QTc compared to JTc for monitoring drug-induced repolarization changes in the setting of ventricular pacing

Shane F. Tsai, Mahmoud Houmsse, Barrah Dakhil, Ralph Augostini, John D. Hummel, Steven J. Kalbfleisch, Zhengou Liu, Charles Love, Troy Rhodes, Jaret Tyler, Raul Weiss, Ismail Hamam, Marshall Winner, Emile G. Daoud

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

Background QT prolongation is a risk factor for proarrhythmia when beginning antiarrhythmic drug therapy (AAD). However, there are no data regarding monitoring repolarization changes during a ventricular paced (VP) rhythm. Objective The purpose of this study was to compare serial changes in corrected QT and JT intervals, during native conduction (NC) and VP rhythms when initiating Class III AADs. Methods Twenty-two patients (73% men; mean age 65 ± 11 years) with an implantable device and with <10% VP were monitored during AAD initiation (16 sotalol, 6 dofetilide). QTc and JTc were measured from ECGs obtained during NC and VP at baseline (pre-AAD) and then after each AAD dose. Results During AAD loading, mean QTc increased significantly during NC (431 ± 28 ms to 463 ± 33 ms, P =.002) but not with VP (520 ± 48 ms to 538 ± 45 ms, P =.07). Mean percent increase in peak QTc during NC was significantly greater than during VP (12% vs 7%, P =.003). In contrast, peak JTc during AAD loading was not significantly different between NC and VP (P =.67). Conclusion When initiating AAD, the change in QTc during VP does not correlate with the change in QTc during NC; thus, the VP QTc is inadequate for monitoring repolarization changes. However, VP JTc correlates well with JTc during NC. When initiating Class III AADs in patients with VP rhythms, the JTc, and not the QTc, interval is the useful marker for assessing repolarization.

Original languageEnglish (US)
Pages (from-to)485-491
Number of pages7
JournalHeart Rhythm
Volume11
Issue number3
DOIs
StatePublished - Mar 1 2014

Keywords

  • Antiarrhythmic drug
  • Electrocardiography
  • JT interval
  • Pacing
  • QT interval
  • Repolarization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Tsai, S. F., Houmsse, M., Dakhil, B., Augostini, R., Hummel, J. D., Kalbfleisch, S. J., Liu, Z., Love, C., Rhodes, T., Tyler, J., Weiss, R., Hamam, I., Winner, M., & Daoud, E. G. (2014). QTc compared to JTc for monitoring drug-induced repolarization changes in the setting of ventricular pacing. Heart Rhythm, 11(3), 485-491. https://doi.org/10.1016/j.hrthm.2013.11.017