Arrhythmic substrate

Escitalopram Induced Torsade de Pointes and Cardiac Arrest in a Patient With Surgically Treated Mitral Valve Prolapse

“…Though they are known to be associated with QTc prolongation, the incidence of significant arrhythmias is low and often occurs in patients with predisposing factors such electrolyte abnormalities, congenital long QTc syndrome, and other structural cardiac diseases [7]. The pathophysiology of ventricular arrhythmias can be explained using the concept of an arrhythmogenic substrate that comprises a focal area that has the potential to generate abnormal electrical impulses, the triggers, and the modulators (Figure 4) [8]. Mitral valve prolapse (MVP) is often associated with a mechanical myocardial and papillary muscle injury and fibrosis that can form a focus from which aberrant electrical potentials can be generated [9].…”