Pacing-Induced Increase in QT Dispersion Predicts Sudden Cardiac Death Following Cardiac Resynchronization Therapy

Chalil, Shajil; Yousef, Zaheer; Muyhaldeen, Sarkaw A.; Smith, R. V.; Jordan, Pamela; Gibbs, C R; Leyva, Francisco

doi:10.1016/j.jacc.2005.12.074

Cited by 42 publications

(40 citation statements)

References 20 publications

(19 reference statements)

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“…In a study of 75 patients undergoing CRT, variation in QT dispersion before and after implantation was an independent predictor of major arrhythmic events; in a follow-up of 807 days, in the group with increased QT dispersion the incidence of events was 29%, while in those in whom it decreased, the incidence was 3% (p=0.0017). 30 The same study 30 assessed the interval between the peak and the end of the T wave (T peak-end ), another marker of dispersion of repolarization. Patients who suffered arrhythmic events during follow-up had a significantly smaller reduction in T peak-end than those who were event-free (−1.5±12.8 ms vs. −20.0±5.4 ms, p=0.047).…”

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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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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“…Chalil et al [17] examined retrospectively the prognostic value of these parameters in predicting sudden cardiac death in CRT patients. Like our study they reported that increase in QT dispersion was the independent predictor of sudden cardiac death.…”

Section: Discussionmentioning

confidence: 99%

Increase in QTC Dispersion Predicts Arrhythmic Events in Patients With Cardiac Resynchronization Therapy

Kocas¹,

Abacı

Kılıçkesmez

et al. 2014

Russ J Cardiol

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Aim. Benefits of CRT on mortality and morbidity in patients with severe CHF are clear but the effect of CRT on sudden cardiac death is more controversial. It has been suggested that CRT may catalyze arrhythmogenicity by reversing the normal depolarization pattern. The purpose of this study was to examine the effect of CRT on dispersion of repolarization as assessed by ECG. We also sought to determine the value of dispersion of repolarization ECG parameters in predicting the occurrence of major arrhythmic events (MAE) in follow-up. Material and methods. A total of 48 patients with end-stage heart failure and QRS duration >120 ms underwent CRT. QT dispersion (QTd), T peak t end interval (Tpe) and T peak t end dispersion (Tpe dispersion) were measured before and immediately after CRT implantation. All patients were followed at least 12 months for ventricular tachycardia or fibrillation that were treated with antitachicardia pace or cardioversion. Results. Over 16±7.1 months, 14 patients had a MAE. Compared to baseline, after CRT, QTc dispersion (84.66±37.7 vs 100.36±47.4, p=0.04) and Tpe interval (104.1±20.4 vs 122.03±33, p=0.02) increased significantly. Increase in QTD (∆QTD) (31.66±39.5 vs 5.57±5.59, p=0.03), and QTc dispersion (∆QTc dispersion) (40.19±46.6 vs 4.39±14.35, p=0.04) from baseline was signifcantly higher in MAE group. In multiple regression analyses, ∆QTc dispersion predicted MAE (p=0.045, CI: 1.000-1.033). Цель. Преимущества сердечной ресинхронизирующей терапии (CRT) в сни-жении смертности и заболеваемости больных с тяжелой ХСН ясны, но дейст-вие CRT при внезапной сердечной смерти является более спорным. Было высказано предположение, что CRT может катализировать аритмогенность, реверсируя нормальную деполяризационную структуру. Целью данного исследования было изучить влияние CRT на дисперсию реполяризации, при оценке ЭКГ. Мы также стремились определить значение дисперсии реполяри-зации параметров ЭКГ в прогнозировании возникновения крупных аритмиче-ских событий (MAE) в последующем. Материал и методы. Всего 48 пациентов с терминальной стадией сердеч-ной недостаточности и длительностью комплекса QRS >120 мс прошли CRT. Дисперсия QT (QTd), T пик t end интервал (Tpe) и T пик t end дисперсии (Tpe дисперсии) были измерены до и сразу после CRT имплантации. Все паци-енты находились под наблюдением, по крайней мере, 12 месяцев, желудоч-ковая тахикардия или аритмия лечились кардиостимуляцией или кардио-версией. Conclusion. Immediately after CRT implantationРезультаты. Более 16±7.1 месяцев у 14 пациентов были MAE. По сравнению с исходными данными, после CRT, QTc дисперсия (84.66±на 37,7 против 100.36±47.4, p=0,04) и Tpe интервал (104.1±20.4 против 122.03±33, p=0.02) значительно увеличились. Увеличение QTD (t QTd) (31.66±39.5 против 5.57±5.59, p=0,03), и QTc дисперсии (t QTc дисперсии) (40.19±против 46.6 4.39±14.35, p=0,04) от исходного уровня были значительно выше в группе с MAE. При множественном регрессионном анализе ∆QTc дисперсия предска-зывала развитие MAE (р=0,045 (CI): 1.000-1.033). Заключение. Сразу по...

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“…Recent publications have reported that repolarization abnormalities play a role in arrhythmogenesis (32,33). In this context, analysis of the duration of wave intervals in electrocardiograms (ECG) could potentially identify patients at risk for cardiac death and sudden cardiac death.…”

Section: Introductionmentioning

confidence: 99%

Tracheal instillation of urban PM2.5 suspension promotes acute cardiac polarization changes in rats

Maatz

Wood

Rivero

et al. 2009

Braz J Med Biol Res

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The mechanisms by which PM 2.5 increases cardiovascular mortality are not fully identified. Autonomic alterations are the current main hypotheses. Our objective was to determine if PM 2.5 induces acute cardiac polarization alterations in healthy Wistar rats. PM 2.5 samples were collected on polycarbonate filters. Solutions containing 10, 20, and 50 μg PM 2.5 were administered by tracheal instillation. P wave duration decreased significantly at 20 μg (0.99 ± 0.06, 0.95 ± 0.06, and 0.96 ± 0.07; P < 0.001), and 50 μg (0.98 ± 0.06, 0.98 ± 0.07, and 0.96 ± 0.08; 60, 90 and 120 min, respectively) compared to blank filter solution (P < 0.001). PR interval duration decreased significantly at 20 μg (0.99 ± 0.06, 0.98 ± 0.07, and 0.97 ± 0.08) and 50 μg (0.99 ± 0.05, 0.97 ± 0.0, and 0.95 ± 0.05; 60, 90, and 120 min, respectively) compared to blank filter and 10 μg (P < 0.001). QRS interval duration decreased at 20 and 50 μg in relation to blank filter solution and 10 μg (P < 0.001). QT interval duration decreased significantly (P < 0.001) with time in animals receiving 20 μg (0.94 ± 0.12, 0.88 ± 0.14, and 0.88 ± 0.11) and 50 μg (1.00 ± 0.13; 0.97 ± 0.11 and 0.98 ± 0.16; 60, 90 and 120 min, respectively) compared to blank filter solution and 10 μg (P < 0.001). PM 2.5 induced reduced cardiac conduction time, within a short period, indicating that depolarization occurs more rapidly across ventricular tissue.

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Pacing-Induced Increase in QT Dispersion Predicts Sudden Cardiac Death Following Cardiac Resynchronization Therapy

Abstract: The MAE in patients with BiVP are related to pacing-induced increases in QTD. Measures of ventricular repolarization at the time of pacemaker implantation may guide selection of patients for combined CRT and defibrillator therapy.

Cited by 42 publications

References 20 publications

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

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

Increase in QTC Dispersion Predicts Arrhythmic Events in Patients With Cardiac Resynchronization Therapy

Tracheal instillation of urban PM2.5 suspension promotes acute cardiac polarization changes in rats

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