Clinical Scorecard: Tpeak-Tend Duration as a Predictor of Ventricular Tachycardia Inducibility in Patients with Arrhythmogenic Mitral Valve Prolapse Syndrome
Prolonged Tpeak-Tend interval and Tpeak-Tend/QTc ratio indicating transmural dispersion of repolarization linked to ventricular arrhythmia inducibility
Target Population
Patients with suspected arrhythmogenic mitral valve prolapse exhibiting ventricular arrhythmias
Care Setting
Electrophysiological study and cardiac imaging in specialized cardiology centers
Key Highlights
Prolonged Tpeak-Tend (>90 ms) and elevated Tpeak-Tend/QTc ratio are significantly associated with inducible ventricular arrhythmias in AMVP patients.
Sustained polymorphic ventricular tachycardia or ventricular fibrillation was inducible in 29.2% of patients undergoing programmed ventricular stimulation.
Among known risk factors, only previous syncope showed a significant correlation with ventricular arrhythmia inducibility.
Guideline-Based Recommendations
Diagnosis
Use 12-lead ECG to measure Tpeak-Tend interval in lead V2 or leads V3–V5 if V2 is unsuitable.
Perform cardiac MRI to assess mitral annular disjunction (MAD) and late gadolinium enhancement (LGE) in the mitral apparatus.
Consider programmed ventricular stimulation (EPS) for risk stratification in suspected AMVP.
Management
Identify patients with prolonged Tpeak-Tend (>90 ms) as higher risk for ventricular arrhythmias.
Use EPS findings alongside clinical history (e.g., syncope) to guide decisions on implantable cardioverter defibrillator (ICD) implantation.
Monitoring & Follow-up
Regular ECG monitoring for ventricular arrhythmia burden and Tpeak-Tend interval changes.
Holter ECG to detect frequent or complex ventricular arrhythmias.
Follow-up cardiac imaging to monitor structural changes such as MAD and LGE.
Risks
Patients with prolonged Tpeak-Tend and history of syncope have increased risk of inducible ventricular tachyarrhythmias.
Absence of monomorphic VT inducibility; arrhythmias induced were polymorphic VT or VF.
Risk stratification remains challenging due to limited large-scale prospective data.
Patient & Prescribing Data
65 patients with suspected arrhythmogenic mitral valve prolapse undergoing electrophysiological study
Prolonged Tpeak-Tend and Tpeak-Tend/QTc identify patients at higher risk for ventricular arrhythmia inducibility, potentially guiding ICD implantation decisions.
Clinical Best Practices
Measure Tpeak-Tend interval precisely using digital tools and average over three cardiac cycles for accuracy.
Incorporate programmed ventricular stimulation as an adjunctive tool for risk stratification in AMVP.
Evaluate history of syncope carefully as it correlates with ventricular arrhythmia inducibility.
Use cardiac MRI to assess structural substrates such as MAD and LGE relevant to arrhythmogenesis.
