Dispersion of ventricular repolarization: Temporal and spatial

Arteyeva, Natalia V.

doi:10.4330/wjc.v12.i9.437

Cited by 13 publications

(6 citation statements)

References 126 publications

(141 reference statements)

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“…Увеличенная временнáя и пространственная гетерогенность реполяризации по-разному влияют на функционирование сердца, особенно, в патогенетических условиях, включая генетические нарушения, электрическое моделирование при заболеваниях, изменения в работе ионных каналов по действием фармацевтических препаратов и др. [1]. Временнáя и пространственная гетерогенность реполяризации проявляются в разных электрокардиографических параметрах конца сердечного цикла, таких как длительности QT и Tpeak-Tend интервалов, QT дисперсия, морфология и амплитуда зубца T, желудочковый градиент и др.…”

Section: Discussionunclassified

“…В нормальном сердце физиологическая гетерогенность в структуре электрической и механической активности обеспечивает необходимые последовательность и эффективность возбуждения и сокращения миокарда. Превышение физиологически необходимого уровня гетерогенности реполяризации миокарда может приводить к возникновению жизнеугрожающих желудочковых аритмий и внезапной сердечной смерти [1,2].…”

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Survival prognosis in individuals with a high spatial QRS-T angle

et al. 2022

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Aim. To evaluate medium-term survival without irreversible and fatal cardiovascular events in individuals with a high spatial QRS-T angle (sQRS-Ta) from a regional Russian sample.Material and methods. We analyzed 1394 electrocardiographic records from a random regional sample of men (30%) and women aged 25-64, which were included in the ESSE-RF1 study. Women were on average 5 years older than men, but there was no difference in mean age in the 45-64 groups. The follow-up period lasted 7 year; 26 irreversible events (cardiovascular death, non-fatal myocardial infarction or stroke) and 63 composite endpoints (CEs) (irreversible event or heart failure progression or revascularization) were identified. Irreversible events and composite endpoint in men were noted more often than in women as follows: 3,7% vs 1,1% (p=0,003) and 6,9% vs 3,6% (p=0,01), respectively. sQRS-Ta was estimated as the angle between the integral QRS and T vectors in the orthogonal leads. Survival was assessed by Kaplan-Meier curves using a log-rank test. Differences were considered significant at p≤0,05. Results. Sex groups did not differ in mean sQRS-Ta. sQRS-Ta ≥90o was considered to be increased. The divergence of survival curves by the end of follow-up period in men with increased sQRS-Ta relative to men with sQRS-Ta <900 was greater than in women as follows: 0,88 vs 0,96 for CE (p=0,0026) and 0,93 vs 0,96 for irreversible events (p=0,009); in women — 0,94 vs 0,98 for CE only (p=0,0016). Initial event and CE in men with increased sQRS-Ta occurred earlier than those with normal sQRS-Ta and then in women with increased sQRS-Ta. There were no differences in the frequency of sQRS-Ta increase among 45-64-year-old men and women, but irreversible events in men with increased sQRS-Ta occurred 5 times more often than in women. According to two-stage logistic regression, the probability of irreversible event in men is 4,35 times higher than in women (p=0,0002). After adjusting for sex, in individuals with increased sQRS-Ta, it is 2,75 times higher than in individuals with sQRS-Ta <90o (p=0,015).Conclusion. In men with increased sQRS-Ta (≥90o), survival without irreversible and fatal cardiovascular events was worse, and life expectancy was shorter than in men with normal sQRS-Ta or women with increased sQRS-Ta. The prognosis of irreversible events was significantly affected by male sex and sQRS-Ta increase.

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Section: Discussionunclassified

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Survival prognosis in individuals with a high spatial QRS-T angle

et al. 2022

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“…In addition, it provokes further spontaneous calcium release from the sarcoplasmic reticulum. These events can lead to two different, yet closely related activities in the myocardium: 1) transmural dispersion of repolarization (TDR) as indicated by the time between the peak and the end of T wave, and 2) early afterdepolarization (EAD) or Twave alternans (22). All of these can potentially induce ventricular arrhythmias, including torsades de pointes (21).…”

Section: Late Sodium Currentmentioning

confidence: 99%

The Role of Ranolazine in the Treatment of Ventricular Tachycardia and Atrial Fibrillation: A Narrative Review of the Clinical Evidence

Murai,

Vasigh,

Alexy

et al. 2024

Preprint

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Cardiac arrhythmias are among the leading causes of morbidity and mortality worldwide. While antiarrhythmic drugs traditionally represent the first-line management strategy, their use is often limited by profound proarrhythmic effects. Several studies, including randomized control trials (RCTs), have demonstrated the antiarrhythmic efficacy of ranolazine, registered as an antianginal agent while also establishing its safety profile. This review compiles clinical evidence investigating the antiarrhythmic properties of ranolazine, focusing primarily on ventricular tachycardia (VT) and atrial fibrillation (AF), as common rhythm abnormalities with serious complications. Data from RCTs indicate that ranolazine reduces VT incidence, although this effect is not universal. Therefore, we attempt to better describe the patient population that gains the most benefit from ranolazine by VT suppression. Additionally, ranolazine is known to enhance the conversion rate of AF to sinus rhythm when combined with other antiarrhythmic drugs such as amiodarone, highlighting its synergistic effect in the atrium without provoking ventricular dysrhythmias. Despite the heterogeneity in currently available data, ranolazine appears to be an effective and safe option for the management of various arrhythmias.

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“…The normal range of TpTe is 80-100 ms, re ecting the degree of transmural dispersion of action potential repolarization between intracardiac and epicardial cells and M cells, [25][26][27][28][29]Antipsychotics drugs prolong ventricular repolarization time by inhibiting I Kr and thus reducing net outward currents, And the endocardial or epicardial repolarization rate slowed less than M cells, resulting in more signi cant T wave drop time, increased transwall discrete of action potential, and induced depolarization triggers TdP [30][31].TpTe ≥ 103.3 ± 17.4ms was considered to be prolonged [32]. In this study, the minimum and maximum mean values of male TpTes (117.18 ± 24.58 ~ 126.82 ± 29.14ms) exceeded the high limit, while the annual minimum and maximum mean values of female TpTes (115.29 ± 27.51 ~ 123.79 ± 33.59ms) exceeded the high limit.…”

Section: Changes In the Ventricular Repolarization Index Over 5 Yearsmentioning

confidence: 99%

“…If TpTe is prolonged, the transmural heterogeneity of ventricular myocytes is increased, which may induce malignant ventricular arrhythmia [16][17][18][19]. At present, the above new index of ventricular repolarization is rare in the study of psychotropic drugs [20]. The purpose of this study is to examine the effects of continuous combination antipsychotics on QRS time constraints, heart rate, and various ventricular repolarization measures, and the correlation of these changes with induced and aggravated arrhythmias in the real world, and to clinically evaluate novel indicators of ventricular repolarization.…”

Section: Introductionmentioning

confidence: 99%

Effect of long-term combined use of antipsychotics on ventricular repolarization index

Liu,

yuan,

Sheng

et al. 2023

Preprint

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Objective Antipsychotics can prolong the time of ventricular repolarization. Multiple-drug interactions may increase the risk of developing cardiac arrhythmias. It is generally recommended to avoid the combination of drugs that prolong ventricular repolarization or drugs that interact with pharmacokinetics, but in the real world,the combination is inevitable. We retrospectively analyzed heart rate, QRS duration, QT, QTc, TpTe, TpTe, TpTe / QRS, TpTe / QT, TpTe / QTc in consecutive patients with schizophrenia, cardiac electrophysiological balance index (iCEB), iCEBc,and compared with QTc interval to evaluate more effective alternative indexes and to explore the safety of long-term combined use of antipsychotics. And the significance of arrhythmia induced or aggravated by the change of ventricular repolarization index. Methods Patients with schizophrenia who take drugs in combination. 12-lead synchronous ECG examination was collected every 2-4 weeks. The electrocardiogram with the most significant abnormal changes each year was used to measure the duration of the QRS wave and to measure and calculate a series of ventricular repolarization indexes. The types and times of arrhythmias were observed, the types and doses of drugs taken were recorded, and the hematological indexes were monitored and compared with those of the previous year. Results When the patients were treated with antipsychotics for 5 years, There was no significant difference in gender effect on RR interval. The duration of the QRS wave in males was longer than that in females. TpTe, TpTe/QRS TpTe/QT, TpTe/QTc, iCEB, and iCEBc increased significantly with the prolongation of hospital stay, while TpTe, TpTe/QRS, TpTe/QT, and TpTe/QTc more obvious changes in such indicators appeared in female patients( P < 0.01). The changes in iCEB and iCEBc were more significant in males ( P < 0.01). The incidence of arrhythmia within 5 years was 2.5%, 6.25%, 6.25%,6.25% and 5%, respectively. More than 90% of patients treated with antipsychotics did not have any arrhythmias. No TdP syncope, or other cardiovascular symptoms were found in all patients. Conclusion Long-term combined use of antipsychotics had no significant effect on ventricular depolarization (QRS duration). iCEB, iCEBc, TpTe, TpTe/QT, TpTe/QTc, and TpTe/QRS prolonged with increasing treatment time.Among them, the gender differences were significant for TpTe, TpTe / QTc, TpTe / QT, iCEB, and iCEBc. The arrhythmic rate was low within the observed 5 years, and the prolongation of the ventricular repolarization index did not significantly increase the incidence of arrhythmia.

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Dispersion of ventricular repolarization: Temporal and spatial

Cited by 13 publications

References 126 publications

Survival prognosis in individuals with a high spatial QRS-T angle

Survival prognosis in individuals with a high spatial QRS-T angle

The Role of Ranolazine in the Treatment of Ventricular Tachycardia and Atrial Fibrillation: A Narrative Review of the Clinical Evidence

Effect of long-term combined use of antipsychotics on ventricular repolarization index

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