QT interval variability and spontaneous ventricular tachycardia or fibrillation in the Multicenter Automatic Defibrillator Implantation Trial (MADIT) II patients

Haigney, Mark C.; Zaręba, Wojciech; Gentlesk, Philip J.; Goldstein, Robert E.; Illovsky, Michael; McNitt, Scott; Andrews, Mark; Moss, Arthur J.

doi:10.1016/j.jacc.2004.06.063

Cited by 223 publications

(144 citation statements)

References 17 publications

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“…Prolongation of QTVI and increased temporal repolarisation lability is related to ventricular arrhythmia and sudden cardiac death [13,15,20]. In adults [13], QTVI > )0.47 indicates very high risk of sudden cardiac death.…”

Section: Discussionmentioning

confidence: 99%

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Effects of sevoflurane on QT parameters in children with congenital sensorineural hearing loss

Kim

et al. 2008

Anaesthesia

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SummarySevoflurane prolongs the QT interval (QTI). Patients with congenital sensorineural hearing loss (SNHL) often have a prolonged QTI. This study was to investigate the effects of sevoflurane on the QTI in SNHL and control children. Thirty patients with SNHL and 30 controls were studied. The corrected QT interval (QTc), interval from peak to end of T wave (Tp-e) and QT variability index (QTVI) were analysed. QTc and Tp-e were estimated by the average QTc and Tp-e measured beat-by-beat for 15 min. Heart rate power spectral analysis was performed. In both groups, QTc and QTVI increased during anaesthesia, but Tp-e did not change. There were no differences in QTc, QTVI, Tp-e, low-and high-frequency power between the two groups. In both groups, sevoflurane lengthened the QTc and QTVI intervals but not Tp-e. Sevoflurane is a popular inhalational agent for general anaesthesia. It blocks the slowly activating delayed rectifier K current (I Ks ) and prolongs the QT interval in both children [1,2] and adults [3,4]. Such changes may be of clinical significance in patients presenting with long QT syndrome, hypokalaemia or in the presence of other agents or factors that lengthen the QT interval.The Jervell and Lange-Nielson syndrome [5] is a long-QT syndrome found among patients with congenital sensorineural hearing loss (SNHL). The deafness is attributed to mutations on the KCNQ1 or KCNE1 genes encoding the rapidly activating delayed rectifier K + channel (I Kr ) in the inner ear. Similar mutations, present in the cardiomyocyte, cause the long QT syndrome. However, it was reported that even patients with congenital SNHL who do not meet the criteria for Jervell and Lange-Nielsen syndrome have increased QTc [6,7]. Thus such children may be at increased risk of corrected QT (QTc) prolongation during sevoflurane anaesthesia.The aim of this study was to investigate how sevoflurane changes the QT parameters in children with congenital SNHL, and whether this differs from the changes in normal children produced by sevoflurane.The QT parameters we analysed were QTc, interval from peak to end of T wave (Tp-e) and QT variability index (QTVI) which reflect the action potential duration of the ventricle, transmural repolarisation dispersion in the action potential duration [8,9] and temporal repolarisation lability [10], respectively. The clinical importance of increases in QT parameter values lies in their association with malignant ventricular arrhythmias [11][12][13]. To improve the accuracy of the average of QTc and Tp-e, we averaged all beat-by-beat QTc and Tp-e values measured automatically over the 15 min period, as well as four manually measured values of QTc and Tp-e. Methods Study populationAfter obtaining approval from the institutional ethics committee of the hospital and written informed consent from parents or guardians, the study was performed on 30 children with congenital SNHL (SNHL group) and 30 patients with chronic otitis media (control group), both of whom required ear surgery and were aged between 2 and 15 year...

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Section: Discussionmentioning

confidence: 99%

“…1a,b). The algorithm used for QT analysis has been described in detail by Berger et al [10] and has been used in previous studies [13,15,16]. In brief, the beat-by-beat QT interval was detected by a template matching strategy algorithm.…”

Section: Study Protocolmentioning

confidence: 99%

Effects of sevoflurane on QT parameters in children with congenital sensorineural hearing loss

Kim

et al. 2008

Anaesthesia

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“…Увеличение QTVI указы-вает на высокий риск внезапной сердечной смерти, поэтому определение QTVI полезно при стратифи-кации риска внезапной смерти [12,[15][16]. Изме-нения QTVI отражают нарушения реполяризации миокарда независимо от этиологии заболевания и установлены при патологии миокарда различного генеза [11].…”

Section: Discussionunclassified

“…Не исключается, что электрическая нестабильность миокарда у больных с ОДХСН может усугубляться на фоне метаболиче-ских и водно-электролитных нарушений, свойствен-ных ОПП. Между тем, увеличение продолжительно-сти и вариабельности QRS, повышение индекса вари-абельности QT, показатели вариабельности и турбу-лентности сердечного ритма, отражая электрическое ремоделирование миокарда, связаны с повышением риска смерти [11,12]. В связи с высоким риском раз-вития желудочковых нарушений ритма Европейское общество кардиологов по предупреждению внезап-ной сердечной смерти и Американская ассоциация сердца рекомендуют мониторировать электрокарди-ографические параметры сердца у больных с острой декомпенсацией хронической сердечной недостаточ-ности [13].…”

Section: Introductionunclassified

Risk Factors of Arrhythmias in Patients With Acute Decompensation of Chronic Heart Failure

Larionova¹,

Шутов²,

Мензоров³

et al. 2017

Arhivʺ vnutr. med.

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“…(2003), an increased spatial QRS‐T angle had more prognostic value for fatal endpoints than any classic cardiovascular risk factor, including diabetes. Finally, a number of studies show that the index of QT interval variability QTVI (Berger et al., 1997) can identify patients at risk for sudden cardiac death (Atiga et al., 1998; Haigney et al., 2004; Piccirillo et al., 2007), possibly even more than both left ventricular ejection fraction (as assessed by ultracardiography) and T‐wave alternans (Atiga et al., 1998; Berger et al., 1997). …”

Section: Introductionmentioning

confidence: 99%

Evidence of cardiac electrical remodeling in patients with Huntington disease

et al. 2018

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ObjectiveAlthough Huntington's disease (HD) is a disease of the central nervous system, HD mortality surveys indicate heart disease as a major cause of death. Cardiac dysfunction in HD might be a primary consequence of peripherally expressed mutant huntingtin or secondary to either a general decline in health or the onset of neurological dysfunction. The aim of the study was to clarify the heart muscle involvement.Materials and MethodsWe measured conventional and advanced resting ECG indices. Thirtyone subjects with a confirmed huntingtin gene mutation and 31 age‐ and gender‐matched controls were included. The HD subjects were divided into four groups based on their Unified Huntington Disease Rating Scale (UHDRS) motor score.ResultsWe detected changes in advanced ECG variables connected with electrical ventricular remodeling (t test, p < 0.01). The increase in the unexplained part of both QT variability and the standard deviation of normal‐to‐normal QT intervals, presumably reflecting beat‐to‐beat changes in repolarization, was most pronounced. Further, both variables correlated with the product of the cytosine–adenine–guanine (CAG) triplets’ repeat length and the subjects’ age (CAP), the former R = 0.423 (p = 0.018) and the latter R = 0.499 (p = 0.004). There was no correlation between the CAP score and any of variables representing autonomic nervous system activity.ConclusionsBoth autonomic nervous system dysfunction and cardiac electrical remodeling are present in patients with HD. The changes in advanced ECG variables observed in the study evolve with HD progression. The increased values of QT unexplained variability may be a marker of temporal inhomogeneity in ventricular repolarization associated with malignant ventricular arrhythmias.

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QT interval variability and spontaneous ventricular tachycardia or fibrillation in the Multicenter Automatic Defibrillator Implantation Trial (MADIT) II patients

Abstract: In postinfarction patients with severe left ventricular dysfunction, increased QT variability, a marker of repolarization lability, is associated with an increased risk for VT/VF.

Cited by 223 publications

References 17 publications

Effects of sevoflurane on QT parameters in children with congenital sensorineural hearing loss

Effects of sevoflurane on QT parameters in children with congenital sensorineural hearing loss

Risk Factors of Arrhythmias in Patients With Acute Decompensation of Chronic Heart Failure

Evidence of cardiac electrical remodeling in patients with Huntington disease

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