Early repolarization is associated with a significantly increased risk of ventricular arrhythmias and sudden cardiac death in patients with structural heart diseases

Introduction: Idiopathic ventricular tachycardia and ventricular fibrillation, as causes of sudden cardiac death, are entities with mechanisms poorly studied and understood to date. The electrocardiogram (ECG) is a simple tool, but with great diagnostic and prognostic value, which has allowed the identification of certain markers associated with increased risk of development of malignant ventricular arrhythmias and sudden cardiac death. Methods: To identify the electrocardiographic markers related to the risk of developing idiopathic malignant ventricular arrhythmias, a review of the literature was performed, looking for the most recent articles with the greatest scientific impact on the topic. Outcome: Although the number of studies published to date is scarce, the published evidence has shown three electrocardiographic risk markers that have emerged in recent years and which have been related to the development of idiopathic malignant ventricular arrhythmias: the early repolarization (ER) pattern, QRS fragmentation (QRSF) and the Tpeak-Tend (Tp-Te) interval. The ECG marker that has shown most evidence to date is the pattern of ER, as a cause of changes in both ventricular depolarization and repolarization. The QRSF and the Tp-Te interval have also been related to the development of idiopathic ventricular arrhythmias, although with less evidence in this regard. Conclusion: In the last years, three electrocardiographic markers have appeared as variables related to the development of malignant ventricular arrhythmias, as is the case of ER, QRSF and Tp-Te interval. However, evidence is scarce in this specific patient profile and further randomized clinical trials are necessary to demonstrate its true relationship and usefulness.

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Abstract 2415: Long-Term Baroreflex Activation Therapy Increases the Threshold for the Induction of Lethal Ventricular Arrhythmias in Dogs with Chronic Advanced Heart Failure

Circulation ◽

10.1161/circ.118.suppl_18.s_722 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Mengjun Wang ◽

Valerio Zaca ◽

Alice Jiang ◽

Itamar Ilsar ◽

Matthew Ebinger ◽

...

Keyword(s):

Heart Failure ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Ventricular Arrhythmias ◽

Lv Function ◽

Baroreflex Activation Therapy ◽

Increased Risk ◽

Lv Remodeling ◽

Activation Therapy

Heart failure (HF) is associated with a high incidence of ventricular tachycardia (VT) and fibrillation (VF). Patients with HF in whom these lethal arrhythmias can be induced by electrophysiological (EP) testing carry a high risk of sudden cardiac death. We showed that chronic electrical carotid baroreflex activation therapy (BAT) with the Rheos® System (CVRx, Inc.) improves LV function, attenuates LV remodeling and restores autonomic sympathetic-parasympathetic balance in dogs with HF. This study examined the effects of long-term therapy with BAT on the induction of VT or VF in dogs with coronary microembolization-induced HF (LV ejection fraction ~20%). Eleven dogs with HF underwent EP testing at baseline prior to therapy and after 3 and 6 months of therapy with BAT and again 6 weeks after withdrawal of BAT therapy (n = 7) or no therapy at all (Control, n = 4). Programmed ventricular stimulation was performed from the right ventricular apex and included delivery of up to 4 extrastimuli at progressively shorter coupling intervals (in steps of 10 msec). The extrastimuli were delivered following 8 ventricular paced beats with a drive cycle length between 600 and 200 msec. If a sustained monomorphic VT or VF could not be induced, isoproterenol infusion was initiated to increase the sinus rate by ~30% and the EP stimulation protocol was repeated. At baseline, a sustained VT or VF was induced in all 11 dogs (100%). After 3 and 6 months of follow-up, all Control dogs (100%) were induced into sustained VT or VF. After 3 months of BAT, only 3 of 7 dogs (43%) were induced into sustained VT or VF. After 6 months of BAT, only 2 of 7 dogs (29%) were induced into sustained VT or VF. Finally after withdrawal of BAT therapy, all dogs (100%) were again induced into systained VT or VF. In addition to improving LV function and attenuating LV remodeling, long-term monotherapy with BAT markedly increases the threshold for lethal ventricular arrhythmias in dogs with chronic HF. This is a marked improvement over inducibility of lethal arrhythmias seen in historical untreated controls. This benefit of BAT supports the continued exploration of this device as a therapeutic modality for treating patients with chronic HF and increased risk of sudden cardiac death.

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Common RyR2 variants associate with ventricular arrhythmias and sudden cardiac death in chronic heart failure

Clinical Science ◽

10.1042/cs20090656 ◽

2010 ◽

Vol 119 (5) ◽

pp. 215-226 ◽

Cited By ~ 19

Author(s):

Yuqin Ran ◽

Jingzhou Chen ◽

Ning Li ◽

Weili Zhang ◽

Li Feng ◽

...

Keyword(s):

Heart Failure ◽

Sudden Cardiac Death ◽

Chronic Heart Failure ◽

Cardiac Death ◽

Ventricular Arrhythmias ◽

Protective Factor ◽

Critical Role ◽

Functional Variants ◽

Increased Risk ◽

Genes Encoding

Ca2+ cycling plays a critical role in heart failure and lethal arrhythmias. As susceptibility to sudden cardiac death is considered to be a heritable trait in general population, we have therefore investigated whether potentially functional variants of genes encoding RyR2 (ryanodine receptor 2) and the L-type Ca2+ channel are related to the risk of ventricular arrhythmias and sudden cardiac death in CHF (chronic heart failure) in a case-control study. We found that the A allele of rs3766871 in RYR2 was associated with an increased risk of ventricular arrhythmias in patients with CHF {odds ratio, 1.66 [95% CI (confidence interval), 1.21–2.26]; P=0.002}. During a median follow-up period of 32 months in 1058 (85.0%) patients, 296 (28.0%) patients died from heart failure, of whom 141 (47.6%) had sudden cardiac death. After adjustment for age, gender and suspected risk factors, patients carrying the A allele of rs3766871 had an increased risk of cardiac death {HR (hazard ratio), 1.53 [95% CI, 1.11–2.12]; P=0.010} and sudden cardiac death [HR, 1.92 (95% CI, 1.25–2.94); P=0.003]. Patients carrying the A allele of rs790896 in RYR2 had a reduced risk of sudden cardiac death [HR, 0.65 (95% CI, 0.45–0.92); P=0.015]. In conclusion, the A allele of rs3766871 in RYR2 not only associates with ventricular arrhythmias, but also serves as an independent predictor of sudden cardiac death, and the A allele of rs790896 in RYR2 is a protective factor against sudden cardiac death in patients with CHF.

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Arrhythmic Sudden Cardiac Death and the Role of Implantable Cardioverter-Defibrillator in Patients with Cardiac Amyloidosis—A Narrative Literature Review

Journal of Clinical Medicine ◽

10.3390/jcm10091858 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1858

Author(s):

Aleksandra Liżewska-Springer ◽

Grzegorz Sławiński ◽

Ewa Lewicka

Keyword(s):

Sudden Cardiac Death ◽

Implantable Cardioverter Defibrillator ◽

Cardiac Death ◽

Ventricular Arrhythmias ◽

Cardiac Amyloidosis ◽

Cardioverter Defibrillator ◽

Increased Risk ◽

Narrative Literature ◽

Narrative Literature Review

Cardiac amyloidosis (CA) is considered to be associated with an increased risk of sudden cardiac death (SCD) due to ventricular tachyarrhythmias and electromechanical dissociation. However, current arrhythmic risk stratification and the role of an implantable cardioverter-defibrillator (ICD) for primary prevention of SCD remains unclear. This article provides a narrative review of the literature on electrophysiological abnormalities in the context of ventricular arrhythmias in patients with CA and the role of ICD in terms of survival benefit in this group of patients.

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Electrocardiographic Changes in Athletes of Black Ethnicity

International Cardiovascular Forum Journal ◽

10.17987/icfj.v13i0.484 ◽

2018 ◽

Vol 13 ◽

Author(s):

Dillan Ismail ◽

Anders Eriksson ◽

Stellan Mörner ◽

Annika Rydberg

Keyword(s):

Sudden Cardiac Death ◽

Cardiac Death ◽

Heart Diseases ◽

Cardiac Events ◽

St Segment Elevation ◽

Positive Effects ◽

African Heritage ◽

St Segment ◽

Increased Risk ◽

Electrocardiographic Changes

AbstractIntensive participation in sport has positive physiological effects on the heart. The contractility of the heart improves, the ejection fraction increases and the muscle mass of the heart increases, thus leading to a greater cardiac output. Despite these positive effects, there is still an increased risk for acute cardiac events. The workload of the heart can be very high in some sports and may in some cases be the reason for sudden cardiac death. In these cases, there is often an underlying heart disease (cardiomyopathy) unknown before the actual event. Electrocardiographic examination (ECG) may reveal some of these diseases but although ECG examinations can be a useful tool to discover pathological conditions, there could be difficulties in interpreting different ECG patterns, especially in athletes. In some cases, athletes may exhibit ECG patterns that are similar to those in heart diseases such as cardiomyopathies (QRS-amplitudes, ST-segment elevation and T wave inversions in lateral leads). This pattern is even more common in athletes of African origins. Furthermore, cardiomyopathies such as hypertrophic cardiomyopathy (HCM) are more common among athletes with African heritage than in white athletes. Thus correct interpretation of ECG is crucial for several reasons: to distinguish between benign physiological (‘athlete’s heart’) and pathological changes, to lower the risk of sudden cardiac death, and to save time and money by not undertaking further examination of the heart.

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Early repolarization pattern and syndrome — norm or pathology?

Medical alphabet ◽

10.33667/2078-5631-2020-25-38-41 ◽

2020 ◽

pp. 38-41

Author(s):

A. L. Bobrov

Keyword(s):

Sudden Cardiac Death ◽

Cardiac Death ◽

Structural Heart Disease ◽

Polymorphic Ventricular Tachycardia ◽

Early Repolarization ◽

Multicenter Studies ◽

St Segment ◽

Increased Risk ◽

Ecg Leads ◽

J Wave

The review article is devoted to the diagnosis and clinical significance of early ventricular repolarization phenomenon and syndrome. Just 13 years ago, the phenomenon was recognized as an unambiguous version of the norm. However, the results of a series of multicenter studies have shown that the phenomenon is associated with an increased risk of sudden cardiac death. The following criteria are recognized as criteria for early repolarization: the presence of a notch or a junction wave on the descending part of the R wave with a concomitant (or absent) elevation of the ST segment (at the Jt point); J wave (point) ≥0.1mV peak elevation (at Jp point) in ≥2 adjacent 12-channel ECG leads, except for V1–3 leads; QRS duration, measured in leads with J wave (point) <120 ms. Early repolarization syndrome is a clinical condition involving a combination of the pattern of early repolarization and polymorphic ventricular tachycardia, ventricular fibrillation and/or sudden cardiac death in persons without structural heart disease. Treatment is required in patients with a symptom of ventricular tacharrhythmia or family history early repolarization with sudden cardiac death.

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Arrhythmogenic right ventricular dysplasia/cardiomyopathy

Cardiology in the Young ◽

10.1017/s1047951116002249 ◽

2017 ◽

Vol 27 (S1) ◽

pp. S57-S61 ◽

Cited By ~ 3

Author(s):

Gabriela M. Orgeron ◽

Jane E. Crosson

Keyword(s):

Sudden Cardiac Death ◽

Right Ventricular ◽

Cardiac Death ◽

Ventricular Arrhythmias ◽

Arrhythmogenic Right Ventricular Dysplasia ◽

Pharmacological Therapy ◽

Implantable Defibrillators ◽

Right Ventricular Dysplasia ◽

Inherited Cardiomyopathy ◽

Increased Risk

AbstractArrhythmogenic right ventricular dysplasia/cardiomyopathy is an inherited cardiomyopathy characterised by ventricular arrhythmias and an increased risk of sudden cardiac death. Arrhythmogenic right ventricular dysplasia/cardiomyopathy diagnosis is based on criteria that take into account electrical and structural cardiac abnormalities, as well as mutation analysis. Appropriate pharmacological therapy and the prevention of sudden death with implantable defibrillators are important in the management of these patients. Exercise is considered an important environmental factor for the development and progression of the disease.

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The Early Repolarization ECG Pattern – An Update

Acta Medica Marisiensis ◽

10.1515/amma-2017-0032 ◽

2017 ◽

Vol 63 (4) ◽

pp. 165-169

Author(s):

István Adorján Szabó ◽

Annamária Fárr ◽

Ildikó Kocsis ◽

Lehel Máthé ◽

László Szilágyi ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Ventricular Fibrillation ◽

Cardiac Death ◽

Epidemiological Data ◽

Early Repolarization ◽

Future Directions ◽

Idiopathic Ventricular Fibrillation ◽

Increased Risk ◽

Long Time ◽

J Wave

AbstractEarly repolarization pattern (ERP), a form of J-wave syndromes, was considered long time a benign ECG phenomenon. However, recent data confirmed that certain phenotypes of ERP are related to an increased risk of sudden cardiac death (idiopathic ventricular fibrillation). Our paper gives a short and practical update regarding the main issues related to ERP: epidemiological data, molecular and electrophysiological background, clinical significance and risk stratification. At the end, the future directions of research and clinical management related to ERP are presented.

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Ventricular Arrhythmias in Cardiac Sarcoidosis

Circulation ◽

10.1161/circulationaha.118.034687 ◽

2018 ◽

Vol 138 (12) ◽

pp. 1253-1264 ◽

Cited By ~ 10

Author(s):

David R. Okada ◽

John Smith ◽

Arsalan Derakhshan ◽

Zain Gowani ◽

Satish Misra ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Cardiac Death ◽

Ventricular Arrhythmias ◽

Antiarrhythmic Drugs ◽

Consensus Statement ◽

Cardiac Sarcoidosis ◽

Heart Rhythm ◽

Immunosuppressant Therapy ◽

Cardioverter Defibrillator ◽

Increased Risk

The diagnosis of cardiac sarcoidosis (CS), especially in cases where there is limited or no extracardiac involvement, is challenging. Patients with CS are at increased risk of ventricular arrhythmias and sudden cardiac death. Several techniques for risk stratification for sudden cardiac death have been proposed in this population, including advanced cardiac imaging and electrophysiology study. Clinical ventricular arrhythmias in patients with CS may be treated with immunosuppressant therapy, antiarrhythmic drugs, catheter ablation, or implantable cardioverter-defibrillator placement. This article will provide an update on techniques for diagnosing CS, risk stratifying patients with CS for sudden cardiac death, and treating patients with CS with ventricular arrhythmias, focusing on evidence that has become available since publication of the 2014 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Management of Arrhythmias Associated With Cardiac Sarcoidosis.

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