QTc compared to JTc for monitoring drug-induced repolarization changes in the setting of ventricular pacing

Shane F. Tsai, Mahmoud Houmsse, Barrah Dakhil, Ralph Augostini, John D. Hummel, Steven J. Kalbfleisch, Zhengou Liu, Charles Love, Troy Rhodes, Jaret Tyler, Raul Weiss, Ismail Hamam, Marshall Winner, Emile G. Daoud

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background QT prolongation is a risk factor for proarrhythmia when beginning antiarrhythmic drug therapy (AAD). However, there are no data regarding monitoring repolarization changes during a ventricular paced (VP) rhythm. Objective The purpose of this study was to compare serial changes in corrected QT and JT intervals, during native conduction (NC) and VP rhythms when initiating Class III AADs. Methods Twenty-two patients (73% men; mean age 65 ± 11 years) with an implantable device and with <10% VP were monitored during AAD initiation (16 sotalol, 6 dofetilide). QTc and JTc were measured from ECGs obtained during NC and VP at baseline (pre-AAD) and then after each AAD dose. Results During AAD loading, mean QTc increased significantly during NC (431 ± 28 ms to 463 ± 33 ms, P =.002) but not with VP (520 ± 48 ms to 538 ± 45 ms, P =.07). Mean percent increase in peak QTc during NC was significantly greater than during VP (12% vs 7%, P =.003). In contrast, peak JTc during AAD loading was not significantly different between NC and VP (P =.67). Conclusion When initiating AAD, the change in QTc during VP does not correlate with the change in QTc during NC; thus, the VP QTc is inadequate for monitoring repolarization changes. However, VP JTc correlates well with JTc during NC. When initiating Class III AADs in patients with VP rhythms, the JTc, and not the QTc, interval is the useful marker for assessing repolarization.

Original languageEnglish (US)
Pages (from-to)485-491
Number of pages7
JournalHeart Rhythm
Volume11
Issue number3
DOIs
StatePublished - Mar 1 2014

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Drug Monitoring
Anti-Arrhythmia Agents
Drug Therapy
Sotalol
Electrocardiography
Equipment and Supplies

Keywords

  • Antiarrhythmic drug
  • Electrocardiography
  • JT interval
  • Pacing
  • QT interval
  • Repolarization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Tsai, S. F., Houmsse, M., Dakhil, B., Augostini, R., Hummel, J. D., Kalbfleisch, S. J., ... Daoud, E. G. (2014). QTc compared to JTc for monitoring drug-induced repolarization changes in the setting of ventricular pacing. Heart Rhythm, 11(3), 485-491. https://doi.org/10.1016/j.hrthm.2013.11.017

QTc compared to JTc for monitoring drug-induced repolarization changes in the setting of ventricular pacing. / Tsai, Shane F.; Houmsse, Mahmoud; Dakhil, Barrah; Augostini, Ralph; Hummel, John D.; Kalbfleisch, Steven J.; Liu, Zhengou; Love, Charles; Rhodes, Troy; Tyler, Jaret; Weiss, Raul; Hamam, Ismail; Winner, Marshall; Daoud, Emile G.

In: Heart Rhythm, Vol. 11, No. 3, 01.03.2014, p. 485-491.

Research output: Contribution to journalArticle

Tsai, SF, Houmsse, M, Dakhil, B, Augostini, R, Hummel, JD, Kalbfleisch, SJ, Liu, Z, Love, C, Rhodes, T, Tyler, J, Weiss, R, Hamam, I, Winner, M & Daoud, EG 2014, 'QTc compared to JTc for monitoring drug-induced repolarization changes in the setting of ventricular pacing', Heart Rhythm, vol. 11, no. 3, pp. 485-491. https://doi.org/10.1016/j.hrthm.2013.11.017
Tsai, Shane F. ; Houmsse, Mahmoud ; Dakhil, Barrah ; Augostini, Ralph ; Hummel, John D. ; Kalbfleisch, Steven J. ; Liu, Zhengou ; Love, Charles ; Rhodes, Troy ; Tyler, Jaret ; Weiss, Raul ; Hamam, Ismail ; Winner, Marshall ; Daoud, Emile G. / QTc compared to JTc for monitoring drug-induced repolarization changes in the setting of ventricular pacing. In: Heart Rhythm. 2014 ; Vol. 11, No. 3. pp. 485-491.
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title = "QTc compared to JTc for monitoring drug-induced repolarization changes in the setting of ventricular pacing",
abstract = "Background QT prolongation is a risk factor for proarrhythmia when beginning antiarrhythmic drug therapy (AAD). However, there are no data regarding monitoring repolarization changes during a ventricular paced (VP) rhythm. Objective The purpose of this study was to compare serial changes in corrected QT and JT intervals, during native conduction (NC) and VP rhythms when initiating Class III AADs. Methods Twenty-two patients (73{\%} men; mean age 65 ± 11 years) with an implantable device and with <10{\%} VP were monitored during AAD initiation (16 sotalol, 6 dofetilide). QTc and JTc were measured from ECGs obtained during NC and VP at baseline (pre-AAD) and then after each AAD dose. Results During AAD loading, mean QTc increased significantly during NC (431 ± 28 ms to 463 ± 33 ms, P =.002) but not with VP (520 ± 48 ms to 538 ± 45 ms, P =.07). Mean percent increase in peak QTc during NC was significantly greater than during VP (12{\%} vs 7{\%}, P =.003). In contrast, peak JTc during AAD loading was not significantly different between NC and VP (P =.67). Conclusion When initiating AAD, the change in QTc during VP does not correlate with the change in QTc during NC; thus, the VP QTc is inadequate for monitoring repolarization changes. However, VP JTc correlates well with JTc during NC. When initiating Class III AADs in patients with VP rhythms, the JTc, and not the QTc, interval is the useful marker for assessing repolarization.",
keywords = "Antiarrhythmic drug, Electrocardiography, JT interval, Pacing, QT interval, Repolarization",
author = "Tsai, {Shane F.} and Mahmoud Houmsse and Barrah Dakhil and Ralph Augostini and Hummel, {John D.} and Kalbfleisch, {Steven J.} and Zhengou Liu and Charles Love and Troy Rhodes and Jaret Tyler and Raul Weiss and Ismail Hamam and Marshall Winner and Daoud, {Emile G.}",
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T1 - QTc compared to JTc for monitoring drug-induced repolarization changes in the setting of ventricular pacing

AU - Tsai, Shane F.

AU - Houmsse, Mahmoud

AU - Dakhil, Barrah

AU - Augostini, Ralph

AU - Hummel, John D.

AU - Kalbfleisch, Steven J.

AU - Liu, Zhengou

AU - Love, Charles

AU - Rhodes, Troy

AU - Tyler, Jaret

AU - Weiss, Raul

AU - Hamam, Ismail

AU - Winner, Marshall

AU - Daoud, Emile G.

PY - 2014/3/1

Y1 - 2014/3/1

N2 - Background QT prolongation is a risk factor for proarrhythmia when beginning antiarrhythmic drug therapy (AAD). However, there are no data regarding monitoring repolarization changes during a ventricular paced (VP) rhythm. Objective The purpose of this study was to compare serial changes in corrected QT and JT intervals, during native conduction (NC) and VP rhythms when initiating Class III AADs. Methods Twenty-two patients (73% men; mean age 65 ± 11 years) with an implantable device and with <10% VP were monitored during AAD initiation (16 sotalol, 6 dofetilide). QTc and JTc were measured from ECGs obtained during NC and VP at baseline (pre-AAD) and then after each AAD dose. Results During AAD loading, mean QTc increased significantly during NC (431 ± 28 ms to 463 ± 33 ms, P =.002) but not with VP (520 ± 48 ms to 538 ± 45 ms, P =.07). Mean percent increase in peak QTc during NC was significantly greater than during VP (12% vs 7%, P =.003). In contrast, peak JTc during AAD loading was not significantly different between NC and VP (P =.67). Conclusion When initiating AAD, the change in QTc during VP does not correlate with the change in QTc during NC; thus, the VP QTc is inadequate for monitoring repolarization changes. However, VP JTc correlates well with JTc during NC. When initiating Class III AADs in patients with VP rhythms, the JTc, and not the QTc, interval is the useful marker for assessing repolarization.

AB - Background QT prolongation is a risk factor for proarrhythmia when beginning antiarrhythmic drug therapy (AAD). However, there are no data regarding monitoring repolarization changes during a ventricular paced (VP) rhythm. Objective The purpose of this study was to compare serial changes in corrected QT and JT intervals, during native conduction (NC) and VP rhythms when initiating Class III AADs. Methods Twenty-two patients (73% men; mean age 65 ± 11 years) with an implantable device and with <10% VP were monitored during AAD initiation (16 sotalol, 6 dofetilide). QTc and JTc were measured from ECGs obtained during NC and VP at baseline (pre-AAD) and then after each AAD dose. Results During AAD loading, mean QTc increased significantly during NC (431 ± 28 ms to 463 ± 33 ms, P =.002) but not with VP (520 ± 48 ms to 538 ± 45 ms, P =.07). Mean percent increase in peak QTc during NC was significantly greater than during VP (12% vs 7%, P =.003). In contrast, peak JTc during AAD loading was not significantly different between NC and VP (P =.67). Conclusion When initiating AAD, the change in QTc during VP does not correlate with the change in QTc during NC; thus, the VP QTc is inadequate for monitoring repolarization changes. However, VP JTc correlates well with JTc during NC. When initiating Class III AADs in patients with VP rhythms, the JTc, and not the QTc, interval is the useful marker for assessing repolarization.

KW - Antiarrhythmic drug

KW - Electrocardiography

KW - JT interval

KW - Pacing

KW - QT interval

KW - Repolarization

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