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Q J Med 2000; 93: 425-431
© 2000 Association of Physicians

Reviews

QT dispersion in medicine: electrophysiological Holy Grail or fool's gold?

P. Sahu, P.O. Lim, B.S. Rana and A.D. Struthers

From the Cardiovascular Research Group, Department of Clinical Pharmacology and Therapeutics, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK


   Introduction
 
If subjects at high risk of sudden cardiac death were easily identifiable, then targeted therapy might be able to reduce cardiac deaths. Unfortunately, we do not yet possess an applicable screening method for this purpose. Techniques exist for this such as signal-averaged electrocardiography (ECG), T-wave alternans and heart rate variability, but they have variable success and tend to require specialized equipment, making them difficult in routine practice. Another possibility is QT interval analysis, which stems from the fact that individuals with long QT syndromes are known to be at high risk of sudden cardiac death. Taking this principle one step further, it is possible that the variation of QT intervals within an ECG in more routine patients may also contain prognostic information. ‘QT interval dispersion’ is at present undergoing vigorous assessment for this purpose. Several years ago, Campbell et al.1 enthusiastically called it the ‘electrophysiological Holy Grail’. The number . . . [Full Text of this Article]


   Development and physiological basis of QT dispersion
 

   Methodological issues
 
QT dispersion measurement
Lead correction
Paper speed
Heart rate correction
Reproducibility
Population studies of QT dispersion

   Clinical applications of QT dispersion
 
Hypertension
Ischaemic heart disease
Myocardial infarction
Heart failure
Diabetes
Other common diseases

   Limitations
 

   Conclusions
 

   Acknowledgments
 

   Notes
 

   References
 

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