QT dispersion in medicine: electrophysiological Holy Grail or fool's gold?

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Abstract
If subjects at high risk of sudden cardiac death were easily identifiable, then targeted therapy might be able to reduce cardiac deaths. Unfortunately, we do not yet possess an applicable screening method for this purpose. Techniques exist for this such as signal‐averaged electrocardiography (ECG), T‐wave alternans and heart rate variability, but they have variable success and tend to require specialized equipment, making them difficult in routine practice. Another possibility is QT interval analysis, which stems from the fact that individuals with long QT syndromes are known to be at high risk of sudden cardiac death. Taking this principle one step further, it is possible that the variation of QT intervals within an ECG in more routine patients may also contain prognostic information. ‘QT interval dispersion’ is at present undergoing vigorous assessment for this purpose. Several years ago, Campbell et al.1 enthusiastically called it the ‘electrophysiological Holy Grail’. The number of studies indexed in the Medline on QT dispersion has risen 34‐fold since its description in 1990. There is therefore a need to synthesize this information and discuss whether this technique could be adopted in clinical practice.

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