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      The Increment of Short-term Variability of Repolarisation Determines the Severity of the Imminent Arrhythmic Outcome

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          Abstract

          Ventricular remodelling can make the heart more susceptible to ventricular arrhythmias like torsades de pointes. Understanding the underlying mechanisms of initiation of ventricular arrhythmias and the determining factors for its severity has the potential to uncover new interventions. Beat-to-beat variation of repolarisation, quantified as short-term variability of repolarisation (STV), has been identified as an important factor contributing to arrhythmogenesis. This article provides an overview of experimental data about STV in relation to the initiation of torsades de pointes in a canine model of complete chronic atrioventricular block susceptible to torsades de pointes arrhythmias. Furthermore, it explores STV in relation to the severity of the arrhythmic outcome.

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          Cardiac plasticity.

          Joseph A. Hill, Eric Olson (2008)
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            Left ventricular remodeling in heart failure: current concepts in clinical significance and assessment.

            Marvin A. Konstam, Daniel G. Kramer, Ayan R. Patel … (2011)
            Ventricular remodeling, first described in animal models of left ventricular (LV) stress and injury, occurs progressively in untreated patients after large myocardial infarction and in those with dilated forms of cardiomyopathy. The gross pathologic changes of increased LV volume and perturbation in the normal elliptical LV chamber configuration is driven, on a histologic level, by myocyte hypertrophy and apoptosis and by increased interstitial collagen. Each of the techniques used for tracking this process-echocardiography, radionuclide ventriculography, and cardiac magnetic resonance-carries advantages and disadvantages. Numerous investigations have demonstrated the value of LV volume measurement at a single time-point and over time in predicting clinical outcomes in patients with heart failure and in those after myocardial infarction. The structural pattern of LV remodeling and evidence of scarring on cardiac magnetic resonance have additional prognostic value. Beyond the impact of abnormal cardiac structure on cardiovascular events, the relationship between LV remodeling and clinical outcomes is likely linked through common local and systemic factors driving vascular as well as myocardial pathology. As demonstrated by a recent meta-analysis of heart failure trials, LV volume stands out among surrogate markers as strongly correlating with the impact of a particular drug or device therapy on patient survival. These findings substantiate the importance of ventricular remodeling as central in the pathophysiology of advancing heart failure and support the role of measures of LV remodeling in the clinical investigation of novel heart failure treatments. 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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              Meta-analysis of the implantable cardioverter defibrillator secondary prevention trials. AVID, CASH and CIDS studies. Antiarrhythmics vs Implantable Defibrillator study. Cardiac Arrest Study Hamburg . Canadian Implantable Defibrillator Study.

              S Boczor, Heveline D. M. Follmann, M Domański … (2000)
              Three randomized trials of implantable cardioverter defibrillator (ICD) therapy vs medical treatment for the prevention of death in survivors of ventricular fibrillation or sustained ventricular tachycardia have been reported with what might appear to be different results. The present analysis was performed to obtain the most precise estimate of the efficacy of the ICD, compared to amiodarone, for prolonging survival in patients with malignant ventricular arrhythmia. Individual patient data from the Antiarrhythmics vs Implantable Defibrillator (AVID) study, the Cardiac Arrest Study Hamburg (CASH) and the Canadian Implantable Defibrillator Study (CIDS) were merged into a master database according to a pre-specified protocol. Proportional hazard modelling of individual patient data was used to estimate hazard ratios and to investigate subgroup interactions. Fixed effect meta-analysis techniques were also used to evaluate treatment effects and to assess heterogeneity across studies. The classic fixed effects meta-analysis showed that the estimates of ICD benefit from the three studies were consistent with each other (P heterogeneity=0.306). It also showed a significant reduction in death from any cause with the ICD; with a summary hazard ratio (ICD:amiodarone) of 0.72 (95% confidence interval 0.60, 0.87;P=0.0006). For the outcome of arrhythmic death, the hazard ratio was 0.50 (95% confidence interval 0.37, 0.67;P<0.0001). Survival was extended by a mean of 4.4 months by the ICD over a follow-up period of 6 years. Patients with left ventricular ejection fraction < or = 35% derived significantly more benefit from ICD therapy than those with better preserved left ventricular function. Patients treated before the availability of non-thoracotomy ICD implants derived significantly less benefit from ICD therapy than those treated in the non-thoracotomy era. Results from the three trials of the ICD vs amiodarone are consistent with each other. There is a 28% reduction in the relative risk of death with the ICD that is due almost entirely to a 50% reduction in arrhythmic death. Copyright 2000 The European Society of Cardiology.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Arrhythm Electrophysiol Rev
                Journal ID (iso-abbrev): Arrhythm Electrophysiol Rev
                Journal ID (publisher-id): AER
                Title: Arrhythmia & Electrophysiology Review
                Publisher: Radcliffe Cardiology
                ISSN (Print): 2050-3369
                ISSN (Electronic): 2050-3377
                Publication date (Print): July 2019
                Volume: 8
                Issue: 3
                Pages: 166-172
                Affiliations
                Department of Medical Physiology, University Medical Center Utrecht Utrecht, the Netherlands
                Author notes

                Disclosure: The authors have no conflicts of interest to declare.

                Correspondence: Marc Vos, Department of Medical Physiology, University Medical Center Utrecht, Utrecht, the Netherlands. E: m.a.vos@ 123456umcutrecht.nl
                Article
                DOI: 10.15420/aer.2019.16.2
                PMC ID: 6766692
                PubMed ID: 31576205
                SO-VID: 97dc1313-73d8-42e9-a520-ff1a696a64fa
                Copyright © Copyright © 2019, Radcliffe Cardiology
                License:

                This work is open access under the CC-BY-NC 4.0 License which allows users to copy, redistribute and make derivative works for non-commercial purposes, provided the original work is cited correctly.

                History
                Date received : 15 January 2019
                Date accepted : 17 June 2019
                Page count
                Pages: 7
                Categories
                Subject: Clinical Arrhythmias

                Keywords: short-term variability of repolarisation,beat-to-beat variation of repolarisation,ventricular arrhythmias,torsades de pointes
                Data availability:
                Keywords: short-term variability of repolarisation, beat-to-beat variation of repolarisation, ventricular arrhythmias, torsades de pointes

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