QTc interval in patients with multiple sclerosis: an inference from the insula of Reil?

Abstract

An increased QTc interval in patients with MS may have a cerebral origin possibly driven by involvement of the insular cortex. With the recent introduction in clinical practice of treatments with potential cardiac effects such as fingolimod, the recognition of a long QTc interval could be clinically crucial and should encourage appropriate electrocardiographic monitoring in order to prevent the risk of malignant ventricular pro-arrhythmia and iatrogenic sudden death.

Association of prolonged QTc interval with Takotsubo cardiomyopathy: A neurocardiac syndrome inside the mystery of the insula of Reil

“…In humans, unlike the rat, the right IC is involved in cardiovascular sympathetic control . In this respect, recent studies suggest that IC in the setting of ischemic stroke, hepatic encephalopathy, and multiple sclerosis could play a major role in the pathogenesis of cerebrogenic long QTc interval. The right insular infarction patients were significantly more likely to show a higher incidence of prolonged QTc interval (53% vs 35%) …”

Insular cortex and QT correction interval: an effect of hemispheric lateralization?

“…However, recent studies have supported the notion that the cardiovascular system is regulated by a cortical network consisting of the Ic, anterior cingulate gyrus and amygdala [3]. Several points should be taken into account when interpreting these results reported by Turri et al [1].…”

“…Thus, the posterior portion of the left Ic might have a strong association with parasympathetic nervous system activity. In the study reported by Turri et al [1], there were no descriptions of the relationship between Ic and QTc interval in relation to the anterior versus posterior Ic of the left hemisphere.…”

“…These results suggest that the left hemisphere, including the left Ic, is predominantly associated with parasympathetic autonomic tone. In the study reported by Turri et al [1], there were no descriptions of the hemispheric lateralization for Ic lesion volume and Ic thickness. The patients with increased right Ic lesion volume or increased left Ic thickness might have longer QTc intervals.…”

“…We read the interesting study by Turri et al [1], who reported that increased insular cortex (Ic) lesion volume and decreased Ic thickness had significant negative associations with QT correction (QTc) interval in patients with multiple sclerosis. In a dog model, the adjusted QT interval at high parasympathetic or low sympathetic tone was significantly longer than that at low parasympathetic or high sympathetic tone [2].…”