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Review
. 2015 Nov;20(6):526-33.
doi: 10.1111/anec.12310. Epub 2015 Sep 22.

Electrocardiographic T Wave Abnormalities and the Risk of Sudden Cardiac Death: The Finnish Perspective

Jani T Tikkanen  1   2 , Tuomas Kenttä  1 , Kimmo Porthan  3 , Heikki V Huikuri  1 , M Juhani Junttila  1
Affiliations
Review

Electrocardiographic T Wave Abnormalities and the Risk of Sudden Cardiac Death: The Finnish Perspective

Jani T Tikkanen et al. Ann Noninvasive Electrocardiol. 2015 Nov.

Abstract

The identification of patients at risk for sudden cardiac death (SCD) is still a significant challenge to clinicians and scientists. Noninvasive identification of high-risk patients has been of great interest, and several ventricular depolarization and repolarization abnormalities in the standard 12-lead electrocardiogram (ECG) have been associated with increased vulnerability to lethal ventricular arrhythmias. Several benign and pathological conditions can induce changes in repolarization detected as alteration of the ST segment or T wave. Changes in the ST segment and T waves can be early markers of an underlying cardiovascular disease, and even minor ST-T abnormalities have predicted reduced survival and increased risk of SCD in the adult population. In this review, we will discuss the current knowledge of the SCD risk with standard 12-lead ECG T wave abnormalities in the general population, and possible T wave changes in various cardiac conditions predisposing to SCD.

Keywords: electrocardiography, clinical; electrophysiology-cardiac arrest/sudden death, clinical; noninvasive techniques.

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Figures

Figure 1
Figure 1
Abnormal T wave inversion in leads V4–V6 in a middle‐aged male. T wave inversion in leads other than V1–V3 has been associated with a threefold risk of SCD in general population.
Figure 2
Figure 2
Abnormal frontal plane QRS‐T angle (>100°) due to abnormal T wave axis (in a middle‐aged individual). Abnormal QRS‐T angle is associated with twofold risk of SCD in general population.
Figure 3
Figure 3
ECG of an individual with ARVD showing T‐inversion in V1 and V2.
Figure 4
Figure 4
Example ECGs of the three phenotypes of Brugada ECG with various ST and T wave alterations. Type 1 is the typical coved ST‐elevation pattern with inverted T waves. In type 2, the T waves are upright, and type 3 has only mild ST changes. Reprinted from European Heart Journal with permission (2004;25:874–878).
Figure 5
Figure 5
Early repolarization pattern, i.e., terminal QRS slurring and notching in two individuals, with horizontal/downsloping ST segments. This pattern of J wave with horizontal/downsloping ST segment is associated with a twofold risk of SCD in general population. Reprinted from Circulation with permission (2011;123:2666–2673).
Figure 6
Figure 6
Example ECGs of three different phenotypes in long QT syndrome. Reprinted from Circulation (1995;92:2929–2934).
See this image and copyright information in PMC

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