Marked QTc Reduction Immediately Following Direct Current Cardioversion of Atrial Fibrillation

Omondi, Arthur; Sirinvaravong, Natee; Spears, Jenna; Sauerwein, Samuel; Taoutel, Roy; Liskov, Steven; Gao, Chuanyu; Liu, Tong; Kowey, Peter R.; Yan, Gan‐Xin

doi:10.1016/j.jacep.2022.10.031

Cited by 2 publications

(4 citation statements)

References 16 publications

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“…This dictates that the QT intervals must be corrected for heart rate by adequate formulas for comparison. 17 Because inactivation of the late sodium channels is also voltagedependent, any factor that prolongs APD/QT indirectly increases I Na,L , resulting in an enhanced rate-dependent change in APD/QT. Amplified changes in APD/QT in response to changes in heart rate by an antiarrhythmic drug is termed reverse use-dependence.…”

Section: 2mentioning

confidence: 99%

“… 15,16 Rate‐dependent change in I Na,L is the major ionic mechanism underlying an inverse relationship of ventricular APD, or the QT interval on ECG, with heart rate. This dictates that the QT intervals must be corrected for heart rate by adequate formulas for comparison 17 . Because inactivation of the late sodium channels is also voltage‐dependent, any factor that prolongs APD/QT indirectly increases I Na,L , resulting in an enhanced rate‐dependent change in APD/QT.…”

Section: Electrophysiological Effects: Mechanisms Of Actionmentioning

confidence: 99%

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Mexiletine: Antiarrhythmic mechanisms, emerging clinical applications and mortality

Olleik,

Kamareddine,

Spears

et al. 2023

Pacing Clinical Electrophis

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Mexiletine, a class Ib antiarrhythmic drug, exhibits its major antiarrhythmic effect via inhibition of the fast and late Na+ currents in myocardial tissues that are dependent on the opening of Na+ channels for their excitation. Through a comprehensive examination of mexiletine's therapeutic benefits and potential risks, we aim to provide valuable insights that reinforce its role as a vital therapeutic option for patients with ventricular arrhythmias, long QT syndrome, and other heart rhythm disorders. This review will highlight the current understandings of the antiarrhythmic effects and rationales for recent off‐label use and address the mortality and proarrhythmic effects of mexiletine utilizing published basic and clinical studies over the past five decades.

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Section: 2mentioning

confidence: 99%

Section: Electrophysiological Effects: Mechanisms Of Actionmentioning

confidence: 99%

Mexiletine: Antiarrhythmic mechanisms, emerging clinical applications and mortality

Olleik,

Kamareddine,

Spears

et al. 2023

Pacing Clinical Electrophis

Self Cite

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“…For example, there are many published examples from LQTS patients in which TWA immediately precedes the onset of its signature arrhythmia, Torsade de pointes (Figure 1 B and C). 18–23 On the other hand, many episodes of Torsade de pointes also occur without immediately preceding TWA, often following a short-long-short sequence (Figure 1D). 24–26 Today, macroscopic TWA is used in assessing arrhythmia risk in patients with LQTS, 27 and microvolt TWA test is used for risk stratification for patients with heart failure.…”

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confidence: 99%

“…11 C , TWA in which TdP is initiated by a PVC falling on the large T-wave of the alternating beats. 23 D , TWA, followed sometime later by TdP initiated by a short-long-short sequence. 24…”

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confidence: 99%

Cardiac Alternans: From Bedside to Bench and Back

Weiss

2023

Circulation Research

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Cardiac alternans arises from dynamical instabilities in the electrical and calcium cycling systems of the heart, and often precedes ventricular arrhythmias and sudden cardiac death. In this review, we integrate clinical observations with theory and experiment to paint a holistic portrait of cardiac alternans: the underlying mechanisms, arrhythmic manifestations and electrocardiographic signatures. We first summarize the cellular and tissue mechanisms of alternans that have been demonstrated both theoretically and experimentally, including 3 voltage-driven and 2 calcium-driven alternans mechanisms. Based on experimental and simulation results, we describe their relevance to mechanisms of arrhythmogenesis under different disease conditions, and their link to electrocardiographic characteristics of alternans observed in patients. Our major conclusion is that alternans is not only a predictor, but also a causal mechanism of potentially lethal ventricular and atrial arrhythmias across the full spectrum of arrhythmia mechanisms that culminate in functional reentry, although less important for anatomic reentry and focal arrhythmias.

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Marked QTc Reduction Immediately Following Direct Current Cardioversion of Atrial Fibrillation

Cited by 2 publications

References 16 publications

Mexiletine: Antiarrhythmic mechanisms, emerging clinical applications and mortality

Mexiletine: Antiarrhythmic mechanisms, emerging clinical applications and mortality

Cardiac Alternans: From Bedside to Bench and Back

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