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Münkler P, Klatt N, Scherschel K, Kuklik P, Jungen C, Cavus E, Eickholt C, Christoph J, Lemoine MD, Christ T, Willems S, Riedel R, Kirchhof P, Meyer C. Repolarization indicates electrical instability in ventricular arrhythmia originating from papillary muscle. Europace 2022; 25:688-697. [PMID: 35989424 PMCID: PMC9935011 DOI: 10.1093/europace/euac126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 06/30/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Cardiac arrhythmia originating from the papillary muscle (PM) can trigger ventricular fibrillation (VF) and cause sudden cardiac death even in the absence of structural heart disease. Most premature ventricular contractions, however, are benign and hitherto difficult to distinguish from a potentially fatal arrhythmia. Altered repolarization characteristics are associated with electrical instability, but electrophysiological changes which precede degeneration into VF are still not fully understood. METHODS AND RESULTS Ventricular arrhythmia (VA) was induced by aconitine injection into PMs of healthy sheep. To investigate mechanisms of degeneration of stable VA into VF in structurally healthy hearts, endocardial high-density and epicardial mapping was performed during sinus rhythm (SR) and VA. The electrical restitution curve, modelling the relation of diastolic interval and activation recovery interval (a surrogate parameter for action potential duration), is steeper in VA than in non-arrhythmia (ventricular pacing and SR). Steeper restitution curves reflect electrical instability and propensity to degenerate into VF. Importantly, we find the parameter repolarization time in relation to cycle length (RT/CL) to differentiate self-limiting from degenerating arrhythmia with high specificity and sensitivity. CONCLUSION RT/CL may serve as a simple index to aid differentiation between self-limiting and electrically instable arrhythmia with the propensity to degenerate to VF. RT/CL is independent of cycle length and could easily be measured to identify electrical instability in patients.
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Affiliation(s)
- Paula Münkler
- Corresponding author. Tel: +49 040 7410 0; fax: +49 040 7410 55862. E-mail address:
| | - Niklas Klatt
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Katharina Scherschel
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany,Division of Cardiology, Angiology and Intensive Care, Cardiac Neuro- and Electrophysiology Research Consortium (cNEP), EKV Düsseldorf, Düsseldorf, Germany,Cardiac Neuro- and Electrophysiology Research Consortium (cNEP), Medical Faculty, Heinrich Heine University Düsseldorf, Kirchfeldstraße 40, 40217, Düsseldorf, Germany
| | - Pawel Kuklik
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany,Department of Cardiology, Asklepios Hospital St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Christiane Jungen
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany,Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ersin Cavus
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Christian Eickholt
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany,Department of Cardiology, Asklepios Hospital St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Jan Christoph
- Cardiovascular Research Institute University of California, San Francisco, 555 Mission Bay Blvd South, 352S, San Francisco, CA, USA
| | - Marc D Lemoine
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Torsten Christ
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany,Institute of Experimental Pharmacology and Toxicology, University Medical Centre, Martinistraße 52, 20246 Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany,Department of Cardiology, Asklepios Hospital St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - René Riedel
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany,Max Planck Institute for Evolutionary Biology, Plön, Germany,German Rheumatism Research Centre Berlin—an Institute of the Leibniz Association, Berlin, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Christian Meyer
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany,Division of Cardiology, Angiology and Intensive Care, Cardiac Neuro- and Electrophysiology Research Consortium (cNEP), EKV Düsseldorf, Düsseldorf, Germany,Cardiac Neuro- and Electrophysiology Research Consortium (cNEP), Medical Faculty, Heinrich Heine University Düsseldorf, Kirchfeldstraße 40, 40217, Düsseldorf, Germany
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Al-Nimer MS, Al-Mahdawi SA, Abdullah NM, Al-Mahdawi A. Epileptic Patients are at Risk of Cardiac Arrhythmias: A Novel Approach using QT-nomogram, Tachogram, and Cardiac Restitution Plots. J Neurosci Rural Pract 2017; 8:7-13. [PMID: 28149075 PMCID: PMC5225727 DOI: 10.4103/0976-3147.193553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Sudden death is reported in patients who had a history of epilepsy and some authors believed that is due to cardiac arrhythmias. OBJECTIVES This study aimed to predict that the epileptic patients are at risk of serious cardiac arrhythmias by QT-nomogram, tachogram (Lorenz), and cardiac restitution plots. METHODS A total number of 71 healthy subjects (Group I) and 64 newly diagnosed epileptic patients (Group II) were recruited from Al-Yarmouk and Baghdad Teaching hospitals in Baghdad from March 2015 to July 2015 and included in this study. The diagnosis of epilepsy achieved clinically, electroencephalograph record and radio-images including computerized tomography and magnetic image resonance. At the time of entry into the study, an electrocardiography (ECG) was done, and the determinants of each ECG record were calculated. The QT-nomogram, tachogram, and cardiac restitution plots were used to identify the patients at risk of cardiac arrhythmias. RESULTS Significant prolonged corrected QT corrected (QTc) and JT corrected intervals were observed in female compared with male at age ≥50 years while the TQ interval was significantly prolonged in males of Group II. Eight patients of Group II had a significant pathological prolonged QTc interval compared with undetectable finding in Group I. QT nomogram did not disclose significant findings while the plots of Lorenz and restitution steepness disclose that the patients of Group II were vulnerable to cardiac arrhythmias. Abnormal ECG findings were observed in the age extremities (≤18 years and ≥50 years) in Group II compared with Group I. CONCLUSION Utilization of QT-nomogram, restitution steepness, and tachogram plots is useful tools for detection subclinical vulnerable epileptic patient with cardiac arrhythmias.
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Affiliation(s)
- Marwan S Al-Nimer
- Department of Pharmacology, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq; Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Sura A Al-Mahdawi
- Department of Pharmacology, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
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