[Ventricular arrhythmias and the ATc index in patients with ischemic heart disease]
J Foremny1, E Nowalany-Kozielska, P Buszman
1I Klinika Kardiologii IK Sl. AM w Katowicach.
Insights
Prolonged QT corrected (QTc) intervals were not linked to ventricular arrhythmias in ischemic heart disease patients. However, increased QTc was associated with a higher incidence of documented ventricular tachycardia/fibrillation (VT/VF).
Area of Science:
- Cardiology
- Electrophysiology
- Internal Medicine
Background:
- Ischemic heart disease (IHD) patients often exhibit arrhythmias.
- QTc interval prolongation is a risk factor for cardiac events.
- The relationship between QTc prolongation and ventricular arrhythmias in IHD requires further clarification.
Purpose of the Study:
- To investigate the association between QTc interval prolongation and ventricular arrhythmias in patients with ischemic heart disease.
- To compare QTc values across different Lown's criteria for ventricular arrhythmias.
- To determine if QTc prolongation predicts the occurrence of sustained ventricular tachycardia/fibrillation (VT/VF).
Main Methods:
- A multicenter study included 1,011 IHD patients.
- Standard 12-lead ECG and 24-hour ambulatory ECG monitoring were performed.
- QTc interval was calculated using Bazett's formula; prolonged QTc was defined as >440 ms.
- Ventricular ectopic activity was classified using Lown's criteria.
Main Results:
- No significant differences in mean QTc values were found across Lown's arrhythmia classes.
- The prevalence of prolonged QTc was similar between low-grade (0-2) and high-grade (3-5) arrhythmias (21% vs. 28%).
- Patients with a history of documented VT/VF showed a higher incidence of QTc prolongation (35% vs. 20%, p=0.043).
Conclusions:
- QTc prolongation is not directly correlated with the presence or severity of ventricular arrhythmias in IHD patients.
- Increased QTc interval may be a risk factor for the occurrence of VT/VF in this population.
- Further research is needed to elucidate the predictive value of QTc prolongation for adverse events in IHD.
Abstract:
In this multicenter study a group of 1,011 patients (233 females and 778 males, aged 23-68 years, mean 53) with ischaemic heart disease was included. Only nitrates, nifedipine and diuretics were administered during the investigation. Presence of other chronic disease excluded the patients from study group. In all patients a standard 12-lead electrocardiogram was obtained, from which the QT interval was measured, and its corrected value according to the Bazett's formula calculated [formula: see text] values greater than 440 ms were regarded to be abnormal. A 24-hour ecg ambulatory monitoring was also performed in each patient, and the detected ventricular ectopic activity was classified using the Lown's criteria. Mean QTc values were compared between each class of ventricular arrhythmia. No significant differences were disclosed. All the means were below 440 ms. Also the percentages of patients with a prolonged QTc were similar for all Lown classes of arrhythmia. The patients were then divided into two larger groups: Those with low grade (class 0-2) and high grade (class 3-5) arrhythmia. The portion of patients with the pathologic QTc was not significantly different (21% vs. 28%, NS). Such incidence of QTc prolongation was described for clinically healthy population. Since a 24-hour ecg fails to disclose the entire spectrum of arrhythmia in each individual, the fraction of patients with documented VT/VF in the past was analyzed separately. This subgroup was characterized by more frequent occurrence of QTc prolongation than other patients (35% vs. 20%, p = 0.043). Thus, no firm relationship was found between QTc prolongation and ventricular arrhythmias, but increased QTc favoured the occurrence of VT/VF.
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