Abstract
Although experimental evidence of a significant role of myocardial repolarisation inhomogeneity in arrhythmogenesis has been grown rapidly, progress in the clinical arena has been comparatively slow. There continues to be methodological uncertainty regarding ventricular repolarisation assessment from body surface electrocardiogram. Multiple approaches are currently being investigated for this purpose, indicating that no one satisfactory method has yet been found. Despite rapid development of sophisticated computer-assisted algorithms for QT-interval and QT-dispersion measurement, low reproducibility of repeated measurements, particularly of QT-dispersion, remains a major limitation. In recent years, some progress has been made in developing alternative methods of ventricular repolarisation assessment. Suggested approaches have focused on analysis of QT-interval variability during 24-hour Holter recording (QT/RR dynamicity) and beat-to-beat changes in the repolarisation patterns (T-wave alternans) which reflect two different aspects of ventricular repolarisation: spatial and dynamic. Simultaneous assessment of both aspects is believed to be a promising tool which allows not only to identify patients at high risk of arrhythmic events but also to investigate spontaneous or triggered changes in ventricular repolarisation leading to arrhythmias. Recent studies of T-wave alternans have documented that repolarisation patterns are closely related to arrhythmic and pro-arrhythmic complications, indicating that analysis T and TU-wave morphology may play an important role in risk stratification.Table I Non-invasive methods for ventricular repolarisation assessment Full size tableIn conclusion, further development of practical approaches to quantitative assessment of ventricular repolarisation is essential for better understanding of physiological and pathophysiological processes governing this phenomenon, and for improving of arrhythmogenic risk stratification.Key wordsVentricular repolarisationQT-intervalQT-dispersionQT-variabilityT-wave alternans
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