Tpeak-Tend Duration Predicts Ventricular Tachycardia Inducibility in Arrhythmogenic MVP
Overview
This study found that prolonged Tpeak-Tend interval and Tpeak-Tend/QTc ratio on ECG are significantly associated with inducible ventricular arrhythmias in patients with arrhythmogenic mitral valve prolapse (AMVP). These ECG markers may serve as useful predictors for ventricular tachycardia (VT) inducibility during electrophysiological studies.
Background
Mitral valve prolapse (MVP) is a common cause of mitral insufficiency, generally with a benign prognosis unless severe mitral regurgitation or left ventricular dysfunction occurs. However, an arrhythmic MVP phenotype (AMVP) has been identified, characterized by frequent or complex ventricular arrhythmias and increased risk of sudden cardiac death. Current risk stratification includes clinical history, ECG, and imaging findings, but programmed ventricular stimulation is not routinely incorporated. Transmural dispersion of repolarization, reflected by the Tpeak-Tend interval on ECG, has been linked to arrhythmogenesis in other cardiac conditions but remains understudied in MVP.
Data Highlights
Parameter
All Patients (n=65)
VT/VF Inducible (n=19)
Non-Inducible (n=46)
p-value
Mean Age (years)
48 ± 14
Not specified
Not specified
Not specified
Male (%)
38.5%
Not specified
Not specified
Not specified
Previous Syncope (%)
32.3%
Significantly associated (p=0.02)
Lower incidence
0.02
Non-sustained VT documented (%)
52.3%
Not significantly associated
Not specified
NS
Significant MAD (%)
46.2%
Not significantly associated
Not specified
NS
Relevant LGE (%)
58.1%
Not significantly associated
Not specified
NS
Mean Tpeak-Tend (ms)
89.6 ± 12.2
100.5 ± 10.3
85.1 ± 9.9
0.002
Mean Tpeak-Tend/QTc
0.21 ± 0.03
0.24 ± 0.03
0.20 ± 0.02
0.004
Prolonged Tpeak-Tend (>90 ms) Inducible VT/VF (%)
Not applicable
48.4%
11.8%
0.002
Key Findings
Prolonged Tpeak-Tend interval (>90 ms) is significantly associated with inducibility of ventricular arrhythmias in AMVP patients (48.4% vs. 11.8%, p=0.002).
Mean Tpeak-Tend was longer in patients with inducible VT/VF (100.5 ± 10.3 ms) compared to non-inducible patients (85.1 ± 9.9 ms, p=0.002).
Tpeak-Tend/QTc ratio was also significantly higher in inducible patients (0.24 ± 0.03 vs. 0.20 ± 0.02, p=0.004).
Other known risk factors such as documented non-sustained VT, mitral annular disjunction, and late gadolinium enhancement did not significantly correlate with VT inducibility in this cohort.
A history of syncope was the only clinical parameter significantly associated with inducible ventricular arrhythmias (p=0.02).
Clinical Implications
Tpeak-Tend interval and Tpeak-Tend/QTc ratio on standard 12-lead ECG can serve as accessible, non-invasive markers to identify AMVP patients at higher risk for inducible ventricular arrhythmias. Incorporating these ECG parameters into risk stratification may improve identification of patients who could benefit from further electrophysiological evaluation or closer monitoring. Given the limited predictive value of other imaging and clinical markers in this study, Tpeak-Tend measurements may enhance clinical decision-making regarding arrhythmic risk in MVP.
Conclusion
Prolonged Tpeak-Tend duration and elevated Tpeak-Tend/QTc ratio are associated with increased ventricular arrhythmia inducibility in patients with arrhythmogenic mitral valve prolapse. These ECG markers offer promising tools for improved arrhythmic risk stratification in this population.
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