Evaluation of the spatial aspects of T-wave complexity in the long-QT syndrome

Silvia G. Priori, David W. Mortara, Carlo Napolitano, Livia Diehl, Vincenzo Paganini, Francesco Cantù, Giacomo Cantù, Peter J. Schwartz

Research output: Contribution to journalArticlepeer-review


Background: The duration of the QT interval is only a gross estimate of repolarization. Besides its limited accuracy and reproducibility, it does not provide information on the morphology of the T wave; thus, morphologic alterations such as notches can be only qualitatively described but not objectively quantified. Methods and Results: To measure the complexity of repolarization in the long-QT syndrome (LQTS) patients, we previously applied principal component analysis to body surface mapping and found it useful in distinguishing normal from abnormal repolarization patterns (sensitivity, 87%). In the present study, we applied principal component analysis to 12- lead Holter recordings. The index of complexity of repolarization that we have developed (CR(24h)) reflects the average 24-hour complexity of repolarization and is mathematically defined as the average ratio between the second and the first eigenvalue. We studied 36 LOTS patients and 40 control subjects. A mean of 22±1.3 ECG recordings at 1-hour intervals was used in each patient, and a total of 1655 recordings were analyzed. CR(24h) was significantly higher in LQTS than in control subjects (34±12% versus 13±3%; P20%) was present in 32 of 36 patients (88%). The negative predictive value of CR(24h) in LQTS was 88%, and the combination of prolonged QT and abnormal CR(24h) identified all LQTS patients from normal subjects, including 4 affected symptomatic individuals with a normal QT interval duration, suggesting that CR(24h) provides information independent of QT duration. Conclusions: Our data suggest that principal component analysis applied to 24-hour, 12-lead Holter recording adequately quantifies the complexity of ventricular repolarization and may become a useful noninvasive diagnostic tool in LQTS.

Original languageEnglish
Pages (from-to)3006-3012
Number of pages7
Issue number9
Publication statusPublished - Nov 4 1997


  • Death, sudden
  • Electrocardiography
  • Torsade de pointes

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine


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