J-Shaped Association Between QTc Interval Duration and the Risk of Atrial Fibrillation

Nielsen, Jonas B.; Graff, Claus; Pietersen, Adrian; Lind, Bent; Struijk, Johannes; Olesen, Morten S.; Haunsø, Stig; Gerds, Thomas Alexander; Svendsen, Jesper Hastrup; Køber, Lars; Holst, Anders G.

doi:10.1016/j.jacc.2013.03.032

Cited by 112 publications

(131 citation statements)

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“…Messenger ribonucleic acid expression studies have shown that the expression of important ion channel com- related to an increased incidence of AF. 21, 22 The possible mechanism of QTc predicting AF recurrence after catheter ablation in HCM patients include: (1) atrial myopathy with similar structural and electrophysiological remodeling as the ventricular myopathy. Prolonged atrial action potential duration could induce trigger activity in the atria and then initiate AF.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, QTc has been associated with the development of AF. 21, 22 It is possible that QTc might also predict the outcome of AF ablation, which has never been reported. The reason we chose a HCM population to test our hypothesis in this pilot study was based on the following understanding: (1) similar pathological changes of atrial and ventricular myocardium in HCM patients; (2) comparing to the general population, QTc prolongation at baseline is much more common in HCM patients regarless of the type of heart rhythm (AF or sinus); and (3) many HCM patients develop AF, but ablation of this arrhythmia in this specific population remains challenging.…”

Section: Discussionmentioning

confidence: 99%

“…Actually, QT prolongation has been associated with an increased AF incidence in the general population. 21, 22 Under the condition of HCM, one could hypothesize that the high prevalence of AF is not only a result of atrial overload, but an electrophysiological consequence of atrial myocardial disease that could be evaluated by an abnormal QT/QTc interval. In this study, we investigated the relationship of QTc and arrhythmia recurrence after catheter ablation of AF, and whether this measurement can be used to predict procedural outcome in HCM patients.…”

Section: Electrophysiology Study and Af Ablationmentioning

confidence: 99%

“…The Copenhagen ECG study revealed a J-shaped association, suggesting that either a prolonged or a shortened QTc interval is a risk factor of development of AF. 22 This might also apply to HCM patients in whom QTc prolongation is quite common. Although a short atrial action potential might predispose an individual to AF, epidemiological studies indicated that a prolonged QTc interval (representing ventricular action potential duration) was also and a LAD >44.5 mm.…”

Section: Combining Qtc With Lad Better Predicted Arrhythmia Recurrencementioning

confidence: 99%

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QTc Interval Prolongation Predicts Arrhythmia Recurrence After Catheter Ablation of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy

Wen

Liu

et al. 2015

Circ J

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Background:In hypertrophic cardiomyopathy (HCM) patients complicated with atrial fibrillation (AF), catheter ablation has been recommended as a treatment option. Meanwhile, prolongation of QTc interval has been linked to an increased AF incidence in the general population and to poor outcomes in HCM patients. However, whether QTc prolongation predicts arrhythmia recurrence after AF ablation in the HCM population remains unknown. Methods and Results:Thirty-nine HCM patients undergoing primary AF ablation were enrolled. The ablation strategy included bilateral pulmonary vein isolation (PVI) for paroxysmal AF (n=27) and PVI plus left atrial roof, mitral isthmus and tricuspid isthmus linear ablations for persistent AF (n=12). Pre-procedural QTc was corrected by using the Bazett's formula. At a 14.8-month follow up, 23 patients experienced atrial tachyarrhythmia recurrence. Recurrent patients had longer QTc than non-recurrent patients (461.0±28.8 ms vs. 434.3±18.2 ms, P=0.002). QTc and left atrial diameter (LAD) were independent predictors of recurrence. The cut-off value of QTc 448 ms predicted arrhythmia recurrence with a sensitivity of 73.9% and a specificity of 81.2%. A combination of LAD and QTc (global chisquared=13.209) was better than LAD alone (global chi-squared=6.888) or QTc alone (global chi-squared=8.977) in predicting arrhythmia recurrence after AF ablation in HCM patients. Conclusions:QTc prolongation is an independent predictor of arrhythmia recurrence in HCM patients undergoing AF ablation, and might be useful for identifying those patients likely to have a better outcome following the procedure. (Circ J 2015; 79: 1024 -1030

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Electrophysiology Study and Af Ablationmentioning

confidence: 99%

Section: Combining Qtc With Lad Better Predicted Arrhythmia Recurrencementioning

confidence: 99%

See 2 more Smart Citations

QTc Interval Prolongation Predicts Arrhythmia Recurrence After Catheter Ablation of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy

Wen

Liu

et al. 2015

Circ J

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“…However, there is increasing evidence that prolongation of the mean QT interval is associated with AF (330). A recent study including digital ECGs from more than 300,000 persons confirmed that the QTc interval length is a predictive parameter for the susceptibility of AF (308). Of note, both shortened and in particular prolonged QTc interval duration are risk factors for AF (308).…”

Section: Striking the Wrong Note: Genetic Variation Causing Arrhytmentioning

confidence: 99%

Cardiac Potassium Channel Subtypes: New Roles in Repolarization and Arrhythmia

Schmitt

Grunnet

Olesen

2014

Physiological Reviews

196

197

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About 10 distinct potassium channels in the heart are involved in shaping the action potential. Some of the K+ channels are primarily responsible for early repolarization, whereas others drive late repolarization and still others are open throughout the cardiac cycle. Three main K+ channels drive the late repolarization of the ventricle with some redundancy, and in atria this repolarization reserve is supplemented by the fairly atrial-specific KV1.5, Kir3, KCa, and K2P channels. The role of the latter two subtypes in atria is currently being clarified, and several findings indicate that they could constitute targets for new pharmacological treatment of atrial fibrillation. The interplay between the different K+ channel subtypes in both atria and ventricle is dynamic, and a significant up- and downregulation occurs in disease states such as atrial fibrillation or heart failure. The underlying posttranscriptional and posttranslational remodeling of the individual K+ channels changes their activity and significance relative to each other, and they must be viewed together to understand their role in keeping a stable heart rhythm, also under menacing conditions like attacks of reentry arrhythmia.

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Left Anterior Fascicular Block and the Risk of Cardiovascular Outcomes

et al. 2014

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panding from 6.4% of patients receiving IMV in 2001 to 13.8% in 2011 at an annual growth rate of 11.4% per year (Figure). By 2020, we estimate that there will be 671 986 (SD, 19 922) hospitalizations of patients 65 years or older requiring IMV, of which 19.0% will have a diagnosis of dementia.Discussion | The use of IMV by populations 65 years or older is expected to double between 2001 and 2020, and growth in hospitalizations for patients receiving IMV with an ICD-9-CM diagnosis of dementia is outpacing, by a factor of 4, those for patients receiving IMV without this diagnosis. These projected IMV numbers are consistent with published data. 5,6 The use of ICD-9-CM codes to identify patients with dementia may be limited by poor sensitivity and lack of information about disease severity. Although better recognition of dementia among hospital providers may have contributed to some of the increase that we observed, the results of this study still have important implications for critical care resource planning. Given projected demand for IMV in the next 10 years, physicians and hospital administrators, already working in a strained system, face a potential crisis unless the critical care system is expanded or changes are made to temper current trends.Efforts should therefore be made to promote earlier discussions about goals of care in elderly patients with endstage terminal illnesses. This is most important for the subpopulations of patients (eg, frail elders older than 85 years, patients with end-stage dementia) who are least likely to benefit from IMV and at highest risk for worsening cognitive impairment and death.

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J-Shaped Association Between QTc Interval Duration and the Risk of Atrial Fibrillation

Abstract: In this large ECG study, a J-shaped association was found between QTc interval duration and risk of AF. This association was strongest with respect to the development of lone AF.

Cited by 112 publications

References 41 publications

QTc Interval Prolongation Predicts Arrhythmia Recurrence After Catheter Ablation of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy

QTc Interval Prolongation Predicts Arrhythmia Recurrence After Catheter Ablation of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy

Cardiac Potassium Channel Subtypes: New Roles in Repolarization and Arrhythmia

Left Anterior Fascicular Block and the Risk of Cardiovascular Outcomes

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