Electrocardiographic Predictors of Torsadogenic Risk During Dofetilide or Sotalol Initiation: Utility of a Novel T Wave Analysis Program.

Abstract

INTRODUCTION:

Initiation of class III anti-arrhythmic medications requires telemetric monitoring for ventricular arrhythmias and QT prolongation to reduce the risk of torsades de pointes (TdP). Heart rate-corrected QT interval (QTc) is an indicator of risk, however it is imperfect, and subtle abnormalities of repolarization have been linked with arrhythmogenesis.

PURPOSE:

Identification of electrocardiographic predictors of torsadogenic risk through the application of a novel T wave analysis tool.

METHODS:

Among all patients admitted to Mayo Clinic for initiation of dofetilide or sotalol, we identified 13 cases who developed drug-induced TdP and 26 age and sex matched controls that did not develop TdP. The immediate pre-TdP ECG of those with TdP was compared to the last ECG performed prior to hospital discharge in controls using a novel T wave program that quantified subtle changes in T wave morphology.

RESULTS:

The QTc and 12 T wave parameters successfully distinguished TdP cases from controls. The top performing parameters were the QTc in lead V3 (mean case vs control 480 vs 420 msec, p < 0.001, r = 0.72) and T wave right slope in lead I (mean case vs control -840.29 vs -1668.71 mV/s, p = 0.002, r = 0.45). The addition of T wave right slope to QTc improved prediction accuracy from 79 to 88 %.

CONCLUSION:

Our data demonstrate that, in addition to QTc, the T wave right slope is correlated strongly with TdP risk. This suggests that a computer-based repolarization measurement tool that integrates additional data beyond the QTc may identify patients with the greatest torsadogenic potential.

• Authors: Alan Sugrue, Vaclav Kremen, Bo Qiang, Seth H Sheldon, Christopher V DeSimone, Yehu Sapir, Bryan L Striemer, Peter Brady, Samuel J Asirvatham, Michael J Ackerman, Paul Friedman, Peter A Noseworthy
• Journal: Cardiovascular drugs and therapy (Cardiovasc Drugs Ther) Vol. 29 Issue 5 Pg. 433-41 ( 2015) ISSN: 1573-7241 [Electronic] United States
• PMID: 26411977 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Arrhythmia Agents
• Phenethylamines
• Sulfonamides
• Sotalol
• dofetilide

Topics

• Aged
• Anti-Arrhythmia Agents (adverse effects)
• Case-Control Studies
• Electrocardiography (methods)
• Female
• Humans
• Male
• Middle Aged
• Phenethylamines (adverse effects)
• Predictive Value of Tests
• Software
• Sotalol (adverse effects)
• Sulfonamides (adverse effects)
• Torsades de Pointes (chemically induced, prevention & control)