Dispersion of monophasic action potential durations and activation times during atrial pacing, ventricular pacing, and ventricular premature stimulation in canine ventricles

Kuo, Chien-Suu; Amlie, Jan P.; Munakata, Kazuo; Reddy, C. Pratap; Surawicz, Borys

doi:10.1093/cvr/17.3.152

Cited by 71 publications

(18 citation statements)

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“…Overall, it is believed that localized regions of AP alternans (spatial alternans), exhibiting delayed recovery on an every other beat basis, are intrinsically related to increased repolarization gradients sufficient to produce unidirectional block, wave break, reentry and arrhythmia on-set (Figure 2). This mechanism linking alternans and arrhythmogenesis has been explored by Kuo et al 34 who have shown that increased dispersion of repolarization (DR) is an important condition for the development of reentrant arrhythmias. The mechanistic link between the onset of alternans and the substrate for reentrant arrhythmias also lends support to the notion that beyond medium- and long-term risk stratification, MTWA may also play a role in predicting short -term arrhythmia susceptibility.…”

Section: Emerging Insights On the Pathophysiology Of Mtwamentioning

confidence: 99%

T-Wave Alternans as an Arrhythmic Risk Stratifier: State of the Art

et al. 2013

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Microvolt level T-wave alternans (MTWA), a phenomenon of beat-to-beat variability in the repolarization phase of the ventricles, has been closely associated with an increased risk of ventricular tachyarrhythmic events (VTE) and sudden cardiac death (SCD) during medium- and long-term follow-up. Recent observations also suggest that heightened MTWA magnitude may be closely associated with short-term risk of impending VTE. At the sub-cellular and cellular level, perturbations in calcium transport processes likely play a primary role in the genesis of alternans, which then secondarily lead to alternans of action potential morphology and duration (APD). As such, MTWA may play a role not only in risk stratification but also more fundamentally in the pathogenesis of VTE. In this paper, we outline recent advances in understanding the pathogenesis of MTWA and also the utility of T-wave alternans testing for clinical risk stratification. We also highlight emerging clinical applications for MTWA.

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Section: Emerging Insights On the Pathophysiology Of Mtwamentioning

confidence: 99%

T-Wave Alternans as an Arrhythmic Risk Stratifier: State of the Art

et al. 2013

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“…The mechanism(s) linking RA and arrhythmogenesis have been explored by Kuo et al 93 who have shown that increased dispersion of repolarization (DR) is an important condition for the development of reentrant arrhythmias and Chinushi et al 94, 95 who have shown that increased DR is associated with VTE and concordant or discordant alternans (DR is greater at sites of discordant vs. concordant alternans). Numerous experimental 22, 23, 96, 97 and computational 98-100 studies have demonstrated that APD alternans can provide the substrate for reentry and support the notion that beyond medium and long-term prognosis, heightened RA is also an important short-term predictor of arrhythmia susceptibility.…”

Section: Clinical Relevance Of Repolarization Alternansmentioning

confidence: 99%

Role of Substrate and Triggers in the Genesis of Cardiac Alternans, From the Myocyte to the Whole Heart

Merchant

Armoundas

2012

Circulation

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“…QT interval dispersion, measured as an interlead variability of QT, has been proposed as a marker of heterogeneous repolarization and, hence, of electrical instability. The underlying rationale is that QT dispersion is likely to reflect heterogeneities in recovery of excitability, which is known to increase the propensity for ventricular arrhythmia [4][5][6][7][8][9][10][11] . Previous studies have evaluated the usefulness of QT interval dispersion as a predictor of ventricular arrhythmia and sudden death in patients with the long QT syndrome [5,12] , hypertrophic cardiomyopathy [13] , idiopathic dilated cardiomyopathy [14] , myocardial infarction [15,16] , and chronic heart failure [17] .…”

Section: Introductionmentioning

confidence: 99%

QT dispersion in patients with arrhythmogenic right ventricular dysplasia

Benn

Hansen

Pedersen

1999

European Heart Journal

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Aims Arrhythmogenic right ventricular dysplasia is a rarely diagnosed cardiomyopathy, but a frequent cause of ventricular arrhythmia and sudden cardiac death. QT interval dispersion, measured as an interlead variability of QT, is a marker of dispersion of ventricular repolarization and, hence, of electrical instability. The present study was conducted to assess the occurrence of QT dispersion and its modulation during treatment with sotalol.Methods Twenty-five patients with the diagnosis of arrhythmogenic right ventricular dysplasia were studied retrospectively. Fourteen patients were considered low risk for malignant ventricular arrhythmia and sudden cardiac death, and 11 high risk due to documented sustained ventricular arrhythmia, cardiac arrest, or sudden cardiac death. Twenty five healthy volunteers served as control subjects.Results Dispersion of repolarization was significantly higher in patients than in control subjects (QTd and JTd: P<0·05). Dispersion of repolarization was equal in patients both with and without malignant arrhythmias. There was no significant change in dispersion after treatment with sotalol. Adjacent QT dispersion between leads V 3 -V 4 , V 4 -V 5 and V 5 -V 6 , respectively, was higher in patients than in control subjects (P<0·05), while no differences were seen in leads V 1 -V 2 and V 2 -V 3 .Conclusion QT interval dispersion is increased in patients with arrhythmogenic right ventricular dysplasia. However, the degree of dispersion is not related to the severity of symptoms, nor is it influenced by treatment with sotalol. (Eur Heart J 1999; 20: 764-770)

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Dispersion of monophasic action potential durations and activation times during atrial pacing, ventricular pacing, and ventricular premature stimulation in canine ventricles

Cited by 71 publications

References 0 publications

T-Wave Alternans as an Arrhythmic Risk Stratifier: State of the Art

T-Wave Alternans as an Arrhythmic Risk Stratifier: State of the Art

Role of Substrate and Triggers in the Genesis of Cardiac Alternans, From the Myocyte to the Whole Heart

QT dispersion in patients with arrhythmogenic right ventricular dysplasia

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