Association of Electrocardiographic Spatial Heterogeneity of Repolarization and Spatial Heterogeneity of Atrial Depolarization with Left Ventricular Fibrosis

Overview

Journal Europace

Publisher Oxford University Press

Specialties Cardiology & Vascular Diseases
Physiology

Date 2023 Jan 13

PMID 36635858

Authors

Jenni J Hekkanen

Tuomas V Kentta

Lauri Holmstrom

Mikko P Tulppo

Olavi H Ukkola

Lasse Pakanen

M Juhani Junttila

Heikki V Huikuri

Juha S Perkiomaki

Affiliations

Soon will be listed here.

Abstract

Aims: To evaluate the relationship between spatial heterogeneity of electrocardiographic repolarization and spatial heterogeneity of atrial depolarization with arrhythmic substrate represented by left ventricular fibrosis.

Methods And Results: We assessed the associations of T- and P-wave morphology parameters analysed from the standard 12-lead electrocardiograms with left ventricular fibrosis in 378 victims of unexpected sudden cardiac death (SCD) who underwent medico-legal autopsy. Based on autopsy findings, the SCD victims were categorized into four different groups according to different stages of severity of left ventricular fibrosis (substantial fibrosis, moderate patchy fibrosis, scattered mild fibrosis, no fibrosis). T-wave and P-wave area dispersion (TWAd: 0.0841 ± 0.496, 0.170 ± 0.492, 0.302 ± 404, 0.296 ± 0.476, P = 0.008; PWAd: 0.574 ± 0.384, 0.561 ± 0.367, 0.654 ± 0.281, 0.717 ± 0.257, P = 0.011, respectively; low values abnormal), non-dipolar components of T-wave and P-wave morphology (T_NonDipolarABS: 0.0496 ± 0.0377, 0.0571 ± 0.0487, 0.0432 ± 0.0476, 0.0380 ± 0.0377, P = 0.027; P_NonDipolarABS: 0.0132 ± 0.0164, 0.0130 ± 0.0135, 0.0092 ± 0.0117, 0.0069 ± 0.00472, P = 0.005, respectively, high values abnormal), T-wave morphology dispersion (TMD: 45.9 ± 28.3, 40.5 ± 25.8, 35.5 ± 24.9, 33.0 ± 24.6, P = 0.030, respectively, high values abnormal), and P-wave heterogeneity (PWH: 20.0 ± 9.44, 19.7 ± 8.87, 17.9 ± 9.78, 15.4 ± 4.60, P = 0.019, respectively, high values abnormal) differed significantly between the groups with different stages of left ventricular fibrosis. After adjustment with heart weight, T_NonDipolarABS [standardized β (sβ) = 0.131, P = 0.014], PWAd (sβ = -0.161, P = 0.003), P_NonDipolarABS (sβ = 0.174, P = 0.001), and PWH (sβ = 0.128, P = 0.015) retained independent association, and TWAd (sβ = -0.091, P = 0.074) and TMD (sβ = 0.097, P = 0.063) tended to retain their association with the degree of myocardial fibrosis.

Conclusion: Our findings suggest that abnormal values of T- and P-wave morphology are associated with arrhythmic substrate represented by ventricular fibrosis partly explaining the mechanism behind their prognostic significance.

Citing Articles

The Effect of Obesity on Repolarization and Other ECG Parameters.

Dykiert I, Kraik K, Jurczenko L, Gac P, Poreba R, Poreba M J Clin Med. 2024; 13(12).

PMID: 38930116 PMC: 11205044. DOI: 10.3390/jcm13123587.

Sudden cardiac death and atrial depolarization in coronary artery disease-Authors' reply.

Perkiomaki J, Hekkanen J, Junttila M, Huikuri H Europace. 2023; 25(5).

PMID: 37099638 PMC: 10227753. DOI: 10.1093/europace/euad111.

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