Electrocardiographic Predictors of Torsadogenic Risk During Dofetilide or Sotalol Initiation: Utility of a Novel T Wave Analysis Program

Alan Sugrue, Vaclav Kremen, Bo Qiang, Seth H. Sheldon, Christopher V. DeSimone, Yehu Sapir, Bryan L. Striemer, Peter Brady, Samuel J Asirvatham, Michael John Ackerman, Paul Andrew Friedman, Peter Noseworthy

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Introduction: Initiation of class III anti-arrhythmic medications requires telemetric monitoring for ventricular arrhythmias and QT prolongation to reduce the risk of torsades de pointes (TdP). Heart rate-corrected QT interval (QTc) is an indicator of risk, however it is imperfect, and subtle abnormalities of repolarization have been linked with arrhythmogenesis. Purpose: Identification of electrocardiographic predictors of torsadogenic risk through the application of a novel T wave analysis tool. Methods: Among all patients admitted to Mayo Clinic for initiation of dofetilide or sotalol, we identified 13 cases who developed drug-induced TdP and 26 age and sex matched controls that did not develop TdP. The immediate pre-TdP ECG of those with TdP was compared to the last ECG performed prior to hospital discharge in controls using a novel T wave program that quantified subtle changes in T wave morphology. Results: The QTc and 12 T wave parameters successfully distinguished TdP cases from controls. The top performing parameters were the QTc in lead V3 (mean case vs control 480 vs 420 msec, p <0.001, r = 0.72) and T wave right slope in lead I (mean case vs control −840.29 vs −1668.71 mV/s, p = 0.002, r = 0.45). The addition of T wave right slope to QTc improved prediction accuracy from 79 to 88 %. Conclusion: Our data demonstrate that, in addition to QTc, the T wave right slope is correlated strongly with TdP risk. This suggests that a computer-based repolarization measurement tool that integrates additional data beyond the QTc may identify patients with the greatest torsadogenic potential.

Original languageEnglish (US)
Pages (from-to)433-441
Number of pages9
JournalCardiovascular Drugs and Therapy
Volume29
Issue number5
DOIs
StatePublished - Sep 28 2015

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Keywords

  • Class III antiarrhythmics
  • Electrocardiography
  • Risk stratification
  • T wave analysis
  • Torsade de pointes

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Cardiology and Cardiovascular Medicine
  • Pharmacology

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