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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2015; 3(8): 705-720
Published online Aug 16, 2015. doi: 10.12998/wjcc.v3.i8.705
Ventricular repolarization markers for predicting malignant arrhythmias in clinical practice
Yaniel Castro-Torres, Raimundo Carmona-Puerta, Richard E Katholi
Yaniel Castro-Torres, Facultad de Medicina, Universidad de Ciencias Médicas Dr. Serafín Ruiz de Zárate Ruiz, Santa Clara 50200, Villa Clara, Cuba
Raimundo Carmona-Puerta, Cardiocentro Ernesto Che Guevara, Santa Clara 50200, Villa Clara, Cuba
Richard E Katholi, Southern Illinois University School of Medicine and Prairie Cardiovascular Consultants, Springfield, IL 62701, United States
Author contributions: Castro-Torres Y, Carmona-Puerta R and Katholi RE were all involved in the design of the manuscript, wrote major sections, contributed to multiple revisions and approved the final version.
Conflict-of-interest statement: There is no conflict of interests to disclosure.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yaniel Castro-Torres, MD, Facultad de Medicina, Universidad de Ciencias Médicas Dr. Serafín Ruiz de Zárate Ruiz, Luz Caballero 161 e/Hospital y Alejandro Oms, Santa Clara 50200, Villa Clara, Cuba. castrotorresy@gmail.com
Telephone: +53-42-272776
Received: July 25, 2014
Peer-review started: July 27, 2014
First decision: August 14, 2014
Revised: February 22, 2015
Accepted: June 4, 2015
Article in press: June 8, 2015
Published online: August 16, 2015
Processing time: 392 Days and 3 Hours
Abstract

Malignant cardiac arrhythmias which result in sudden cardiac death may be present in individuals apparently healthy or be associated with other medical conditions. The way to predict their appearance represents a challenge for the medical community due to the tragic outcomes in most cases. In the last two decades some ventricular repolarization (VR) markers have been found to be useful to predict malignant cardiac arrhythmias in several clinical conditions. The corrected QT, QT dispersion, Tpeak-Tend, Tpeak-Tend dispersion and Tp-e/QT have been studied and implemented in clinical practice for this purpose. These markers are obtained from 12 lead surface electrocardiogram. In this review we discuss how these markers have demonstrated to be effective to predict malignant arrhythmias in medical conditions such as long and short QT syndromes, Brugada syndrome, early repolarization syndrome, acute myocardial ischemia, heart failure, hypertension, diabetes mellitus, obesity and highly trained athletes. Also the main pathophysiological mechanisms that explain the arrhythmogenic predisposition in these diseases and the basis for the VR markers are discussed. However, the same results have not been found in all conditions. Further studies are needed to reach a global consensus in order to incorporate these VR parameters in risk stratification of these patients.

Keywords: Electrocardiographic predictor; Ventricular repolarization markers; Ventricular fibrillation; Sudden cardiac death; QT interval; Corrected QT interval; QT dispersion; Tpeak-Tend interval; Tpeak-Tend QT ratio

Core tip: Malignant ventricular arrhythmias are a common cause of sudden cardiac death in clinical practice. They may present in individuals apparently healthy or be associated with other medical conditions. It is possible to predict the appearances of ventricular arrhythmias by analysing ventricular repolarization markers through surface 12 leads electrocardiogram. It may represent a tool to evaluate the risk stratification and for achieving a better medical management of our patients.