Roles of Atrial Arrhythmias in Triggering Torsade de Pointes in Patients With Acquired Long-QT Syndrome.

IF 9.1 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation. Arrhythmia and electrophysiology Pub Date : 2024-09-05 DOI:10.1161/CIRCEP.123.012675

Nobuhiro Takasugi, Susumu Endo, Mieko Takasugi, Ryota Tochibora, Akihiro Yoshida, Takatomo Watanabe, Tomonori Kawaguchi, Yoshihisa Yamada, Hiromitsu Kanamori, Hiroaki Ushikoshi, Hiroyuki Okura

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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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房性心律失常在诱发获得性长 QT 综合征患者 Torsade de Pointes 中的作用。

背景：人们对房性心律失常（AAs）在诱发长QT综合征（LQTS）患者的Torsade de Pointes（TdP）中的作用知之甚少。本研究旨在探讨 AAs 对获得性 LQTS 患者 TdP 发生的影响：方法：分析了连续 34 例急性获得性 LQTS 患者（14 例男性，中位年龄 69 岁，中位 QTc 645.5 毫秒）中有记录的 81 次 TdP 的起始模式。TdP 的起始模式分为 3 类：（1）先兆短长序列（SLS）；（2）无先兆 SLS 的突发 R-on-T 现象；（3）心房率增快。根据有无AAs诱导的TdP将患者分为两组：AAs诱导组（18人）和非AAs诱导组（16人）。评估了临床/ECG 特征和开始常规治疗后的 TdP 频率与 AAs 诱导的 TdP 的相关性。各组间的比较采用 Mann-Whitney U 检验或 Fisher exact 检验：结果：AAs诱发组占研究患者的52.9%（18/34）。41.2%的患者（14/34）在TdP之前由AA引发SLS，23.5%的患者（8/34）由R-on-T AAs直接诱发（AAs在T波期间巧遇易受影响的再极化区域）。在 81 次 TdP 发作中，有 48 次（59.3%）由 AAs 触发。在 SLS 诱导的 TdP 发作中，67.8%（40/59）的 SLS 由 AA 引发。R-on-T配气占 TdP 发作的 23.5%（19/81）。与非 AAs 诱发组相比，AAs 诱发组在开始治疗后发生 TdP 的频率更高（2.5 次对 1 次，P=0.008）。AAs诱导组比非AAs诱导组更频繁地出现宏观T波交替（6对0，P=0.02）：结论：AAs 在引发半数以上急性获得性 LQTS 患者的 TdP 中起着关键作用，并可在开始治疗后增加 TdP 频率。因此，在急性获得性 LQTS 患者中，AAs 并非良性，反而可能危及生命。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Circulation. Arrhythmia and electrophysiology 医学-心血管系统

CiteScore

13.70

自引率

4.80%

发文量

187

审稿时长

4-8 weeks

期刊介绍： Circulation: Arrhythmia and Electrophysiology is a journal dedicated to the study and application of clinical cardiac electrophysiology. It covers a wide range of topics including the diagnosis and treatment of cardiac arrhythmias, as well as research in this field. The journal accepts various types of studies, including observational research, clinical trials, epidemiological studies, and advancements in translational research.

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