Time-Dependent Changes in QT Dynamics after Initiation and Termination of Paroxysmal Atrial Fibrillation

Yamaguchi, Yoshiaki; Mizumaki, Koichi; Nishida, Keiya; Sakamoto, Tamotsu; Kataoka, Naoya; Nakatani, Yosuke; Inoue, Hiroshi

doi:10.1111/pace.12746

Cited by 5 publications

(6 citation statements)

References 26 publications

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“…Yamaguchi et al found an attenuated QT/RR slope with a maximum of 4-5 hr after restoration to SR in paroxysmal AF with a diurnal Holter recording in five patients on AA drugs (Darbar et al, 2008;Lenhoff et al, 2016;Yamaguchi et al, 2015). In our study, the diurnal rhythm was more pronounced in patients on sotalol as compared to patients on metoprolol, at night.…”

Section: Discussionsupporting

confidence: 46%

“…We have previously described QTc prolongation after CV that seems reversed one week later (Kirchhof et al., 2016 ) and Darbar et al showed prolongation of QTc shortly after CV compared to during AF (Bexton et al., 1986 ). Yamaguchi et al found an attenuated QT/RR slope with a maximum of 4–5 hr after restoration to SR in paroxysmal AF with a diurnal Holter recording in five patients on AA drugs (Darbar et al., 2008 ; Lenhoff et al., 2016 ; Yamaguchi et al., 2015 ). In our study, the diurnal rhythm was more pronounced in patients on sotalol as compared to patients on metoprolol, at night.…”

Section: Discussionmentioning

confidence: 99%

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Diurnal QT analysis in patients with sotalol after cardioversion of atrial fibrillation

Lenhoff

Darpö

Page

et al. 2021

Noninvasive Electrocardiol

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Section: Discussionsupporting

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Diurnal QT analysis in patients with sotalol after cardioversion of atrial fibrillation

Lenhoff

Darpö

Page

et al. 2021

Noninvasive Electrocardiol

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“…Repolarization delay predisposes patients to TdP and the short-long-short sequences that classically trigger TdP may be more common in AF than in SR. Many patients are treated for AF with class III antiarrhythmic drugs; these agents are often initiated while patients are in AF and reliable detection of excessive QT prolongation is necessary to minimize proarrhythmia [18,23]. …”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, detection of repolarization delay during AF is of substantial clinical significance, for example during initiation of treatment with class III antiarrhythmic agents. Several methods have been suggested to deal with the problem [13–18]. We sought to determine if the exponential weight models with an immediate response component derived from SR and atrial pacing data also provide a consistent description of QT dynamics in AF.…”

Section: Introductionmentioning

confidence: 99%

Recent heart rate history affects QT interval duration in atrial fibrillation

et al. 2017

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QT interval prolongation is associated with a risk of polymorphic ventricular tachycardia. QT interval shortens with increasing heart rate and correction for this effect is necessary for meaningful QT interval assessment. We aim to improve current methods of correcting the QT interval during atrial fibrillation (AF). Digitized Holter recordings were analyzed from patients with AF. Models of QT interval dependence on RR intervals were tested by sorting the beats into 20 bins based on corrected RR interval and assessing ST-T variability within the bins. Signal-averaging within bins was performed to determine QT/RR dependence. Data from 30 patients (29 men, 69.3±7.3 years) were evaluated. QT behavior in AF is well described by a linear function (slope ~0.19) of steady-state corrected RR interval. Corrected RR is calculated as a combination of an exponential weight function with time-constant of 2 minutes and a smaller “immediate response” component (weight ~ 0.18). This model performs significantly (p<0.0001) better than models based on instantaneous RR interval only including Bazett and Fridericia. It also outperforms models based on shorter time-constants and other previously proposed models. This model may improve detection of repolarization delay in AF. QT response to heart rate changes in AF is similar to previously published QT dynamics during atrial pacing and in sinus rhythm.

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“…Additionally, recent evidence demonstrates improvements in the QT correction procedures when a range of the past values of HR is taken into account 4 , 21 , 22 . The correction improvement is especially profound in patients with atrial fibrillation, where HR values are unpredictable 23 , 24 .…”

Section: Introductionmentioning

confidence: 99%

Information transfer in QT-RR dynamics: Application to QT-correction

Potapov

Latukka

Kim

et al. 2018

Sci Rep

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The relation between the electrical properties of the heart and the beating rate is essential for the heart functioning. This relation is central when calculating the “corrected QT interval” — an important measure of the risk of potentially lethal arrhythmias. We use the transfer entropy method from information theory to quantitatively study the mutual dynamics of the ventricular action potential duration (the QT interval) and the length of the beat-to-beat (RR) interval. We show that for healthy individuals there is a strong asymmetry in the information transfer: the information flow from RR to QT dominates over the opposite flow (from QT to RR), i.e. QT depends on RR to a larger extent than RR on QT. Moreover, the history of the intervals has a strong effect on the information transfer: at sufficiently long QT history length the information flow asymmetry inverts and the RR influence on QT dynamics weakens. Finally, we demonstrate that the widely used QT correction methods cannot properly capture the changes in the information flows between QT and RR. We conclude that our results obtained through a model-free informational perspective can be utilised to improve and test the QT correction schemes in clinics.

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Time-Dependent Changes in QT Dynamics after Initiation and Termination of Paroxysmal Atrial Fibrillation

Abstract: In patients with paroxysmal AF, bradycardia-dependent QT prolongation was attenuated during AF, and was corrected and gradually augmented along with continuation of SR, especially in patients receiving AADs. This could increase the risk of developing torsade de pointes.

Cited by 5 publications

References 26 publications

Diurnal QT analysis in patients with sotalol after cardioversion of atrial fibrillation

Diurnal QT analysis in patients with sotalol after cardioversion of atrial fibrillation

Recent heart rate history affects QT interval duration in atrial fibrillation

Information transfer in QT-RR dynamics: Application to QT-correction

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