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). Tpeak -Tend intervals, (Tpeak -Tend )/QT ratio and Tpeak -Tend 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 Tpeak -Tend 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 (Tpeak -Tend )/QT ratios (mean difference = 0.019, 95% CI: 0.003-0.036, P  = 0.024; I 2  = 74%) and Tpeak -Tend 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: Tpeak -Tend interval, (Tpeak -Tend )/QT ratio and Tpeak -Tend dispersion were higher in high-risk than low-risk Brugada subjects, and thus offer incremental value for risk stratification.