title: Improved Clinical Risk Stratification in Patients with Long QT Syndrome? Novel Insights from Multi-Channel ECGs.
abstract: BACKGROUND
  We investigated whether multichannel ECG-recordings are useful to risk-stratify patients with congenital long-QT syndrome (LQTS) for risk of sudden cardiac death under optimized medical treatment.
  
  
  METHODS
  In 34 LQTS-patients (11 male; age 31±13 years, QTc 478±51ms; LQT1 n = 8, LQT2 n = 15) we performed a standard 12-channel ECG and a 120-channel body surface potential mapping. The occurrence of clinical events (CE; syncope, torsade de pointes (TdP), sudden cardiac arrest (SCA)) was documented and correlated with different ECG-parameters in all lead positions.
  
  
  RESULTS
  Seven patients developed TdP, four survived SCA and 12 experienced syncope. 12/34 had at least one CE. CE was associated with a longer QTc-interval (519±43ms vs. 458±42ms; p = 0.001), a lower T-wave integral (TWI) on the left upper chest (-1.2±74.4mV*ms vs. 63.0±29.7mV*ms; p = 0.001), a lower range of T-wave amplitude (TWA) in the region of chest lead V8 (0.10±0.08mV vs. 0.18±0.07mV; p = 0.008) and a longer T-peak-T-end time (TpTe) in lead V1 (98±23ms vs. 78±26ms; p = 0.04). Receiver-operating-characteristic (ROC) analyses revealed a sensitivity of 96% and a specificity of 75% (area under curve (AUC) 0.89±0.06, p = 0.001) at a cut-off value of 26.8mV*ms for prediction of CE by TWI, a sensitivity of 86% and a specificity of 83% at a cut-off value of 0.11mV (AUC 0.83±0.09, p = 0.002) for prediction of CE by TWA and a sensitivity of 83% and a specificity of 73% at a cut-off value of 87ms (AUC 0.80±0.07, p = 0.005) for prediction of CE by TpTe.
  
  
  CONCLUSIONS
  Occurrence of CE in LQTS-patients seems to be associated with a prolonged, low-amplitude T-wave.
authors.affiliation: Division of Cardiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Samol
authors.affiliation: Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Gönes
authors.affiliation: Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.|Institute for Genetics of Heart Diseases (IfGH), Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Zumhagen
authors.affiliation: Division of Cardiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Bruns
authors.affiliation: Division of Cardiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.|Institute for Genetics of Heart Diseases (IfGH), Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Paul
authors.affiliation: Division of Cardiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Vahlhaus
authors.affiliation: Division of Cardiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Waltenberger
authors.affiliation: Institute for Genetics of Heart Diseases (IfGH), Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.
authors.forename: Eric
authors.initials: E
authors.lastname: Schulze-Bahr
authors.affiliation: Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Eckardt
authors.affiliation: Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.
authors.forename: Gerold
authors.initials: G
authors.lastname: Mönnig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D053840:Brugada Syndrome / Q000175:diagnosis / Q000503:physiopathology; D000075224:Cardiac Conduction System Disease; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008133:Long QT Syndrome / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D055815:Young Adult