Abstract P130: QTc Prolongation in Acute Medullary Infarction Maps to the Dorsal Vagal Nucleus

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Goun Je ◽  
Yuyao Sun ◽  
Kiandokht Keyhanian ◽  
Nils Henninger
Keyword(s):  
Ischemic Stroke ◽  
Sudden Cardiac Death ◽  
Cardiac Arrhythmia ◽  
Cardiac Death ◽  
Spatial Relationship ◽  
Causal Link ◽  
Qtc Prolongation ◽  
Significant Difference ◽  
Segmentation Approach ◽  
Medullary Infarction

Objective: To determine the spatial relationship between acute medullary infarction and QTc prolongation. Background: Ischemic stroke has been associated with QTc-prolongation which increases the risk of cardiac arrhythmia and sudden cardiac death. In particular, pathological arrhythmia and unexpected sudden cardiac death has been described after acute medullary infarction (AMI). Nevertheless, it is not well understood why only as subset of patients with AMI develop significant cardiac arrhythmia. To gain insight into this issue, we sought to determine the possible anatomical structures relating to QTc-prolongation in patients. Methods: We retrospectively reviewed 1072 consecutive adult patients admitted for an acute ischemic stroke or a transient ischemic attack, who presented within 4.5 hours from the last known well time and had an admission ECG available. 724 patients had brain MRIs and among these, 13 (1.8 %) patients had an AMI and were included. For an unbiased lesion analyses, medullary infarcts were manually outlined on diffusion weighted MRI and manually co-registered with an anatomical atlas. Infarct lesions were then superimposed on each other as stratified by normal versus prolonged (men > 430 ms, women > 450 ms) QTc to determine the area of greatest degree of congruence. Results: 76.9 % of patients (10 out of 13, 9 men and 1 woman) had a prolonged QTc (476.9 ± 43.3 ms for men, 515 ms for women). There was no significant difference in electrolyte levels and preexisting comorbidities between subjects with normal and prolonged QTc. Among patients with QTc prolongation, the greatest degree of congruence of the infarct location was the dorsal vagal nucleus (DVN, 7 out of 10 patients). Conclusions: Our unbiased lesion segmentation approach identified the DVN a key anatomical substrate related to QTc-prolongation. Biological plausibility of our data and the presence of a causal link between the DVN and cardiac arrhythmia stems from the prior animal experimental data showing that selectively silencing the DVN via a pharmacogenetic approach caused QTc-prolongation in the rat. Further studies with more patients and high-resolution, volumetric MRI are needed to confirm our findings.

scholarly journals Non-invasive detection of exercise-induced cardiac conduction abnormalities in sudden cardiac death survivors in the inherited cardiac conditions

EP Europace ◽  
2020 ◽  
Author(s):  
Kevin Ming Wei Leong ◽  
Fu Siong Ng ◽  
Matthew J Shun-Shin ◽  
Michael Koa-Wing ◽  
Norman Qureshi ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Recovery Period ◽  
Lower Score ◽  
Cardiac Conduction ◽  
Protective Mechanism ◽  
Significant Difference ◽  
Exercise Treadmill ◽  
Inherited Cardiac Conditions ◽  
Exercise Induced

Abstract Aims  Rate adaptation of the action potential ensures spatial heterogeneities in conduction across the myocardium are minimized at different heart rates providing a protective mechanism against ventricular fibrillation (VF) and sudden cardiac death (SCD), which can be quantified by the ventricular conduction stability (V-CoS) test previously described. We tested the hypothesis that patients with a history of aborted SCD due to an underlying channelopathy or cardiomyopathy have a reduced capacity to maintain uniform activation following exercise. Methods and results  Sixty individuals, with (n = 28) and without (n = 32) previous aborted-SCD event underwent electro-cardiographic imaging recordings following exercise treadmill test. These included 25 Brugada syndrome, 13 hypertrophic cardiomyopathy, 12 idiopathic VF, and 10 healthy controls. Data were inputted into the V-CoS programme to calculate a V-CoS score that indicate the percentage of ventricle that showed no significant change in ventricular activation, with a lower score indicating the development of greater conduction heterogeneity. The SCD group, compared to those without, had a lower median (interquartile range) V-CoS score at peak exertion [92.8% (89.8–96.3%) vs. 97.3% (94.9–99.1%); P < 0.01] and 2 min into recovery [95.2% (91.1–97.2%) vs. 98.9% (96.9–99.5%); P < 0.01]. No significant difference was observable later into recovery at 5 or 10 min. Using the lowest median V-CoS scores obtained during the entire recovery period post-exertion, SCD survivors had a significantly lower score than those without for each of the different underlying aetiologies. Conclusion  Data from this pilot study demonstrate the potential use of this technique in risk stratification for the inherited cardiac conditions.

Ankyrin-B mutation causes type 4 long-QT cardiac arrhythmia and sudden cardiac death

Nature ◽  
2003 ◽  
Vol 421 (6923) ◽  
pp. 634-639 ◽  
Author(s):  
Peter J. Mohler ◽  
Jean-Jacques Schott ◽  
Anthony O. Gramolini ◽  
Keith W. Dilly ◽  
Silvia Guatimosim ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Cardiac Arrhythmia ◽  
Cardiac Death ◽  
Long Qt ◽  
Ankyrin B

Association of isolated T inversion and sudden cardiac death – etiology and gender differences

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.A.E Haukilahti ◽  
L Holmstrom ◽  
J Vahatalo ◽  
T.V Kentta ◽  
L Pakanen ◽  
...  
Keyword(s):  
Gender Differences ◽  
Sudden Cardiac Death ◽  
General Population ◽  
Cardiac Death ◽  
Left Ventricular ◽  
Common Finding ◽  
Control Group ◽  
Funding Source ◽  
Increased Risk ◽  
Significant Difference

Abstract Background Inferolateral T wave inversion has been associated with increased risk of mortality and sudden cardiac death (SCD) in general population. However, the association between isolated T inversion and SCD is still unclear. Purpose The purpose of this study was to examine whether isolated T inversion associates with SCD, and find out possible gender differences. Methods FinGesture Study has systematically collected clinical data and medico-legal autopsy data from 5,869 consecutive SCD victims (mean age 64.9±12.4 yrs.) in Northern of Finland between years 1998 and 2017. Previously recorded electrocardiograms (ECG) were available and analyzed in 1,101 subjects. The control group consisted of 7,217 subjects representative of Finnish general population (mean age 51.5±12.4 yrs.). T inversion was interpreted isolated if there was at least two T inversions ≥−0.1 mV in at least two contiguous leads, and there were no ECG signs of left ventricular hypertrophy (LVH) defined by Sokolow-Lyon criteria or bunchle brand block (BBB) attached to it. Results In a current study, isolated T inversion was more common finding among SCD victims compared to general population: isolated T inversion in any leads 10.9% vs. 0.9% (SCD vs. general population, p<0.001), laterally 7.7% vs. 0.1% (p<0.001), inferiorly 3.2% vs. 0.5% (p<0.001) and anteriorly 2.9% vs. 0.4% (p<0.001). Particularly, isolated T inversion seemed to assoaciate with ischemic SCD taking into account that 61.5% of the total isolated T inversions were seen in ischemic SCD victims (p=0.018). In addition, 62.1% of the inferior isolated T inversions (p=0.023) and 61.7% of the lateral isolated T inversions (p=0.031) were in ischemic SCD victims versus 37.9% and 38.3% in non-ischemic SCD victims, respectively. The prevalence of isolated T inversion in any lead was also higher among male SCD victims compared to female victims (12.8% vs. 8.2%, p<0.001, respectively). There was no statistically significant difference in the prevalence of LVH and strain changes between the populations. Among bundle branch blocks left BBB was predictably more typical in SCD victims (5.8% vs. 0.5%, p<0.001). Conclusion We noticed an association between isolated T inversion and SCD. The association was most prominent in males and in those with ischemic etiology of SCD. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): The Finnish Medical Foundation, Finnish Foundation for Cardiovascular Research

Sudden Cardiac Death with Clozapine and Sertraline Combination

2001 ◽  
Vol 35 (7-8) ◽  
pp. 862-866 ◽  
Author(s):  
James D Hoehns ◽  
Michelle M Fouts ◽  
Michael W Kelly ◽  
Katie B Tu
Keyword(s):  
Sudden Cardiac Death ◽  
Cardiac Arrhythmia ◽  
Cardiac Death ◽  
Case Reports ◽  
Paranoid Schizophrenia ◽  
Prior History ◽  
Medication Regimen ◽  
Blood Concentrations ◽  
Compulsive Disorder ◽  
Obstructive Sleep

OBJECTIVE: To report a case of sudden cardiac death in a patient receiving combination therapy with clozapine and sertraline. CASE SUMMARY: A 26-year-old white man was discovered dead at his residence. His medical history included chronic paranoid schizophrenia, obsessive—compulsive disorder, major depressive disorder, obstructive sleep apnea, and akathisia. He had no prior history of cardiovascular disease. His medication regimen included clozapine 100 mg twice daily (started 4 y prior to his death), risperidone 3 mg twice daily, sertraline 200 mg once daily, atenolol 50 mg twice daily, and lorazepam 0.5 mg four × daily. Autopsy and toxicology studies revealed cardiomegaly suggestive of idiopathic cardiomyopathy, single-vessel coronary artery disease, sertraline and clozapine blood concentrations in the expected range, undetectable lorazepam and risperidone blood concentrations, obesity, and moderate fatty changes to the liver. The most likely cause of death was sudden cardiac death due to acute cardiac arrhythmia. DISCUSSION: Clozapine is structurally similar to the tricyclic antidepressants, which have type 1A antiarrhythmic properties. Case reports have described electrocardiographic abnormalities, cardiomyopathy, and fatal myocarditis associated with its use. Unexplained death in patients on clozapine therapy has also been reported. Sertraline appears to have less cardiac effect; however, one report has observed clinically significant QT prolongation during sertraline therapy. CONCLUSIONS: Clozapine-induced cardiomyopathy and cardiac arrhythmia from clozapine and/or sertraline use may have contributed to this man's death.

scholarly journals 1228 New predictors of sudden cardiac death in hypertrophic cardiomyopathy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
D M Adamczak ◽  
A Rogala ◽  
M Antoniak ◽  
Z Oko-Sarnowska
Keyword(s):  
Risk Factors ◽  
Hypertrophic Cardiomyopathy ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Left Ventricular ◽  
Volume Index ◽  
Lv Function ◽  
Icd Implantation ◽  
Significant Difference

Abstract BACKGROUND Hypertrophic cardiomyopathy (HCM) is a heart disease characterized by hypertrophy of the left ventricular myocardium. HCM is the most common cause of sudden cardiac death (SCD) in young people and competitive athletes due to fatal ventricular arrhythmias. However, in most patients, HCM has a benign course. That is why it is of utmost importance to properly evaluate patients and identify those who would benefit from a cardioverter-defibrillator (ICD) implantation. The HCM SCD-Risk Calculator is a useful tool for estimating the risk of SCD. The parameters included in the model at evaluation are: age, maximum left ventricular (LV) wall thickness, left atrial (LA) dimension, maximum gradient in left ventricular outflow tract, family history of SCD, non-sustained ventricular tachycardia (nsVT) and unexplained syncope. Nevertheless, there is potential to improve and optimize the effectiveness of this tool in clinical practice. Therefore, the following new risk factors are proposed: LV global longitudinal strain (GLS), LV average strain (ASI) and LA volume index (LAVI). GLS and ASI are sensitive and noninvasive methods of assessing LV function. LAVI more accurately characterizes the size of the left atrium in comparison to the LA dimension. METHODS 252 HCM patients (aged 20-88 years, of which 49,6% were men) treated in our Department from 2005 to 2018, were examined. The follow-up period was 0-13 years (average: 3.8 years). SCD was defined as sudden cardiac arrest (SCA) or an appropriate ICD intervention. All patients underwent an echocardiographic examination. The medical and family histories were collected and ICD examinations were performed. RESULTS 76 patients underwent an ICD implantation during the follow-up period. 20 patients have reached an SCD end-point. 1 patient died due to SCA and 19 had an appropriate ICD intervention. There were statistically significant differences of GLS and ASI values between SCD and non-SCD groups; p = 0.026389 and p = 0.006208, respectively. The average GLS in the SCD group was -12.4% ± 3.4%, and -15.1% ± 3.5% in the non-SCD group. The average ASI values were -9.9% ± 3.8% and -12.4% ± 3.5%, respectively. There was a statistically significant difference between LAVI values in SCD and non-SCD groups; p = 0.005343. The median LAVI value in the SCD group was 45.7 ml/m2 and 37.6 ml/m2 in the non-SCD group. The ROC curves showed the following cut-off points for GLS, ASI and LAVI: -13.8%, -13.7% and 41 ml/m2, respectively. Cox’s proportional hazards model for the parameters used in the Calculator was at the borderline of significance; p = 0.04385. The model with new variables (GLS and LAVI instead of LA dimension) was significant; p = 0.00094. The important factors were LAVI; p = 0.000075 and nsVT; p = 0.012267. CONCLUSIONS The proposed new SCD risk factors were statistically significant in the study population and should be taken into account when considering ICD implantation.

Consistency of heart rate–QTc prolongation consistency and sudden cardiac death: The Rotterdam Study

Heart Rhythm ◽  
2015 ◽  
Vol 12 (10) ◽  
pp. 2078-2085 ◽  
Author(s):  
Maartje N. Niemeijer ◽  
Marten E. van den Berg ◽  
Jaap W. Deckers ◽  
Oscar H. Franco ◽  
Albert Hofman ◽  
...  
Keyword(s):  
Heart Rate ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Rotterdam Study ◽  
Qtc Prolongation

scholarly journals The Relationships between the Repolarisation and Depolarisation Markers of Sudden Cardiac Death in Smokers

2020 ◽  
Vol 9 (1) ◽  
pp. 5-5
Author(s):  
Ayhan Cosgun ◽  
Mustafa Hamidullah Türkkanı
Keyword(s):  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Simple Random Sampling ◽  
Wave Dispersion ◽  
P Wave ◽  
Control Group ◽  
Study Group ◽  
P Wave Dispersion ◽  
Significant Difference ◽  
The Right

Backgroung: The risk of sudden cardiac death (SCD) and atrial fibrillation (AF) increase in smokers. This study aimed to determine the relationships between the repolarization and depolarization predictors of SCD in routine electrocardiography (ECG) in smokers. Methods: Between January and August-2019, ninety-eight healthy patients smoking for more than five years were included in the study group by simple random sampling. The control group consisted of one hundred twenty-two non-smokers. In the study and control group, following a routine physical examination and blood tests, P wave dispersion in the right precordial leads (PWdR) and the left precordial leads (PWdL), T peak-end interval in the right precordial leads (Tp-eR) and the left precordial leads (Tp-eL), QRS dispersion in the right precordial leads (dQRSR) and the left precordial leads (dQRSL), and QRS duration values in the right precordial leads (QRSR) and the left precordial leads (QRSL) were calculated in routine 12-lead ECG + right precordial leads. Results: There was a statistically significant moderate positive correlation between dQRSRxTp-eR/QRSR-value and smoking time in the study group. Also, there was a statistically significant weak negative correlation between dQRSLxTp-eL/QRSL-value and smoking time in the study group (Respectively, R=0.52, and P<0.01, R=0.41 and P<0.01). There was a significant difference between correlation ratio of dQRSRxTp-eR/QRS-value and smoking time and dQRSLxTp-eL/QRSL-value and smoking time in the study group (Z=5.73, p<0.01). Conclusions: In the current smokers, dQRSRxTp-eR/QRSR and dQRSLxTp-eL/QRSL values significantly higher than in the control group.

scholarly journals TpTe and TpTe/QT: novel markers to predict sudden cardiac death in ESRD?

2019 ◽  
Vol 41 (1) ◽  
pp. 38-47 ◽  
Author(s):  
Basil M. Saour ◽  
Jeffrey H. Wang ◽  
Michael P. Lavelle ◽  
Roy O. Mathew ◽  
Mandeep S. Sidhu ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Retrospective Chart Review ◽  
Dialysis Initiation ◽  
Significant Difference ◽  
All Cause Mortality ◽  
High Risk Populations ◽  
Veterans Affairs Medical Centers ◽  
Stage Renal Disease ◽  
End Stage

ABSTRACT Introduction: Reliable markers to predict sudden cardiac death (SCD) in patients with end stage renal disease (ESRD) remain elusive, but echocardiogram (ECG) parameters may help stratify patients. Given their roles as markers for myocardial dispersion especially in high risk populations such as those with Brugada syndrome, we hypothesized that the Tpeak to Tend (TpTe) interval and TpTe/QT are independent risk factors for SCD in ESRD. Methods: Retrospective chart review was conducted on a cohort of patients with ESRD starting hemodialysis. Patients were US veterans who utilized the Veterans Affairs medical centers for health care. Average age of all participants was 66 years and the majority were males, consistent with a US veteran population. ECGs that were performed within 18 months of dialysis initiation were manually evaluated for TpTe and TpTe/QT. The primary outcomes were SCD and all-cause mortality, and these were assessed up to 5 years following dialysis initiation. Results: After exclusion criteria, 205 patients were identified, of whom 94 had a prolonged TpTe, and 61 had a prolonged TpTe/QT interval (not mutually exclusive). Overall mortality was 70.2% at 5 years and SCD was 15.2%. No significant difference was observed in the primary outcomes when examining TpTe (SCD: prolonged 16.0% vs. normal 14.4%, p=0.73; all-cause mortality: prolonged 55.3% vs. normal 47.7%, p=0.43). Likewise, no significant difference was found for TpTe/QT (SCD: prolonged 15.4% vs. normal 15.0%, p=0.51; all-cause mortality: prolonged 80.7% vs. normal 66.7%, p=0.39). Conclusions: In ESRD patients on hemodialysis, prolonged TpTe or TpTe/QT was not associated with a significant increase in SCD or all-cause mortality.

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