T(peak)‐T(end), T(peak)‐T(end)/QT ratio and T(peak)‐T(end) dispersion for risk stratification in Brugada Syndrome: A systematic review and meta‐analysis

BACKGROUND: Brugada syndrome is an ion channelopathy that predisposes affected subjects to ventricular tachycardia/fibrillation (VT/VF), potentially leading to sudden cardiac death (SCD). T(peak)‐T(end) intervals, (T(peak)‐T(end))/QT ratio and T(peak)‐T(end) dispersion have been proposed for risk stratification, but their predictive values in Brugada syndrome have been challenged recently. METHODS: A systematic review and meta‐analysis was conducted to examine their values in predicting arrhythmic and mortality outcomes in Brugada Syndrome. PubMed and Embase databases were searched until 1 May 2018, identifying 29 and 57 studies. RESULTS: Nine studies involving 1740 subjects (mean age 45 years old, 80% male, mean follow‐up duration was 68 ± 27 months) were included. The mean T(peak)‐T(end) interval was 98.9 ms (95% CI: 90.5‐107.2 ms) for patients with adverse events (ventricular arrhythmias or SCD) compared to 87.7 ms (95% CI: 80.5‐94.9 ms) for those without such events, with a mean difference of 11.9 ms (95% CI: 3.6‐20.2 ms, P = 0.005; I (2) = 86%). Higher (T(peak)‐T(end))/QT ratios (mean difference = 0.019, 95% CI: 0.003‐0.036, P = 0.024; I (2) = 74%) and T(peak)‐T(end) dispersion (mean difference = 7.8 ms, 95% CI: 2.1‐13.4 ms, P = 0.007; I (2) = 80%) were observed for the event‐positive group. CONCLUSION: T(peak)‐T(end) interval, (T(peak)‐T(end))/QT ratio and T(peak)‐T(end) dispersion were higher in high‐risk than low‐risk Brugada subjects, and thus offer incremental value for risk stratification.