients after myocardial infarction.
abstract: BACKGROUND
  Risk prediction of ventricular arrhythmias after myocardial infarction (MI) is still insufficient. Prolonged QTc is a known risk marker of mortality and ventricular arrhythmias. QTc has not achieved clinical importance in predicting arrhythmic events in patients after MI. Recent studies have displayed that the terminal part of the QT-interval, Tpeak to Tend (TpTe), may be a more promising predictor of adverse outcome. Herein, we assessed whether TpTe may serve as a predictor of ventricular arrhythmias in patients with previous MI fulfilling current implantable cardioverter-defibrillator (ICD) indications.
  
  
  METHODS
  Seventy-six patients with previous MI eligible for ICD therapy were prospectively enrolled. ECG measurements at baseline were recorded using a 12-lead ECG with 50 mm/s paper speed. TpTe was measured from peak of the T wave to end of T wave. Events during follow up were defined as ventricular arrhythmias requiring appropriate ICD therapy, including antitachycardia pacing and shock.
  
  
  RESULTS
  During 23 ± 19 months, arrhythmic events occurred in 36 (47%) patients. TpTe was longer in ICD patients with recorded ventricular arrhythmias compared with those without (116 ± 26 ms vs. 102 ± 20 ms; P = 0.01), whereas ejection fraction (EF) at baseline did not differ (35 ± 9% vs. 35 ± 11%; P = 0.87). TpTe was an independent predictor of ventricular arrhythmias when adjusted for age, EF and QRS duration (HR 1.16; 95% CI 1.03-1.31; P = 0.02).
  
  
  CONCLUSIONS
  TpTe predicted malignant arrhythmias in patients after MI independently of EF. TpTe may contribute in the risk stratification of patients to identify post-MI patients disposed to malignant arrhythmias and their need of ICD therapy.
authors.affiliation: University of Oslo, Oslo, Norway.
authors.forename: Mathias
authors.initials: M
authors.lastname: Hetland
authors.forename: Kristina H
authors.initials: KH
authors.lastname: Haugaa
authors.forename: Sebastian I
authors.initials: SI
authors.lastname: Sarvari
authors.forename: Gunnar
authors.initials: G
authors.lastname: Erikssen
authors.forename: Erik
authors.initials: E
authors.lastname: Kongsgaard
authors.forename: Thor
authors.initials: T
authors.lastname: Edvardsen
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D017147:Defibrillators, Implantable; D004562:Electrocardiography / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy
keywords: ECG; myocardial infarction; ventricular arrhythmias