Differences in the upslope of the precordial body surface ECG T wave reflect right to left dispersion of repolarization in the intact human heart

BACKGROUND: The relationship between the surface electrocardiogram (ECG) T wave to intracardiac repolarization is poorly understood. OBJECTIVE: The purpose of this study was to examine the association between intracardiac ventricular repolarization and the T wave on the body surface ECG (SECG(TW)). METHODS: Ten patients with a normal heart (age 35 ± 15 years; 6 men) were studied. Decapolar electrophysiological catheters were placed in the right ventricle (RV) and lateral left ventricle (LV) to record in an apicobasal orientation and in the lateral LV branch of the coronary sinus (CS) for transmural recording. Each catheter (CS, LV, RV) was sequentially paced using an S1–S2 restitution protocol. Intracardiac repolarization time and apicobasal, RV–LV, and transmural repolarization dispersion were correlated with the SECG(TW), and a total of 23,946 T waves analyzed. RESULTS: RV endocardial repolarization occurred on the upslope of lead V(1), V(2), and V(3) SECG(TW), with sensitivity of 0.89, 0.91, and 0.84 and specificity of 0.67, 0.68, and 0.65, respectively. LV basal endocardial, epicardial, and mid-endocardial repolarization occurred on the upslope of leads V(6) and I, with sensitivity of 0.79 and 0.8 and specificity of 0.66 and 0.67, respectively. Differences between the end of the upslope in V(1), V(2), and V(3) vs V(6) strongly correlated with right to left dispersion of repolarization (intraclass correlation coefficient 0.81, 0.83, and 0.85, respectively; P <.001). Poor association between the T wave and apicobasal and transmural dispersion of repolarization was seen. CONCLUSION: The precordial SECG(TW) reflects regional repolarization differences between right and left heart. These findings have important implications for accurately identifying biomarkers of arrhythmogenic risk in disease.