caa a22 4500 606158669 CHVBK 20210128100620.0 cr unu---uuuuu 210128e20151001xx s 000 0 eng 10.1007/s10557-015-6619-0 doi (NATIONALLICENCE)springer-10.1007/s10557-015-6619-0 Electrocardiographic Predictors of Torsadogenic Risk During Dofetilide or Sotalol Initiation: Utility of a Novel T Wave Analysis Program [Elektronische Daten] [Alan Sugrue, Vaclav Kremen, Bo Qiang, Seth Sheldon, Christopher DeSimone, Yehu Sapir, Bryan Striemer, Peter Brady, Samuel Asirvatham, Michael Ackerman, Paul Friedman, Peter Noseworthy] 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 12T wave parameters successfully distinguished TdP cases from controls. The top performing parameters were the QTc in lead V3 (mean case vs control 480 vs 420msec, p < 0.001, r = 0.72) and T wave right slope in lead I (mean case vs control −840.29 vs −1668.71mV/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. Springer Science+Business Media New York, 2015 Class III antiarrhythmics nationallicence Torsade de pointes nationallicence Risk stratification nationallicence T wave analysis nationallicence Electrocardiography nationallicence Sugrue Alan Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA aut Kremen Vaclav Czech Institute of Informatics, Robotics, and Cybernetics, Czech Technical University in Prague, Prague, Czech Republic aut Qiang Bo Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA aut Sheldon Seth Department of Cardiology, University of Michigan, Ann Arbor, MI, USA aut DeSimone Christopher Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA aut Sapir Yehu Ben Gurion University of the Negev, Beersheba, Israel aut Striemer Bryan Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA aut Brady Peter Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA aut Asirvatham Samuel Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA aut Ackerman Michael Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA aut Friedman Paul Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA aut Noseworthy Peter Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA aut Cardiovascular Drugs and Therapy Springer US; http://www.springer-ny.com 29/5(2015-10-01), 433-441 0920-3206 29:5<433 2015 29 10557 https://doi.org/10.1007/s10557-015-6619-0 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s10557-015-6619-0 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Sugrue Alan Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA aut NATIONALLICENCE 700 1- Kremen Vaclav Czech Institute of Informatics, Robotics, and Cybernetics, Czech Technical University in Prague, Prague, Czech Republic aut NATIONALLICENCE 700 1- Qiang Bo Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA aut NATIONALLICENCE 700 1- Sheldon Seth Department of Cardiology, University of Michigan, Ann Arbor, MI, USA aut NATIONALLICENCE 700 1- DeSimone Christopher Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA aut NATIONALLICENCE 700 1- Sapir Yehu Ben Gurion University of the Negev, Beersheba, Israel aut NATIONALLICENCE 700 1- Striemer Bryan Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA aut NATIONALLICENCE 700 1- Brady Peter Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA aut NATIONALLICENCE 700 1- Asirvatham Samuel Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA aut NATIONALLICENCE 700 1- Ackerman Michael Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA aut NATIONALLICENCE 700 1- Friedman Paul Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA aut NATIONALLICENCE 700 1- Noseworthy Peter Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA aut NATIONALLICENCE 773 0- Cardiovascular Drugs and Therapy Springer US; http://www.springer-ny.com 29/5(2015-10-01), 433-441 0920-3206 29:5<433 2015 29 10557