Acquired Long QT Syndrome by A. John Camm

By A. John Camm

In recent times there was significant curiosity within the prognosis and knowing of ventricular repolarisation, quite the QT period prolongation and irregular T and T/U wave morphology linked to torsades de pointes. Advances in ion channel cloning have tremendously more desirable our realizing of the function of ionic channels in mediating cardiac repolarisation. regrettably, it truly is more and more recognized variety of medicines, either these linked to changing repolarisation, and others for non-cardiac stipulations can bring up the propensity for polymorphic ventricular tachycardia, syncope or even ventricular traumatic inflammation and surprising death.In this quantity, arrhythmia experts from St. George’s clinic clinical university, London speak about the mechanisms in the back of QT prolongation and torsades de pointes. They concentration quite at the possibility of person cardiac and non-cardiac medicinal drugs in scary lengthy QT syndrome, delivering a accomplished overview on the way to be necessary for all electrophysiologists treating polymorphic ventricular tachycardias, and may reveal vital regulatory matters for pharmaceutical experts and for the broader scientific group.

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Several techniques have been used previously but all approaches are associated with potential inaccuracies. The most frequently cited method is that proposed by Surawicz and Knoebel [1]. In this method, the ECG is recorded at a paper speed of 50 mm/s and at gain of 20 mm/mV using a multichannel recorder capable of simultaneous recording of all 12 leads. A tangent line to the steepest part of the descending portion of the T wave is drawn and the intercept between the tangent line and the isoelectric line is defined as the end of T wave [2].

Mechanisms of acquired QT prolongation and TdP 23 31 Schwartz PJ, Moss AJ, Vincent GM, Crampton RS. Diagnostic criteria for the long QT syndrome: an update. Circulation 1993; 88: 782–4. 32 Abbott GW, Sesti F, Splawski I, Buck ME, Lehmann MH, Timothy KW, Keating MT, Goldstein SA. MiRP1 forms IKr potassium channels with HERG and is associated with cardiac arrhythmia. Cell 1999; 97 (2): 175–87. 33 Schulze-Bahr E, Haverkamp W, Hordt M, Wedekind H, Borggrefe M. Do mutations in cardiac ion channel genes predispose to drug-induced (acquired) long QT syndrome?

10 Two examples of poor quality of manual QT interval measurement are shown. The tracings in panel A are of lead II from serial electrocardiograms of the same subject recorded during a Phase I study. In each of these leads, the QT intervals in three cardiac complexes should have been measured. The ticks were made by an operator identifying complexes that he/she measured. Note that these include cardiac cycles in which no T wave could have been identified. In the tracing from a different Phase I study shown in panel B, the QT interval was measured correctly but the operator included the couplet of extrasystoles into the calculation of heart rate (dividing the interval between the first and last sinus rhythm QRS complex by 9 RR intervals).

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