Skip to main content
British Heart Journal logoLink to British Heart Journal
. 1991 Sep;66(3):230–237. doi: 10.1136/hrt.66.3.230

Dynamics of ventricular repolarisation in the congenital long QT syndromes.

N J Linker 1, A J Camm 1, D E Ward 1
PMCID: PMC1024650  PMID: 1931351

Abstract

Patients with congenital QT interval prolongation are at risk of ventricular arrhythmias and sudden death. It has been suggested that the susceptibility to arrhythmias in these syndromes may be related to the abnormal dynamics of ventricular repolarisation. The dynamics of ventricular repolarisation, including assessment of the effect of changing heart rate on the QT interval and the duration of the right ventricular monophasic action potential, were studied in eight patients with congenital long QT syndromes. The effects of altered sympathetic tone on these dynamics were investigated with isoprenaline, propranolol, and left stellate ganglion block. The rate adaptation of the QT interval was abnormal in only a few patients and in some patients this feature may be related to the severity of the condition. These abnormalities may be exaggerated by isoprenaline and lessened by propranolol and left stellate ganglion block. Monophasic action potential dynamics were normal in all patients. The hypothesis that impaired QT rate adaptation may play a role in the genesis of ventricular arrhythmias in these syndromes is not, in general, supported by the present data. However, in patients with impaired adaptation the normalisation of QT dynamics after beta blockade and left stellate ganglion block was consistent with the efficacy of these forms of treatment.

Full text

PDF
230

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Akhras F., Rickards A. F. The relationship between QT interval and heart rate during physiological exercise and pacing. Jpn Heart J. 1981 May;22(3):345–351. doi: 10.1536/ihj.22.345. [DOI] [PubMed] [Google Scholar]
  2. Attwell D., Lee J. A. A cellular basis for the primary long Q-T syndromes. Lancet. 1988 May 21;1(8595):1136–1139. doi: 10.1016/s0140-6736(88)91953-8. [DOI] [PubMed] [Google Scholar]
  3. Bonatti V., Rolli A., Botti G. Recording of monophasic action potentials of the right ventricle in long QT syndromes complicated by severe ventricular arrhythmias. Eur Heart J. 1983 Mar;4(3):168–179. doi: 10.1093/oxfordjournals.eurheartj.a061436. [DOI] [PubMed] [Google Scholar]
  4. Brorson L., Olsson S. B. Right atrial monophasic action potential in healthy males. Studies during spontaneous sinus rhythm and atrial pacing. Acta Med Scand. 1976;199(6):433–446. doi: 10.1111/j.0954-6820.1976.tb06761.x. [DOI] [PubMed] [Google Scholar]
  5. Cowan J. C., Yusoff K., Moore M., Amos P. A., Gold A. E., Bourke J. P., Tansuphaswadikul S., Campbell R. W. Importance of lead selection in QT interval measurement. Am J Cardiol. 1988 Jan 1;61(1):83–87. doi: 10.1016/0002-9149(88)91309-4. [DOI] [PubMed] [Google Scholar]
  6. Creamer J. E., Nathan A. W., Shennan A., Camm A. J. Acute and chronic effects of sotalol and propranolol on ventricular repolarization using constant-rate pacing. Am J Cardiol. 1986 May 1;57(13):1092–1096. doi: 10.1016/0002-9149(86)90680-6. [DOI] [PubMed] [Google Scholar]
  7. Day C. P., McComb J. M., Campbell R. W. QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Br Heart J. 1990 Jun;63(6):342–344. doi: 10.1136/hrt.63.6.342. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Edvardsson N., Olsson S. B. Effects of acute and chronic beta-receptor blockade on ventricular repolarisation in man. Br Heart J. 1981 Jun;45(6):628–636. doi: 10.1136/hrt.45.6.628. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Franz M. R., Bargheer K., Rafflenbeul W., Haverich A., Lichtlen P. R. Monophasic action potential mapping in human subjects with normal electrocardiograms: direct evidence for the genesis of the T wave. Circulation. 1987 Feb;75(2):379–386. doi: 10.1161/01.cir.75.2.379. [DOI] [PubMed] [Google Scholar]
  10. Franz M. R., Swerdlow C. D., Liem L. B., Schaefer J. Cycle length dependence of human action potential duration in vivo. Effects of single extrastimuli, sudden sustained rate acceleration and deceleration, and different steady-state frequencies. J Clin Invest. 1988 Sep;82(3):972–979. doi: 10.1172/JCI113706. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. HAN J., MOE G. K. NONUNIFORM RECOVERY OF EXCITABILITY IN VENTRICULAR MUSCLE. Circ Res. 1964 Jan;14:44–60. doi: 10.1161/01.res.14.1.44. [DOI] [PubMed] [Google Scholar]
  12. HOFFMAN B. F., CRANEFIELD P. F., LEPESCHKIN E., SURAWICZ B., HERRLICH H. C. Comparison of cardiac monophasic action potentials recorded by intracellular and suction electrodes. Am J Physiol. 1959 Jun;196(6):1297–1301. doi: 10.1152/ajplegacy.1959.196.6.1297. [DOI] [PubMed] [Google Scholar]
  13. Han J., Goel B. G. Electrophysiologic precursors of ventricular tachyarrhythmias. Arch Intern Med. 1972 May;129(5):749–755. [PubMed] [Google Scholar]
  14. Horstmann E., Koenn B. Temporal relationship between exercise and QT shortening in patients with QT pacemakers. Pacing Clin Electrophysiol. 1989 Jul;12(7 Pt 1):1080–1084. doi: 10.1111/j.1540-8159.1989.tb01930.x. [DOI] [PubMed] [Google Scholar]
  15. JERVELL A., LANGE-NIELSEN F. Congenital deaf-mutism, functional heart disease with prolongation of the Q-T interval and sudden death. Am Heart J. 1957 Jul;54(1):59–68. doi: 10.1016/0002-8703(57)90079-0. [DOI] [PubMed] [Google Scholar]
  16. Jackman W. M., Friday K. J., Anderson J. L., Aliot E. M., Clark M., Lazzara R. The long QT syndromes: a critical review, new clinical observations and a unifying hypothesis. Prog Cardiovasc Dis. 1988 Sep-Oct;31(2):115–172. doi: 10.1016/0033-0620(88)90014-x. [DOI] [PubMed] [Google Scholar]
  17. Kuo C. S., Munakata K., Reddy C. P., Surawicz B. Characteristics and possible mechanism of ventricular arrhythmia dependent on the dispersion of action potential durations. Circulation. 1983 Jun;67(6):1356–1367. doi: 10.1161/01.cir.67.6.1356. [DOI] [PubMed] [Google Scholar]
  18. Lau C. P., Freedman A. R., Fleming S., Malik M., Camm A. J., Ward D. E. Hysteresis of the ventricular paced QT interval in response to abrupt changes in pacing rate. Cardiovasc Res. 1988 Jan;22(1):67–72. doi: 10.1093/cvr/22.1.67. [DOI] [PubMed] [Google Scholar]
  19. Lecocq B., Lecocq V., Jaillon P. Physiologic relation between cardiac cycle and QT duration in healthy volunteers. Am J Cardiol. 1989 Sep 1;64(8):481–486. doi: 10.1016/0002-9149(89)90425-6. [DOI] [PubMed] [Google Scholar]
  20. Levine J. H., Spear J. F., Guarnieri T., Weisfeldt M. L., de Langen C. D., Becker L. C., Moore E. N. Cesium chloride-induced long QT syndrome: demonstration of afterdepolarizations and triggered activity in vivo. Circulation. 1985 Nov;72(5):1092–1103. doi: 10.1161/01.cir.72.5.1092. [DOI] [PubMed] [Google Scholar]
  21. MOORE E. N., PRESTON J. B., MOE G. K. DURATIONS OF TRANSMEMBRANE ACTION POTENTIALS AND FUNCTIONAL REFRACTORY PERIODS OF CANINE FALSE TENDON AND VENTRICULAR MYOCARDIUM: COMPARISONS IN SINGLE FIBERS. Circ Res. 1965 Sep;17:259–273. doi: 10.1161/01.res.17.3.259. [DOI] [PubMed] [Google Scholar]
  22. Milne J. R., Camm A. J., Ward D. E., Spurrell R. A. Effect of intravenous propranolol on QT interval. A new method of assessment. Br Heart J. 1980 Jan;43(1):1–6. doi: 10.1136/hrt.43.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Milne J. R., Ward D. E., Spurrell R. A., Camm A. J. The ventricular paced QT interval--the effects of rate and exercise. Pacing Clin Electrophysiol. 1982 May;5(3):352–358. doi: 10.1111/j.1540-8159.1982.tb02242.x. [DOI] [PubMed] [Google Scholar]
  24. Mitsutake A., Takeshita A., Kuroiwa A., Nakamura M. Usefulness of the Valsalva maneuver in management of the long QT syndrome. Circulation. 1981 May;63(5):1029–1035. doi: 10.1161/01.cir.63.5.1029. [DOI] [PubMed] [Google Scholar]
  25. Murdock D. K., Euler D. E., Becker D. M., Murdock J. D., Scanlon P. J., Gunnar R. M. Ventricular fibrillation during coronary angiography: an analysis of mechanisms. Am Heart J. 1985 Feb;109(2):265–273. doi: 10.1016/0002-8703(85)90593-9. [DOI] [PubMed] [Google Scholar]
  26. Olsson S. B., Brorson L., Edvardsson N., Varnauskas E. Estimation of ventricular repolarization in man by monophasic action potential recording technique. Eur Heart J. 1985 Nov;6 (Suppl 500):71–79. doi: 10.1093/eurheartj/6.suppl_d.71. [DOI] [PubMed] [Google Scholar]
  27. Phillips J., Ichinose H. Clinical and pathologic studies in the hereditary syndrome of a long QT interval, syncopal spells and sudden death. Chest. 1970 Sep;58(3):236–243. doi: 10.1378/chest.58.3.236. [DOI] [PubMed] [Google Scholar]
  28. ROMANO C., GEMME G., PONGIGLIONE R. ARITMIE CARDIACHE RARE DELL'ETA' PEDIATRICA. II. ACCESSI SINCOPALI PER FIBRILLAZIONE VENTRICOLARE PAROSSISTICA. (PRESENTAZIONE DEL PRIMO CASO DELLA LETTERATURA PEDIATRICA ITALIANA) Clin Pediatr (Bologna) 1963 Sep;45:656–683. [PubMed] [Google Scholar]
  29. Rickards A. F., Norman J. Relation between QT interval and heart rate. New design of physiologically adaptive cardiac pacemaker. Br Heart J. 1981 Jan;45(1):56–61. doi: 10.1136/hrt.45.1.56. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Romano M., Clarizia M., Onofrio E., Caiazzo M. R., Adinolfi L., Cutillo S., Chiariello M., Condorelli M. Heart rate, PR, and QT intervals in normal children: a 24-hour Holter monitoring study. Clin Cardiol. 1988 Dec;11(12):839–842. doi: 10.1002/clc.4960111208. [DOI] [PubMed] [Google Scholar]
  31. Schwartz P. J., Locati E. The idiopathic long QT syndrome: pathogenetic mechanisms and therapy. Eur Heart J. 1985 Nov;6 (Suppl 500):103–114. doi: 10.1093/eurheartj/6.suppl_d.103. [DOI] [PubMed] [Google Scholar]
  32. Surawicz B. Electrophysiologic substrate of torsade de pointes: dispersion of repolarization or early afterdepolarizations? J Am Coll Cardiol. 1989 Jul;14(1):172–184. doi: 10.1016/0735-1097(89)90069-7. [DOI] [PubMed] [Google Scholar]
  33. Surawicz B., Knoebel S. B. Long QT: good, bad or indifferent? J Am Coll Cardiol. 1984 Aug;4(2):398–413. doi: 10.1016/s0735-1097(84)80232-6. [DOI] [PubMed] [Google Scholar]
  34. Susmano A., Graettinger J. S., Carleton R. A. The relationship between Q-T interval and heart rate. J Electrocardiol. 1969 Jul;2(3):269–273. doi: 10.1016/s0022-0736(69)80087-7. [DOI] [PubMed] [Google Scholar]
  35. WARD O. C. A NEW FAMILIAL CARDIAC SYNDROME IN CHILDREN. J Ir Med Assoc. 1964 Apr;54:103–106. [PubMed] [Google Scholar]
  36. Ward D. E. Prolongation of the QT interval as an indicator of risk of a cardiac event. Eur Heart J. 1988 May;9 (Suppl G):139–144. doi: 10.1093/eurheartj/9.suppl_g.139. [DOI] [PubMed] [Google Scholar]
  37. Way B. P., Forfar J. C., Cobbe S. M. Comparison of the effects of chronic oral therapy with atenolol and sotalol on ventricular monophasic action potential duration and effective refractory period. Am Heart J. 1988 Sep;116(3):740–746. doi: 10.1016/0002-8703(88)90332-8. [DOI] [PubMed] [Google Scholar]
  38. Wellens H. J., Vermeulen A., Durrer D. Ventricular fibrillation occurring on arousal from sleep by auditory stimuli. Circulation. 1972 Oct;46(4):661–665. doi: 10.1161/01.cir.46.4.661. [DOI] [PubMed] [Google Scholar]
  39. von Savigny L., Hohnloser S., Antoni H. Effects of changes in frequency on guinea pig ventricular action potential duration and on QT interval under different experimental conditions. Basic Res Cardiol. 1981 May-Jun;76(3):276–288. doi: 10.1007/BF01907772. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES