title: Increased Tpeak-Tend interval is highly and independently related to arrhythmic events in Brugada syndrome.
abstract: BACKGROUND
  Risk stratification in Brugada syndrome (BS) remains controversial. The time interval between the peak and the end of the T wave (Tpe interval), a marker of transmural dispersion of repolarization, has been linked to malignant ventricular arrhythmias in various settings but leads to discordant results in BS.
  
  
  OBJECTIVE
  We study the correlation of the Tpe interval with arrhythmic events in a large cohort of patients with BS.
  
  
  METHODS
  A total of 325 consecutive patients with BS (mean age 47±13 years, 259 men-80%) with spontaneous (n=143, 44%) or drug-induced (n=182, 56%) type 1 electrocardiogram were retrospectively included. 235 were asymptomatic (70%), 80 presented with unexplained syncope (22%), and 10 presented with sudden death (SD) or appropriate implantable cardioverter-defibrillator therapy (AT) (8%) at diagnosis or over a mean follow-up of 48 ± 34 months. The Tpe interval was calculated as the difference between the QT interval and the QT peak interval as measured in each of the precordial leads.
  
  
  RESULTS
  The Tpe interval from lead V1 to lead V4, maximum value of the Tpe interval (max Tpe), and Tpe dispersion in all precordial leads were significantly higher in patients with SD/AT or in patients with syncope than in asymptomatic patients (P < .001). A max Tpe of ≥100 ms was present in 47 of 226 asymptomatic patients (21%), in 48 of 73 patients with syncope (66%), and in 22 of 26 patients with SD/AT (85%) (P < .0001). In multivariate analysis, a max Tpe of ≥100 ms was independently related to arrhythmic events (odds ratio 9.61; 95% confidence interval 3.13-29.41; P < .0001).
  
  
  CONCLUSIONS
  The Tpe interval in the precordial leads is highly related to malignant ventricular arrhythmias in this large cohort of patients with BS. This simple electrocardiographic parameter could be used to refine risk stratification.
authors.affiliation: University Hospital Rangueil, Toulouse, France. Electronic address: mauryjphil@hotmail.com.
authors.forename: Philippe
authors.initials: P
authors.lastname: Maury
authors.affiliation: University Hospital Haut-Leveque, Bordeaux-Pessac, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Sacher
authors.affiliation: Institut du Thorax, Nantes, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Gourraud
authors.affiliation: University Hospital Arnaud de Villeneuve, Montpellier, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Pasquié
authors.affiliation: University Hospital Arnaud de Villeneuve, Montpellier, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Raczka
authors.affiliation: University Hospital Rangueil, Toulouse, France.
authors.forename: Vanina
authors.initials: V
authors.lastname: Bongard
authors.affiliation: University Hospital Rangueil, Toulouse, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Duparc
authors.affiliation: University Hospital Rangueil, Toulouse, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Mondoly
authors.affiliation: University Hospital Rangueil, Toulouse, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Sadron
authors.affiliation: Institut du Thorax, Nantes, France.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Chatel
authors.affiliation: University Hospital Haut-Leveque, Bordeaux-Pessac, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Derval
authors.affiliation: University Hospital Haut-Leveque, Bordeaux-Pessac, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Denis
authors.affiliation: University Hospital Rangueil, Toulouse, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Cardin
authors.affiliation: University Hospital Arnaud de Villeneuve, Montpellier, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Davy
authors.affiliation: University Hospital Haut-Leveque, Bordeaux-Pessac, France.
authors.forename: Meleze
authors.initials: M
authors.lastname: Hocini
authors.affiliation: University Hospital Haut-Leveque, Bordeaux-Pessac, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
authors.affiliation: University Hospital Haut-Leveque, Bordeaux-Pessac, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Jesel
authors.affiliation: University Hospital Rangueil, Toulouse, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Carrié
authors.affiliation: University Hospital Rangueil, Toulouse, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Galinier
authors.affiliation: University Hospital Haut-Leveque, Bordeaux-Pessac, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
authors.affiliation: Institut du Thorax, Nantes, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Probst
authors.affiliation: University Hospital Rangueil, Toulouse, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Rollin
mesh_terms: D000328:Adult; D053840:Brugada Syndrome / Q000150:complications* / Q000503:physiopathology* / Q000628:therapy; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment
keywords: Brugada syndrome; QT interval; Sudden death; Transmural dispersion of repolarization