Gene‐Specific Effect of Beta‐Adrenergic Blockade on Corrected QT Interval in the Long QT Syndrome

Extramiana, Fabrice; Maison‐Blanche, Pierre; Denjoy, Isabelle; Jode, P. De; Labbé, Jean-Philippe; Leenhardt, Antoine

doi:10.1111/anec.12048

Cited by 8 publications

(2 citation statements)

References 30 publications

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“…Augmentation of sympathetic tone, such as exercise, is one of the important triggers of cardiac events and can be prevented by beta-blocking agents. Attenuation of transmural dispersion of repolarization and reduction of QT interval have been suggested as mechanisms of beta-blocking protection despite some controversies [ 33 – 35 ]. In LQT2, the effectiveness of beta-blockers has been thought to be less than that in LQT1 [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of beta-blockers depending on the genotype of congenital long-QT syndrome: A meta-analysis

et al. 2017

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BackgroundBeta-blockers are first-line therapy in patients with congenital long-QT syndrome (LQTS).ObjectiveThis study sought to determine the differences in effectiveness of beta-blockers on risk reduction according to LQTS genotype.MethodsWe searched MEDLINE, EMBASE, and CENTRAL databases to investigate the use of beta-blockers (atenolol, nadolol, propranolol, and metoprolol) in patients with LQTS. Hazard ratio (HR) and relative risk (RR) were extracted or calculated from studies reporting cardiac events (syncope, aborted cardiac arrest (ACA), or sudden cardiac death (SCD)).ResultsAmong 2,113 articles searched, 10 studies (7 registry-based cohort studies (Cohort) and 3 interrupted time series studies (ITS)) involving 9,727 patients were included. In a meta-analysis using a random-effect model, the use of beta-blocker was associated with significant risk reduction of all cardiac events (HR 0.49, p<0.001 in Cohort; RR 0.39, p<0.001 in ITS) and serious cardiac events (ACA or SCD) (HR 0.47, p<0.001 in Cohort). In both LQT1 and LQT2, the risk was reduced with beta-blocker therapy in Cohort (HR 0.59 in LQT1; HR 0.39 in LQT2) as well as ITS (RR 0.29 in LQT1; RR 0.48 in LQT2). Among the beta-blockers, nadolol showed a significant risk reduction in both LQT1 and LQT2 (HR 0.47 and 0.27, respectively), whereas atenolol and propranolol decreased the risk only in LQT1 (HR 0.36 and 0.46, respectively). Metoprolol showed no significant reduction in either genotype. In LQT3, beta-blocker therapy was not as effective as LQT1 or LQT2; however, it was inconclusive due to data insufficiency.ConclusionThis meta-analysis showed that beta-blockers were effective in reducing risk of cardiac events in patients with LQTS. Among them, nadolol was effective in LQT1 and LQT2, whereas other drugs showed different effectiveness depending on LQT genotype.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of beta-blockers depending on the genotype of congenital long-QT syndrome: A meta-analysis

et al. 2017

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“…All Holter recordings were 24-hour recordings (2 or 3 lead configuration) recorded from different clinical devices. The LQTS data was donated to the THEW 8 by the Hospital Lariboisière (Paris, France), 9, 10 while the recordings from healthy subjects were recorded during the Intercity Digital Electrocardiology Alliance project (IDEAL). 8 In addition to genetic testing, demographic data and cardiac events, i.e.…”

Section: Methodsmentioning

confidence: 99%

“QT clock” to improve detection of QT prolongation in long QT syndrome patients

et al. 2016

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Background The QT interval is a risk marker for cardiac events such as TdP. However, QT measurements obtained from a 12-lead ECG during clinic hours may not capture the full extent of a patient’s daily QT range. Objective We evaluated the utility of 24-hour Holter ECG recording in patients with long QT syndrome to identify dynamic changes in the heart-rate corrected QT interval, and we investigated methods of visualizing the resulting data sets. Methods Beat-to-beat QTc (Bazett) intervals were automatically measured across 24-hour Holters from 202 LQT1, 89 LQT2, 14 LQT3 genotyped patients and a reference group of 200 healthy individuals. We measured the percentage of beats with QTc greater than the gender-specific threshold (QTc>470ms in women and QTc>450ms in men). The percentage of beats with QTc prolongation was determined across the 24-hour recordings. Results Based on the median percentage of heart beats per patient with QTc prolongation, LQT1 patients showed more frequent QTc prolongation during the day (~3PM) than they did at night (~3AM): 97% vs. 48%, p~10−4 for men, 68% vs. 30%, p~10−5 for women. LQT2 patients showed less frequent QTc prolongation during the day, compared to nighttime: 87% vs. 100%, p~10−4 for men, 62% vs. 100%, p~10−3 for women. Conclusion In patients with genotype positive LQTS, significant differences exist in the degree of daytime and nocturnal QTc prolongation. Holter monitoring using the “QT clock” concept may provide an easy, fast, and accurate method to assess the true personalized burden of QTc prolongation.

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Neuromodulation of Cardiac Repolarization and Arrhythmogenesis

Extramiana

Maison‐Blanche

2019

Cardiac Repolarization

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Gene‐Specific Effect of Beta‐Adrenergic Blockade on Corrected QT Interval in the Long QT Syndrome

Cited by 8 publications

References 30 publications

Effectiveness of beta-blockers depending on the genotype of congenital long-QT syndrome: A meta-analysis

Effectiveness of beta-blockers depending on the genotype of congenital long-QT syndrome: A meta-analysis

“QT clock” to improve detection of QT prolongation in long QT syndrome patients

Neuromodulation of Cardiac Repolarization and Arrhythmogenesis

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