Impact of Infarct-Related Artery Flow on QT Dynamicity in Patients Undergoing Direct Percutaneous Coronary Intervention for Acute Myocardial Infarction

Bonnemeier, Hendrik; Wiegand, Uwe K.H.; Bode, Frank; Hartmann, Franz; Kurowski, Volkhard; Katus, Hugo A.; Richardt, Gert

doi:10.1161/01.cir.0000103682.19844.10

Cited by 25 publications

(24 citation statements)

References 37 publications

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“…QT dynamicity is a surrogate measure of the cellular action potential, influenced by changing variables such as underlying heart rate, cardiac autonomic nervous activity, and the local ventricular electrical milieu. An abnormal dynamic behavior of ventricular repolarization in relation to heart rate changes has been linked to vulnerability to ventricular arrhythmias [12, 13]. …”

Section: Discussionmentioning

confidence: 99%

Coronary Artery Bypass Grafting Is Associated with a Significant Worsening of QT Dynamicity and Heart Rate Variability

Yavuz¹,

Duman

Abalı³

et al. 2006

Cardiology

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Background: Imbalance in autonomic nervous system and impaired myocardial repolarization has been shown to increase the risk for arrhythmias in patients with coronary artery disease. This study evaluated the effects of coronary artery bypass grafting (CABG) on heart rate variability and QT interval dynamicity in subjects with coronary artery disease undergoing elective CABG surgery. Methods: The study group consisted of 68 consecutive patients (mean age ±SD: 61 ± 9 years) with coronary artery disease who underwent elective CABG. Twenty-four-hour Holter monitoring was performed 2–5 days before cardiac surgery and was repeated 10 days after CABG. ELATEC holter software was used to calculate heart rate variability and QT dynamicity parameters. All subjects had a complete history, laboratory examination and transthoracic echocardiography. Results: All patients had beta-blocking agent medication pre- and postoperatively. Standard deviation of all NN intervals for a selected time period, square root of the mean of the sum of the squares of differences between adjacent RR intervals, the proportion of differences in successive NN intervals greater than 50 ms, normalized low-frequency power, and normalized high-frequency power were significantly decreased after CABG surgery, whereas low-frequency/high-frequency ratio was significantly increased after CABG. QT/RR slopes over 24 h were significantly increased after CABG surgery for QT end and QT apex (QTapex/RR: 0.16 ± 0.13 vs. 0.28 ± 0.19, p < 0.001; QTend/RR: 0.18 ± 0.13 vs. 0.36 ± 0.23, p < 0.001). Conclusion: This prospective study showed for the first time that CABG was associated with a significant worsening of heart rate variability and QT dynamicity parameters in the postoperative period.

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Section: Discussionmentioning

confidence: 99%

Coronary Artery Bypass Grafting Is Associated with a Significant Worsening of QT Dynamicity and Heart Rate Variability

Yavuz¹,

Duman

Abalı³

et al. 2006

Cardiology

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“…It is thought that factors such as severe systolic dysfunction, 29 perfusion disturbances 31 and stimulation of LV myocardium in areas close to fibrotic tissue 32 could in theory be related to changes in QT dispersion.…”

Section: Discussionmentioning

confidence: 99%

The proarrhythmic effect of cardiac resynchronization therapy: An issue that should be borne in mind

Cabanelas

Oliveira

Silva

et al. 2014

Revista Portuguesa de Cardiologia (English Edition)

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The demonstrated benefits of cardiac resynchronization therapy (CRT) in reducing mortality and hospitalizations for heart failure, improving NYHA functional class and inducing reverse remodeling have led to its increasing use in clinical practice. However, its potential contribution to complex ventricular arrhythmias is controversial.We present the case of a female patient with valvular heart failure and severe systolic dysfunction, in NYHA class III and under optimal medical therapy, without previous documented ventricular arrhythmias. After implantation of a CRT defibrillator, she suffered an arrhythmic storm with multiple episodes of monomorphic ventricular tachycardia (VT), requiring 12 shocks. Subsequently, a pattern of ventricular bigeminy was observed, as well as reproducible VT runs induced by biventricular pacing.Since no other vein of the coronary sinus system was accessible, it was decided to implant an epicardial lead to stimulate the left ventricle, positioned in the left ventricular mid-lateral wall. No arrhythmias were detected in the following six months.This case highlights the possible proarrhythmic effect of biventricular pacing with a left ventricular lead positioned in the coronary sinus venous system. © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L. All rights reserved. 309.e2 N. Cabanelas et al. PALAVRAS-CHAVE Heterogeneidade da repolarizaçãode remodelagem inversa em doentes selecionados com insuficiência cardíaca (ICC), têm contribuído para a crescente utilização destes dispositivos na prática clínica. No entanto, permanece controverso o impacto da TRC como fator causador de arritmias ventriculares complexas. Apresentamos o caso duma doente com cardiopatia valvular operada, disfunção sistólica grave e ICC classe III da NYHA, com terapêutica médica otimizada, sem documentação prévia de arritmias ventriculares significativas. Após implantação do sistema de TRC com cardioversor-desfibrilhador, desenvolveu quadro de tempestade arrítmica com múltiplos episódios de taquicardia ventricular monomórfica (TV) e necessidade de 12 choques, mantendo padrão de bigeminismo ventricular reprodutível e indução de salvas de TV pelo pacing biventricular. Dada a inacessibilidade a outra veia tributária do seio coronário foi decidido implantar elétrodo epicárdico em localização diferente (de veia póstero-lateral para posição lateral-mediana), sem registo de recorrência de arritmias num follow-up de seis meses. Este caso sugere que a TRC pode contribuir para um efeito pró-arrítmico com consequências clínicas potencialmente graves.

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“…This dynamic QT/RR relationship is to a major extent governed by the cardiac autonomic activity and the underlying properties of the ventricular myocardium. Autonomic blockade decreases QT/RR slope, 32 whereas a greater extent of myocardial malperfusion and necrosis increases QT/RR slope 12 . The larger area of functional ventricular autonomic denervation and the absence of relevant myocardial cell necrosis in patients with transient AB may therefore explain significantly flatter QT/RR slopes than in patients after MI.…”

Section: Discussionmentioning

confidence: 99%

“…The larger area of functional ventricular autonomic denervation and the absence of relevant myocardial cell necrosis in patients with transient AB may therefore explain significantly flatter QT/RR slopes than in patients after MI. It has been recently demonstrated that this misadaptation of ventricular repolarization to rapid heart rate changes, characterized by steeper QT/RR slopes, predisposes to myocardial electrical instability and ventricular arrhythmias 11,12,33 . Abnormal dynamic response of QT interval induced by adrenergic stimulation may lead to the onset of ventricular arrhythmias through various mechanisms.…”

Section: Discussionmentioning

confidence: 99%

“…QT dynamicity is a major property of ventricular repolarization, reflecting the influence of heart rate, metabolic state of the myocyte, and cardiac autonomic activity. This dynamic QT/RR relationship has been shown to be significantly altered in the setting of acute MI and especially after incomplete reperfusion of the infarct‐related coronary artery 11,12 . There is growing evidence that sympathetic activation following MI contributes to adverse electrical remodeling leading to inhomogeneity of ventricular repolarization 13 .…”

Section: Introductionmentioning

confidence: 99%

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Modulation of Ventricular Repolarization in Patients with Transient Left Ventricular Apical Ballooning: A Case Control Study

Bonnemeier

Ortak

Bode

et al. 2006

Cardiovasc electrophysiol

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The present study is the first to demonstrate significant differences of QT interval modulation in patients with transient left ventricular AB and acute ST-segment elevation MI. Even though transient AB is associated with a significant QT interval prolongation, rate adaptation of ventricular repolarization (i.e., QT dynamicity) is not significantly altered, suggesting a differential effect of autonomic nervous activity on the ventricular myocardium in transient AB and in acute MI.

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Impact of Infarct-Related Artery Flow on QT Dynamicity in Patients Undergoing Direct Percutaneous Coronary Intervention for Acute Myocardial Infarction

Cited by 25 publications

References 37 publications

Coronary Artery Bypass Grafting Is Associated with a Significant Worsening of QT Dynamicity and Heart Rate Variability

Coronary Artery Bypass Grafting Is Associated with a Significant Worsening of QT Dynamicity and Heart Rate Variability

The proarrhythmic effect of cardiac resynchronization therapy: An issue that should be borne in mind

Modulation of Ventricular Repolarization in Patients with Transient Left Ventricular Apical Ballooning: A Case Control Study

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