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

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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.

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Funding Sources

C.V.D. is supported by an NIH T32 Training Grant HL 007111.

V.K. is supported by funding from Czech Science Foundation GACR #P103/11/P106.

Disclosures

Dr Ackerman is a consultant for: Boston Scientific, Medtronic, St. Jude Medical, Transgenomic. Royalties and Intellectual Property from Transgenomic. Dr Asirvatham is a consultant for Abiomed, Atricure, Biotronik, Biosense Webster, Boston Scientific, Medtronic, Spectranetics, St Jude Medical, Sanofi-Aventis, Wolters Kluwer, and Elsevier. The other authors report no disclosures.

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Authors and Affiliations

  1. Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Alan Sugrue

  2. Czech Institute of Informatics, Robotics, and Cybernetics, Czech Technical University in Prague, Prague, Czech Republic

    Vaclav Kremen

  3. Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA

    Vaclav Kremen, Bo Qiang, Christopher V. DeSimone, Bryan L. Striemer, Peter Brady, Samuel J. Asirvatham, Michael J. Ackerman, Paul Friedman & Peter A. Noseworthy

  4. Department of Cardiology, University of Michigan, Ann Arbor, MI, USA

    Seth H. Sheldon

  5. Ben Gurion University of the Negev, Beersheba, Israel

    Yehu Sapir

  6. Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA

    Samuel J. Asirvatham & Michael J. Ackerman

  7. Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA

    Michael J. Ackerman

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  1. Alan Sugrue
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Sugrue, A., Kremen, V., Qiang, B. et al. Electrocardiographic Predictors of Torsadogenic Risk During Dofetilide or Sotalol Initiation: Utility of a Novel T Wave Analysis Program. Cardiovasc Drugs Ther 29, 433–441 (2015). https://doi.org/10.1007/s10557-015-6619-0

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