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Electrocardiographic markers of repolarization heterogeneity during dofetilide or sotalol initiation for paroxysmal atrial fibrillation.
- Source :
-
The American journal of cardiology [Am J Cardiol] 2014 Jun 15; Vol. 113 (12), pp. 2030-5. Date of Electronic Publication: 2014 Apr 01. - Publication Year :
- 2014
-
Abstract
- Serial electrocardiographic monitoring of ΔQTc as an assumed harbinger of proarrhythmia is currently recommended for dofetilide and sotalol initiation. Markers of repolarization heterogeneity such as increased peak to end of T-wave (TpTe) duration and abnormal T-wave morphology may also predict proarrhythmia. We investigated whether such T-wave measurements on baseline electrocardiogram will correlate with ΔQTc after drug initiation. An analysis of 140 consecutive patients with paroxysmal atrial fibrillation hospitalized in sinus rhythm for sotalol or dofetilide initiation was performed. Baseline and serial electrocardiograms were analyzed using QT Guard Plus software (GE Healthcare), which measured QTc and TpTe and scored T-wave morphology for asymmetry, notching, and flatness using T-wave vector magnitude and principal component analysis algorithms. Sotalol and dofetilide were administered in 71% and 29% of patients, respectively. Mean age was 61 ± 14 years, and 34% were women. After a single dose of either drug, there was a statistically significant increase in QTc and TpTe (p <0.01), as well as composite and individual T-wave markers of repolarization heterogeneity (p <0.01). QTc increased by a mean of 19 ± 30 ms after initial antiarrhythmic dose. ΔQTc was inversely related to baseline QTc and TpTe (p <0.01). After controlling for baseline QTc, there was no independent association between T-wave markers of repolarization heterogeneity and ΔQTc. In conclusion, for patients with paroxysmal atrial fibrillation admitted for dofetilide or sotalol loading, T-wave markers of increased repolarization heterogeneity are measurable within hours after initiation. A shorter baseline QTc is associated with an increased ΔQTc; however, there is no independent relation between baseline T-wave markers of repolarization heterogeneity and ΔQTc.<br /> (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Subjects :
- Age Factors
Aged
Anti-Arrhythmia Agents administration & dosage
Atrial Fibrillation diagnosis
Cohort Studies
Diagnosis, Computer-Assisted methods
Dose-Response Relationship, Drug
Drug Administration Schedule
Electrocardiography methods
Female
Heart Rate drug effects
Heart Rate physiology
Humans
Logistic Models
Male
Middle Aged
Recovery of Function
Retrospective Studies
Risk Assessment
Sex Factors
Software
Tachycardia, Paroxysmal diagnosis
Treatment Outcome
Atrial Fibrillation drug therapy
Electrocardiography drug effects
Phenethylamines administration & dosage
Sotalol administration & dosage
Sulfonamides administration & dosage
Tachycardia, Paroxysmal drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1913
- Volume :
- 113
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- The American journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 24793679
- Full Text :
- https://doi.org/10.1016/j.amjcard.2014.03.047