Electrophysiological measurements that can explain and guide temporary accelerated pacing to avert (re)occurrence of torsade de pointes arrhythmias in the canine chronic atrioventricular block model

Wijers, Sofieke C.; Bossu, Alexandre; Dunnink, Albert; Beekman, Jet D.M.; Varkevisser, Rosanne; Hernández, Alfonso Aranda; Meine, Mathias; Vos, Marc A.

doi:10.1016/j.hrthm.2017.02.007

Cited by 8 publications

(14 citation statements)

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“…[7][8][9] This increase in STV occurred before the first sign of ventricular arrhythmia, which usually consists of single ectopic beats (sEB) and multiple ectopic beats (mEB), thus providing sufficient time to initiate antiarrhythmic therapy. 10 HRP at VVI100 reduced STV and effectively prevented TdP in CAVB dogs. 10,11 In the earlier studies, HRP was started manually during the experiment, and STV was determined offline in a semiautomated manner.…”

Section: Introductionmentioning

confidence: 89%

High-rate pacing guided by short-term variability of repolarization prevents imminent ventricular arrhythmias automatically by an implantable cardioverter-defibrillator in the chronic atrioventricular block dog model

et al. 2020

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BACKGROUND The anesthetized, complete chronic atrioventricular block (CAVB) dog model allows reproducible inducibility of torsades de pointes (TdP) arrhythmias due to ventricular remodeling and after a challenge with an I Kr blocker. High-rate pacing (HRP) prevents ventricular arrhythmias but has long-term detrimental effects on cardiac function when applied continuously. Temporal dispersion of repolarization, quantified as short-term variability (STV), increases before ventricular arrhythmias and has been proposed as a marker to guide HRP.OBJECTIVE The purpose of this proof-of-principle study was to show that automatically determined STV can guide HRP to prevent imminent ventricular arrhythmias.METHODS Eight CAVB dogs were implanted with an implantable cardioverter-defibrillator (ICD) with software to automatically determine STV (STV ICD ) in real time. During HRP, STV was measured offline from right ventricular (RV) electrograms (EGMs) and left ventricular (LV) monophasic action potential durations (MAPDs) (STV RV,EGM/LV,MAPD ). The CAVB dogs were challenged twice with dofetilide (0.025 mg/kg intravenously over 5 minutes or until the first TdP). In experiment 1, the individual STV ICD threshold before the first arrhythmic event was determined and programmed into the ICD. In experiment 2, HRP with 100 bpm was initiated automatically once the STV ICD threshold was reached. RESULTSIn experiment 1, 8 of 8 dogs had repetitive TdP, and STV ICD increased from 0.96 6 0.42 ms to 2.10 6 1.26 ms (P ,.05). In experiment 2, all dogs reached the STV threshold. HRP decreased STV RV,EGM/LV,MAPD from 2.02 6 1.12 ms to 0.78 6 0.28 ms, which was accompanied by prevention of TdP in 7 of 8 dogs.CONCLUSION STV can guide HRP automatically by an ICD to prevent ventricular arrhythmias.

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Section: Introductionmentioning

confidence: 89%

High-rate pacing guided by short-term variability of repolarization prevents imminent ventricular arrhythmias automatically by an implantable cardioverter-defibrillator in the chronic atrioventricular block dog model

et al. 2020

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“…[14,21,40] When the ‘final hit’ in the form of an IKr-blocker is infused, the absolute value of STV increases abruptly in the minutes preceding a storm of TdPs (STV arrhythmic ). [13–15,36,41,42] Moreover, STV has been shown to be a superior repolarisation parameter to predict the imminent proarrhythmic outcome, compared with repolarisation prolongation and interventricular dispersion of repolarisation. [25,40]…”

Section: Ventricular Remodelling In the Chronic Complete Atrioventricmentioning

confidence: 99%

“…A dog is considered to be inducible when ≥3 TdPs occur within 10 minutes after the start of infusion with an IKr-blocker such as dofetilide. [41] When a TdP lasts for 10–12 seconds, defibrillation with thoracic patches is performed to restore normal heart rhythm.…”

Section: Relation Of Short-term Variability Of Repolarisation To Sevementioning

confidence: 99%

The Increment of Short-term Variability of Repolarisation Determines the Severity of the Imminent Arrhythmic Outcome

Smoczyńska

Beekman

Vos

2019

Arrhythm Electrophysiol Rev

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Ventricular remodelling can make the heart more susceptible to ventricular arrhythmias like torsades de pointes. Understanding the underlying mechanisms of initiation of ventricular arrhythmias and the determining factors for its severity has the potential to uncover new interventions. Beat-to-beat variation of repolarisation, quantified as short-term variability of repolarisation (STV), has been identified as an important factor contributing to arrhythmogenesis. This article provides an overview of experimental data about STV in relation to the initiation of torsades de pointes in a canine model of complete chronic atrioventricular block susceptible to torsades de pointes arrhythmias. Furthermore, it explores STV in relation to the severity of the arrhythmic outcome.

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“…However, this information would only be useful if appropriate treatment, such as alternative pacing algorithms, can be initiated in time to prevent the arrhythmia from occurring. Recently, Wijers et al (2017) demonstrated that temporary accelerated pacing (TAP) initiated just after the first ectopic beat can prevent TdP-arrhythmias in the CAVB-dog. This is in agreement with clinical studies that show that ratesmoothing pacing algorithms can reduce the number of sustained ventricular tachyarrhythmias in ICD-recipients and patients with long QT-syndrome (Viskin et al, 2000;Wietholt et al, 2003).…”

Section: Clinical Utility Of the Intracardiac Egmmentioning

confidence: 99%

Evaluation of a Fully Automatic Measurement of Short-Term Variability of Repolarization on Intracardiac Electrograms in the Chronic Atrioventricular Block Dog

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Background: Short-term variability (STV) of repolarization of the monophasic action potential duration (MAPD) or activation recovery interval (ARI) on the intracardiac electrogram (EGM) increases abruptly prior to the occurrence of ventricular arrhythmias in the chronic AV-block (CAVB) dog model. Therefore, this parameter might be suitable for continuous monitoring of imminent arrhythmias using the EGM stored on an implanted device. However, 24/7 monitoring would require automatic STV ARI measurement by the device. Objective: To evaluate a newly developed automatic measurement of STV ARI for prediction of dofetilide-induced torsade de pointes (TdP) arrhythmias in the CAVB-dog. Methods: Two retrospective analyses were done on data from recently performed dog experiments. (1) In seven anesthetized CAVB-dogs, the new automatic STV ARI method was compared with the gold standard STV MAPD at baseline and after dofetilide administration (0.025 mg/kg in 5 min). (2) The predictive value of the automatic method was compared to currently used STV ARI methods, i.e., slope method and fiducial segment averaging (FSA) method, in 11 inducible (≥3 TdP arrhythmias) and 10 non-inducible CAVB-dogs. Results: (1) The automatic measurement of STV ARI had good correlation with STV MAPD (r 2 = 0.89; p < 0.001). Bland-Altman analysis showed a small bias of 0.06 ms with limits of agreement between −0.63 and 0.76 ms. (2) STV ARI of all three methods was significantly different between inducible and non-inducible dogs after dofetilide. The automatic method showed the highest predictive performance with an area under the ROC-curve of 0.93, compared to 0.85 and 0.87 of the slope and FSA methods, respectively. With a threshold of STV set at 1.69 ms, STV ARI measured with the automatic method had a sensitivity of 0.91 and specificity of 0.90 in differentiating inducible from non-inducible subjects. Smoczyńska et al.

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Electrophysiological measurements that can explain and guide temporary accelerated pacing to avert (re)occurrence of torsade de pointes arrhythmias in the canine chronic atrioventricular block model

Cited by 8 publications

References 34 publications

High-rate pacing guided by short-term variability of repolarization prevents imminent ventricular arrhythmias automatically by an implantable cardioverter-defibrillator in the chronic atrioventricular block dog model

High-rate pacing guided by short-term variability of repolarization prevents imminent ventricular arrhythmias automatically by an implantable cardioverter-defibrillator in the chronic atrioventricular block dog model

The Increment of Short-term Variability of Repolarisation Determines the Severity of the Imminent Arrhythmic Outcome

Evaluation of a Fully Automatic Measurement of Short-Term Variability of Repolarization on Intracardiac Electrograms in the Chronic Atrioventricular Block Dog

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