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Roles of Atrial Arrhythmias in Triggering Torsade de Pointes in Patients With Acquired Long-QT Syndrome.
Takasugi, Nobuhiro; Endo, Susumu; Takasugi, Mieko; Tochibora, Ryota; Yoshida, Akihiro; Watanabe, Takatomo; Kawaguchi, Tomonori; Yamada, Yoshihisa; Kanamori, Hiromitsu; Ushikoshi, Hiroaki; Okura, Hiroyuki.
Afiliación
  • Takasugi N; Gifu University Hospital (N.T., S.E., R.T., A.Y., T.W., T.K., Y.Y., H.K., H.U., H.O.).
  • Endo S; Gifu University Hospital (N.T., S.E., R.T., A.Y., T.W., T.K., Y.Y., H.K., H.U., H.O.).
  • Takasugi M; Matsunami General Hospital, Gifu, Japan (M.T.).
  • Tochibora R; Gifu University Hospital (N.T., S.E., R.T., A.Y., T.W., T.K., Y.Y., H.K., H.U., H.O.).
  • Yoshida A; Gifu University Hospital (N.T., S.E., R.T., A.Y., T.W., T.K., Y.Y., H.K., H.U., H.O.).
  • Watanabe T; Gifu University Hospital (N.T., S.E., R.T., A.Y., T.W., T.K., Y.Y., H.K., H.U., H.O.).
  • Kawaguchi T; Gifu University Hospital (N.T., S.E., R.T., A.Y., T.W., T.K., Y.Y., H.K., H.U., H.O.).
  • Yamada Y; Gifu University Hospital (N.T., S.E., R.T., A.Y., T.W., T.K., Y.Y., H.K., H.U., H.O.).
  • Kanamori H; Gifu University Hospital (N.T., S.E., R.T., A.Y., T.W., T.K., Y.Y., H.K., H.U., H.O.).
  • Ushikoshi H; Gifu University Hospital (N.T., S.E., R.T., A.Y., T.W., T.K., Y.Y., H.K., H.U., H.O.).
  • Okura H; Gifu University Hospital (N.T., S.E., R.T., A.Y., T.W., T.K., Y.Y., H.K., H.U., H.O.).
Circ Arrhythm Electrophysiol ; : e012675, 2024 Sep 05.
Article en En | MEDLINE | ID: mdl-39234741
ABSTRACT

BACKGROUND:

Little is known about the role of atrial arrhythmias (AAs) in triggering Torsade de Pointes (TdP) in patients with long-QT syndrome (LQTS). The aim of this study was to examine the contribution of AAs to the development of TdP in acquired LQTS patients.

METHODS:

The initiation patterns of 81 episodes of TdP obtained from 34 consecutive acute acquired LQTS patients (14 men, median age, 69 years; median QTc, 645.5 ms) with documented TdP were analyzed. The initiation mode of TdP was divided into 3 categories (1) preceding short-long sequence (SLS); (2) sudden R-on-T phenomenon without preceding SLS; and (3) increased atrial rate. The patients were divided into 2 groups based on the presence or absence of AAs-induced TdP; AAs-induced (n=18) and non-AAs-induced (n=16) groups. The association of clinical/ECG characteristics and TdP frequency after initiating conventional therapy with AAs-induced TdP was evaluated. The groups were compared using the Mann-Whitney U test or Fisher exact test.

RESULTS:

AAs-induced group comprised 52.9% (18/34) of the patients studied. TdP was preceded by AAs-initiated SLSs in 41.2% (14/34) of the patients and was directly induced by R-on-T AAs (AAs coincidentally encountered a vulnerable repolarizing region during the T wave) in 23.5% (8/34). AAs triggered 48 (59.3%) of the 81 TdP episodes. AAs-initiated SLSs in 67.8% (40/59) of the SLS-induced TdP episodes. R-on-T AAs accounted for 23.5% (19/81) of the TdP episodes. AAs-induced group experienced TdP after initiating therapy more frequently than non-AAs-induced group (2.5 versus 1 event, P=0.008). AAs-induced group exhibited macroscopic T-wave alternans more frequently than non-AAs-induced group (6 versus 0, P=0.02).

CONCLUSIONS:

AAs play a key role in triggering TdP in more than half of patients with acute acquired LQTS and can increase TdP frequency after initiating therapy. Thus, AAs are not benign but rather can be life-threatening in patients with acute acquired LQTS.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Circ Arrhythm Electrophysiol Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Circ Arrhythm Electrophysiol Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos