title: Bradycardia-induced abnormal QT prolongation in patients with complete atrioventricular block with torsades de pointes.
abstract: Fourteen patients with complete atrioventricular block with or without torsades de pointes (TdP) were included in this study. They were divided into 2 groups, 6 patients with TdP (TdP[+] group) and 8 patients without TdP (TdP[-] group). The patients were evaluated at 2 different periods, before (acute period) and after (chronic period) pacemaker implantation. In the acute period, the QRS and heart rate during the escape rhythm were not significantly different between the 2 groups; however, the QT and QTc intervals were significantly longer in the TdP(+) group than in the TdP(-) group: 753 +/- 57.5 vs 635 +/- 78.4 ms (p less than 0.01) and 585 +/- 44.8 vs 476 +/- 58.3 ms (p less than 0.01). In the chronic period (greater than 2 months after pacemaker implantation), we changed the pacemaker rate from 90 or 100 beats/min to 50 beats/min and examined the QT interval changes in relation to the heart rate. The QT interval in the TdP(+) group was significantly prolonged compared with the TdP(-) group when the pacing rate was decreased less than or equal to 60 beats/min: 551 +/- 40 vs 503 +/- 36 ms at 60 beats/min (p less than 0.05), and 700 +/- 46 vs 529 +/- 43 ms at 50 beats/min (p less than 0.001). Patients with complete atrioventricular block with TdP had a bradycardia-sensitive repolarization abnormality and this characteristic remained after pacemaker implantation. The critical heart rate that induced abnormal QT prolongation in the TdP(+) group was less than or equal to 60 beats/min.
authors.affiliation: Division of Cardiology, National Cardiovascular Center, Osaka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Kurita
authors.forename: T
authors.initials: T
authors.lastname: Ohe
authors.forename: N
authors.initials: N
authors.lastname: Marui
authors.forename: N
authors.initials: N
authors.lastname: Aihara
authors.forename: H
authors.initials: H
authors.lastname: Takaki
authors.forename: S
authors.initials: S
authors.lastname: Kamakura
authors.forename: M
authors.initials: M
authors.lastname: Matsuhisa
authors.forename: K
authors.initials: K
authors.lastname: Shimomura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001919:Bradycardia / Q000150:complications / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D006327:Heart Block / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016171:Torsades de Pointes / Q000150:complications / Q000503:physiopathology*