Circulation, Vol 86, 1376-1382, Copyright © 1992 by American Heart Association
JT Hii, DG Wyse, AM Gillis, HJ Duff, MA Solylo and LB Mitchell
BACKGROUND. Patients with a history of class Ia drug-induced torsade de
pointes have been treated with chronic amiodarone without recurrence of
torsade de pointes despite comparable prolongation of the QT interval. We
hypothesized that in such patients, class Ia drugs cause nonhomogeneous
prolongation of cardiac repolarization times, whereas amiodarone causes
homogeneous prolongation of cardiac repolarization times. METHODS AND
RESULTS. Thirty-eight consecutive patients who received both class Ia drug
therapy and chronic amiodarone therapy were evaluated. Standard 12-lead
ECGs at baseline and during each therapy were used to calculate precordial
QT interval dispersion (maximum QT in leads V1 through V6 minus minimum QT
leads V1 through V6) as a measure of regional variabilities in ventricular
repolarization times. Nine of these patients had torsade de pointes during
class Ia drug therapy. In these nine patients, class Ia drug therapy and
amiodarone significantly prolonged the maximum QT interval to comparable
extents. However, class Ia drug therapy but not amiodarone therapy
significantly increased precordial QT interval dispersion (101 +/- 37
versus 49 +/- 26 msec; baseline, 44 +/- 12 msec; p = 0.002). In the 29
patients without class Ia drug-induced torsade de pointes, neither class Ia
drug therapy nor amiodarone therapy significantly increased QT interval
dispersion (50 +/- 6 versus 69 +/- 7 msec; baseline, 54 +/- 5 msec). None
of the patients with class Ia drug-induced torsade de pointes had recurrent
torsade de pointes during chronic amiodarone therapy. CONCLUSIONS. An
increase in regional QT interval dispersion during class Ia antiarrhythmic
drug therapy is associated with torsade de pointes. Chronic amiodarone
therapy in patients with a history of class Ia drug- induced torsade de
pointes produces comparable maximum QT interval prolongation but does not
increase QT interval dispersion. This characteristic may explain its
apparent safe use in patients with a history of class Ia drug-induced
torsade de pointes.
ARTICLES
Precordial QT interval dispersion as a marker of torsade de pointes. Disparate effects of class Ia antiarrhythmic drugs and amiodarone
Department of Medicine, Foothills Medical Centre, Calgary, Alberta, Canada.
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