Electrocardiographic T-wave Abnormalities and Premature Ventricular Contraction Burden in Patients With Palpitations: A Regional Study From Northeast India

TL;DR

This study explores how ECG markers like Tp-Te interval and QTc dispersion can predict high PVC burden in patients with palpitations, offering a simpler alternative to Holter monitoring.

Contribution

The study identifies specific ECG repolarization markers that strongly correlate with PVC burden in a regional Indian population.

Findings

Tp-Te interval, Tp-Te/QT ratio, and QTc dispersion showed significant positive correlations with PVC burden.

These ECG markers were significantly higher in patients with >1% PVC burden.

T-wave axis and fQRS-T angle did not correlate with PVC burden.

Abstract

Background: Premature ventricular contractions (PVCs), often presenting as palpitations, are common in cardiology outpatient settings. While a high PVC burden is linked to adverse cardiac outcomes, its detection typically requires 24-hour Holter monitoring - an investigation not always feasible in resource-limited settings. Electrocardiographic (ECG) markers of ventricular repolarization, represented by T-wave abnormalities, such as Tp-Te interval, Tp-Te/QT ratio, and QTc dispersion, may serve as accessible surrogate indicators of PVC burden.

Objective: To evaluate the correlation between surface ECG-derived repolarization markers and PVC burden and determine which parameters best predict higher PVC burden in patients presenting with palpitations.

Methodology: A total of 87 adult patients with palpitations referred to a tertiary care cardiology clinic in Northeast India underwent 12-lead ECG and 24-hour Holter monitoring. Patients were stratified into two groups based on PVC burden (<1% vs. >1%). ECG parameters, including T-wave axis angle, frontal QRS-T (fQRS-T) angle, Tp-Te interval, Tp-Te dispersion, Tp-Te/QT ratio, and QTc dispersion, were compared. Statistical analysis included Welch’s t-test and Spearman’s correlation.

Results: Tp-Te interval (r = 0.5), Tp-Te/QT ratio (r = 0.4), and QTc dispersion (r = 0.3) demonstrated significant positive correlations with total PVC burden. These parameters were also significantly higher in the >1% PVC burden group (P < 0.05). No significant correlation was observed with T-wave axis or fQRS-T angle.

Conclusions: Among surface ECG markers studied, Tp-Te interval, Tp-Te/QT ratio, and QTc dispersion showed the strongest correlation with PVC burden in patients presenting with palpitations. These accessible and non-invasive markers may help identify patients at risk of higher PVC loads who may benefit from further evaluation, especially in settings where Holter monitoring is limited.

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