This review summarizes recent findings and discusses a clinical significance of a vectorcardiographic Global electrical heterogeneity (GEH). GEH idea is based on the concept of the spatial ventricular gradient (SVG), which is a global measure of the dispersion of total recovery time. We quantify GEH by measuring five features of the SVG vector (SVG magnitude, direction (azimuth and elevation), a scalar value, and spatial QRS-T angle) on orthogonal XYZ ECG. In analysis of more than 20,000 adults we showed that GEH is independently associated with sudden cardiac death (SCD) after adjustment for demographics, cardiovascular disease (time-updated incident non-fatal cardiovascular events [coronary heart disease, heart failure, stroke, atrial fibrillation, use of beta-blockers], and known risk factors [cholesterol, triglycerides, physical activity index, smoking, diabetes, obesity, hypertension, anti-hypertensive medications, creatinine, alcohol intake, left ventricular (LV) ejection fraction, and time-updated ECG metrics (heart rate, QTc, QRS duration, ECG-LVH, bundle branch block or interventricular conduction delay)]. This finding suggests that GEH represents an independent electrophysiological substrate. Fast worsening of GEH was associated with increased risk of SCD, whereas slow worsening of GEH was associated with the development of LV dysfunction. Genome-wide association study (GWAS) of GEH identified ten genetic loci, associated with GEH at GWAS-significant level. Nearly half of them (4/10) have not been previously reported associated with any ECG phenotype: loci on chromosomes 9 (near HMCN2), 15 (IGF1R), 11 (11p11.2 region cluster), and 7 (near ACTB). A locus on chromosome 16 (lncRNA RP11-481J2.2) is located between two previously reported loci, associated with QT interval and ST-T wave amplitudes. A locus on chromosome 1 (LUZP1-KDM1A) is located near loci, previously reported associated with QT interval. A locus on chromosome 3 (SCN5A) is a sodium channel gene. Three loci (near TBX3, HAND1, and NFIA) are known loci, associated with QRS duration and PR interval.