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Electrocardiographic Markers of Torsadogenicity

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Biomarkers in Cardiovascular Disease

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Abstract

Torsades de pointes is a potentially lethal ventricular tachycardia which has been associated with QT interval prolongation. Although several sophisticated methods have been used in the assessment of proarrhythmic risk, the standard 12-lead surface electrocardiogram still represents the most common and familiar clinical tool. The risk of arrhythmias in several pathological conditions, as well as the torsadogenic potential of drugs, can be assessed noninvasively by the use of electrocardiographic markers. Even though the QT interval duration is the most well known, a few other more accurate markers, such as JT duration, QT dispersion and variability, Tpeak-to-Tend duration, T wave alternans, TRIaD, and beat-to-beat variability of repolarization, have gradually been introduced into clinical practice and have partly replaced or complemented the classic QT interval duration approach. All these electrocardiographic markers are mainly used for noninvasive risk stratification of torsades de pointes and sudden cardiac death in patients with arrhythmogenic syndromes, such as long QT and Brugada syndrome, and also for assessment of new drugs’ arrhythmogenic potency.

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Abbreviations

AP:

Action potential

APD:

Action potential duration

Bpm:

Beats per minute

BVR:

Beat-to-beat variability of repolarization

CPVT:

Catecholaminergic polymorphic ventricular tachycardia

ECG:

Electrocardiogram

HR:

Heart rate

ICD:

Implantable cardioverter defibrillator

IKr:

Rapid component of delayed rectifier K+ current

LQTS:

Long QT syndrome

MTWA:

Microvolt T wave alternans

QTd:

QT dispersion

QTVI:

QT variability index

SQTS:

Short QT syndrome

STEMI:

Myocardial infarction with ST elevation

STV:

Short-term variability

TdP:

Torsades de pointes

TDR:

Transmural dispersion of repolarization

Tp-e:

Tpeak-to-Tend interval

TRIaD:

Triangulation, reverse use dependence, instability, and dispersion of repolarization

TWA:

T wave alternans

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Author information

Authors and Affiliations

  1. Department of Anesthesia, Aretaieio Hospital, Medical School University of Athens, 76 Vassilissis Sophias Ave., 11528, Athens, Greece

    Chryssoula Staikou

  2. Department of Anesthesia, 219 Military Hospital, 25th May Road, 68300, Didymoteicho, Greece

    Eftychios Stavroulakis

Authors
  1. Chryssoula Staikou
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  2. Eftychios Stavroulakis
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Correspondence to Chryssoula Staikou .

Editor information

Editors and Affiliations

  1. Department of Biomedical Sciences, University of Westminster, London, United Kingdom

    Vinood B. Patel

  2. Sciences Division, King's College, London, United Kingdom

    Victor R. Preedy

Definitions

Brugada syndrome

It is an inherited cardiac channelopathy which follows an autosomal dominant mode of transmission. Patients with Brugada syndrome are at risk of sudden cardiac death due to polymorphic ventricular tachycardia and ventricular fibrillation.

Catecholaminergic polymorphic ventricular tachycardia (CPVT)

It is an inherited cardiac disease following an autosomal dominant mode of transmission. It is associated with adrenergic-dependent ventricular tachyarrhythmias. Patients with CPTV are at risk of ventricular tachycardia, ventricular fibrillation, and sudden cardiac death.

Long QT syndrome

It is a congenital or acquired arrhythmogenic disorder characterized by dysfunction of cardiac ion channels and prolongation of QT interval on the ECG. The congenital form is inherited via an autosomal dominant or recessive pattern. The syndrome is characterized by a high risk of torsades de pointes, ventricular fibrillation, and sudden cardiac death.

New York Heart Association (NYHA) classification

A functional classification for the patients with heart disease. It includes four categories according to the severity of heart failure symptoms and consequent limitation in ordinary physical activity: Class I no symptoms or activity limitation, Class II mild symptoms/activity limitation, Class III marked symptoms/activity limitation, Class IV symptoms even at rest/severe activity limitation.

Short QT syndrome

It is an inherited arrhythmogenic disease following an autosomal dominant mode of transmission. It is characterized by a short QT interval on the ECG, atrial or ventricular arrhythmias – such as ventricular tachycardia and fibrillation – and sudden cardiac death.

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Staikou, C., Stavroulakis, E. (2015). Electrocardiographic Markers of Torsadogenicity. In: Patel, V., Preedy, V. (eds) Biomarkers in Cardiovascular Disease. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-7741-5_8-1

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  • DOI: https://doi.org/10.1007/978-94-007-7741-5_8-1

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  • Online ISBN: 978-94-007-7741-5

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