Repolarization lability measured by spatial TT' angle

Aims: Increased T peaks cloud volume is associated with increased risk of ventricular arrhythmias (VA) in cardiomyopathy (CM) patients. T peaks cloud volume is formed, as a result, of (1) the angle between consecutive T-vectors and (2) temporal variability in T-vector amplitude. This study compares association of these two factors with VA. Methods: Baseline orthogonal ECGs were recorded during 5 min at rest in 414 patients with structural heart disease [mean age 59.4±12.0; 68% whites; 73% men; 45% non-ischemic CM] before implantation of implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death. The spatial TT' angle between consecutive spatial T vectors was calculated using the definition of the inner product. Results: During a median 14 months of follow-up, 61 patients experienced sustained VA with appropriate ICD therapies. In a multivariable Cox regression model after adjustment for age, sex, race, spatial TT' angle was associated with VA (HR 1.03; 95%CI 1.0-1.05; P=0.034). Interaction with CM type was found: TT' angle was strongly associated with polymorphic VT/VF in non-ischemic CM (HR 1.04; 95%CI 1.0-1.05; P=0.033). Conclusion: Increased spatial TT' angle is associated with increased risk of VA.