HACI AHMET KASAPKARA, HÜSEYİN AYHAN, TAHİR DURMAZ, TELAT KELEŞ, CENK SARI, SERDAL BAŞTUĞ, CEMAL KÖSEOĞLU, BİLGE DURAN KARADUMAN, MURAT AKÇAY, NİHAL AKAR BAYRAM, EMİNE BİLEN, ENGİN BOZKURT

Short-term effect of transcatheter aortic valve implantation on QT dispersion

Background/aim: Electrophysiological changes are observed following mechanical stretches due to pressure overload in patients with severe aortic stenosis (AS). The electrical instability occurs after depolarization and dispersion of repolarization. The aim of this study was to evaluate changes in ventricular repolarization following transcatheter aortic valve implantation (TAVI). Materials and methods: The study population included 100 consecutive patients with severe AS that underwent TAVI. Electrocardiography (ECG) was performed at baseline, immediately after TAVI, and 1 week after TAVI. Results: The mean age of the patients was 78.2 ± 7.2 years. Thirty-four (34%) of the patients were male and 66 (66%) were female. Compared to the baseline, mean QT dispersion (QTd) immediately after TAVI and 1 week after TAVI decreased significantly (82.8 ± 26.5, 75.6 ± 25.2, and 65.8 ± 28.3, respectively, P < 0.001). Likewise, compared to the baseline, mean corrected QTd (QTcd) immediately after TAVI and 1 week after TAVI decreased significantly (84.7 ± 25.2, 76.7 ± 30.8, and 69.1 ± 31.4, respectively, P < 0.001). Conclusion: QTd is indicative of heterogeneity of ventricular refractoriness and is prolonged in patients with AS. Following TAVI, a decrease in QTd might reduce the risk of ventricular arrhythmia in patients with severe AS.

Anahtar Kelimeler:

Transcatheter aortic valve implantation, QT dispersion, aortic stenosis

Short-term effect of transcatheter aortic valve implantation on QT dispersion

Keywords:

Transcatheter aortic valve implantation, QT dispersion, aortic stenosis,

PDF

___

1. Bonow RO, Carabello BA, Kanu C, de Leon AC Jr, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O’Gara PT et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease. Circulation 2006; 114: 84–231.
2. Piorecka-Makula A, Werner B. Prolonged QT dispersion in children with congenital valvular aortic stenosis. Med Sci Monit 2009; 15: 534–538.
3. Kremer R. Arrhythmias in the natural history of aortic stenosis. Acta Cardiol 1992; 47: 135–140.
4. van de Loo A, Arendts W, Hohnloser SH. Variability of QT dispersion measurements in the surface electrocardiogram in patients with acute myocardial infarction and in normal subjects. Am J Cardiol 1994; 74: 1113–1118.
5. Üçkuyu A, Çiftçi FC, Çiftçi Ö, Özçimen EE, Toprak E, Turhan E. Effect of ovulation induction on QT dispersion in electrocardiography. Turk J Med Sci 2012; 42: 491–496.
6. Okin PM, Devereux RB, Howard BV, Fabsitz RR, Lee ET, Welty TK. Assessment of QT interval and QT dispersion for prediction of all-cause and cardiovascular mortality in American Indians: The Strong Heart Study. Circulation 2000; 101: 61–66.
7. Beaubien ER, Pylypchuk GB, Akhtar J, Biem HJ. Value of corrected QT interval dispersion in identifying patients initiating dialysis at increased risk of total and cardiovascular mortality. Am J Kidney Dis 2002; 39: 834–842.
8. Darbar D, Cherry CJ, Kerins DM. QT dispersion is reduced after valve replacement in patients with aortic stenosis. Heart 1999; 82: 15–18.
9. Cohle SD, Graham MA, Dowling G, Pounder DJ. Sudden death and left ventricular outflow disease. Pathol Annu 1988; 23: 97– 124.
10. Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Barwolf C, Levang OW, Tornos P, Vanoverschelde JL, Vermeer F, Boersma E et al. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease. Eur Heart J 2003; 24: 1231–1243.
11. Martínez-Useros C, Tornos P, Montoyo J, Permanyer Miralda G, Alijarde M, García del Castillo H, Moreno V, Soler-Soler J. Ventricular arrhythmias in aortic valve disease: a further marker of impaired left ventricular function. Int J Cardiol 1992; 34: 49–56.
12. Messerli FH, Soria F. Ventricular dysrhythmias, left ventricular hypertrophy and sudden death. Cardiovasc Drugs Ther 1994; 8: 557–563.
13. Bikkina M, Larson MG, Levy D. Asymptomatic ventricular arrhythmias and mortality risk in subjects with left ventricular hypertrophy. J Am Coll Cardiol 1993; 22: 1111–1116.
14. Fielitz J, Hein S, Mitrovic V, Pregla R, Zurbrügg HR, Warnecke C, Schaper J, Fleck E, Regitz-Zagrosek V. Activation of the cardiac renin-angiotensin system and increased myocardial collagen expression in human aortic valve disease. J Am Coll Cardiol 2001; 37: 1443–1449.
15. Day CP, McComb JM, Campbell RW. QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Br Heart J 1990; 63: 342–344.
16. Buja G, Miorelli M, Turrini P, Melacini P, Nava A. Comparison of QT dispersion in hypertrophic cardiomyopathy between patients with and without ventricular arrhythmias and sudden death. Am J Cardiol 1993; 72: 973–976.
17. Hii JT, Wyse DG, Gillis AM, Duff HJ, Solylo MA, Mitchell LB. Precordial QT interval dispersion as a marker of torsade de pointes. Disparate effects of class Ia antiarrhythmic drugs and amiodarone. Circulation 1992; 86: 1376–1382.
18. Lorincz I. QT dispersion. Prog Biomed Res 1999; 4: 405–410. 19. Choy AM, Lang CC, Chomsky DM, Rayos GH, Wilson JR, Roden DM. Normalization of acquired QT prolongation in humans by intravenous potassium. Circulation 1997; 96: 2149–2154.
20. Costantino MF, Galderisi M, Dores E, Innelli P, Tarsia G, Di Natale M, Santoro C, De Stefano F, Esposito R, de Simone G. Parallel improvement of left ventricular geometry and filling pressure after transcatheter aortic valve implantation in high risk aortic stenosis: comparison with major prosthetic surgery by standard echo Doppler evaluation. Cardiovasc Ultrasound 2013; 11: 18.
21. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010; 363: 1597–1607 . 22. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR et al. Transcatheter versus surgical aortic-valve replacement in highrisk patients. N Engl J Med 2011; 364: 2187–2198.