Classification and mechanism of initiation in patients with congenital long QT syndrome
Abstract
AIMS: To examine the initiating mode of Torsade de Pointes (TdP) in patients with congenital long QT syndrome (LQTS). METHODS AND RESULTS: We evaluated 111 episodes of TdP recorded on the electrocardiograms of 24 patients with congenital LQTS, and clarified the initiating mode, the three consecutive preceding RR intervals defined as C(2), C(1), and C(0), the timing of initiating premature ventricular contraction (PVC) and the cycle length (CL) of TdP. Three different initiating patterns were observed: (1) a "short-long-short" sequence (SLS) pattern (23 patients, 72 TdP, 65%) defined as one or more short-long cardiac cycles followed by an initiating short-coupled PVC (C(1)>C(2) and C(0)), (2) an "increased sinus rate" (ISR) pattern (8 patients, 28 TdP, 25%) defined as a gradual increase in sinus rate with or without T-wave alternans (C(2)>/=C(1)>/=C(0)), and (3) a "changed depolarization" (CD) pattern (5 patients, 11 TdP, 10%) defined as a sudden long-coupled PVC or fusion beat followed by short-coupled PVC. The C(0) was shorter in ISR than SLS and CD (mean C(0): 488 vs. 587 and 603 ms, respectively; P<0.05). Therefore, the initiating PVC appeared near the T-wave peak of the last beat before onset in ISR, while it occurred after the T-wave peak in SLS and CD. The CL of TdP was shorter in ISR than in SLS (256 vs. 295 ms, P<0.05). CONCLUSIONS: Our data show the existence of three predominant initiating modes of TdP in patients with congenital LQTS and suggests a differential mechanism of initiation of TdP for each mode.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Significant QTc prolongation (to intervals above 470-500 ms) is known to result in a risk of potentially fatal arrhythmias, such as Torsade de Pointes.
“Similarly, significant QTc prolongation (to intervals above 470–500 ms) is known to result in a risk of potentially fatal arrhythmias, such as Torsade de Pointes [100].”
From European guidelines on managing adverse effects of medication for ADHD (2011) · cites this paper as [100]
Cites
Diagnostic criteria for the long QT syndrome. An update.
Schwartz, P. J., Moss, A. J., Vincent, G. M., & Crampton, R. S. (1993) · Circulation · doi:10.1161/01.cir.88.2.782 · Cited by 1,172 · see citing works
The long QT syndrome. Prospective longitudinal study of 328 families.
Moss, A. J., Schwartz, P. J., Crampton, R. S., Tzivoni, D., Locati, E. H., MacCluer, J. W., Hall, W. J., Weitkamp, L., Vincent, G. M., & Garson, A. (1991) · Circulation · doi:10.1161/01.cir.84.3.1136 · Cited by 966 · see citing works
Long QT syndromes and torsade de pointes
Viskin, S. (1999) · The Lancet · doi:10.1016/s0140-6736(99)02107-8 · Cited by 690 · see citing works
Multiple Mechanisms in the Long-QT Syndrome
Roden, D. M., Lazzara, R., Rosen, M. R., Schwartz, P. J., Towbin, J. A., & Vincent, G. M. (1996) · Circulation · doi:10.1161/01.cir.94.8.1996 · Cited by 631 · see citing works
Shimizu, W., & Antzelevitch, C. N. (1997) · Circulation · doi:10.1161/01.cir.96.6.2038 · Cited by 524 · see citing works
Self-citationCellular Basis for the ECG Features of the LQT1 Form of the Long-QT Syndrome
Shimizu, W., & Antzelevitch, C. N. (1998) · Circulation · doi:10.1161/01.cir.98.21.2314 · Cited by 499 · see citing works
Self-citationClinical relevance of cardiac arrhythmias generated by afterdepolarizations
Antzelevitch, C., & Sicouri, S. (1994) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(94)90529-0 · Cited by 491 · see citing works
Kay, G. N., Plumb, V. J., Arciniegas Joaquin, G., Henthorn, R. W., & L, W. (1983) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(83)80226-5 · Cited by 463 · see citing works
The Electrophysiological Mechanism of Ventricular Arrhythmias in the Long QT Syndrome
El‐Sherif, N., Caref, E. B., Yin, H. S., & Restivo, M. (1996) · Circulation Research · doi:10.1161/01.res.79.3.474 · Cited by 425 · see citing works
Cellular mechanisms underlying the long QT syndrome
Antzelevitch, C. N., & Shimizu, W. (2002) · Current Opinion in Cardiology · doi:10.1097/00001573-200201000-00007 · Cited by 313 · see citing works
Self-citationCellular and Ionic Basis for T-Wave Alternans Under Long-QT Conditions
Shimizu, W., & Antzelevitch, C. (1999) · Circulation · doi:10.1161/01.cir.99.11.1499 · Cited by 302 · see citing works
Self-citationYan, G., Wu, Y., Liu, T., Wang, J., Marinchak, R. A., & Kowey, P. R. (2001) · Circulation · doi:10.1161/01.cir.103.23.2851 · Cited by 269 · see citing works
Etiology, warning signs and therapy of torsade de pointes. A study of 10 patients.
Keren, A., Tzivoni, D., Gavish, D., Levi, J., Gottlieb, S., Benhorin, J., & Stern, S. (1981) · Circulation · doi:10.1161/01.cir.64.6.1167 · Cited by 244 · see citing works
Early afterdepolarizations induced by isoproterenol in patients with congenital long QT syndrome.
Shimizu, W., Ohe, T., Kurita, T., et al. (1991) · Circulation · doi:10.1161/01.cir.84.5.1915 · Cited by 188 · see citing works
Self-citationShimizu, W., Ohe, T., Kurita, T., Kawade, M., Arakaki, Y., Aihara, N., Kamakura, S., Kamiya, T., & Shimomura, K. (1995) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(95)00313-4 · Cited by 164 · see citing works
Self-citationMode of onset of torsade de pointes in congenital long QT syndrome
Viskin, S., Alla, S. R., Barron, H. V., Heller, K., Saxon, L. A., Kitzis, I., Hare, G. F. V., Wong, M. J., Lesh, M. D., & Scheinman, M. M. (1996) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(96)00311-7 · Cited by 162 · see citing works
Electrophysiological Basis of Arrhythmogenicity of QT/T Alternans in the Long-QT Syndrome
Chinushi, M., Restivo, M., Caref, E. B., et al. (1998) · Circulation Research · doi:10.1161/01.res.83.6.614 · Cited by 146 · see citing works
Locati, E. H., Maison-Blanche, P., Dejode, P., Cauchemez, B., & Coumel, P. (1995) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(95)00100-i · Cited by 144 · see citing works
Costard‐Jäckle, A., Goetsch, B., Antz, M., & Franz, M. R. (1989) · Circulation · doi:10.1161/01.cir.80.5.1412 · Cited by 131 · see citing works
Acceleration‐Induced Action Potential Prolongation and Early Afterdepolarizations
Burashnikov, A., & Antzelevitch, C. N. (1998) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.1998.tb00134.x · Cited by 124 · see citing works
The Long QT Syndrome and Torsade De Pointes
El‐Sherif, N., & Turitto, G. (1999) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.1999.tb00305.x · Cited by 99 · see citing works
Arrhythmias in the congenital long QT syndrome: how often is torsade de pointes pause dependent?
Viskin, S., Fish, R., Zeltser, D., Belhassen, B., Heller, K., Brosh, D., Laniado, S., & Barron, H. V. (2000) · Heart · doi:10.1136/heart.83.6.661 · Cited by 99 · see citing works
El‐Sherif, N., Caref, E. B., Chinushi, M., & Restivo, M. (1999) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(98)00700-1 · Cited by 74 · see citing works
TU Alternans, Long QTU, and Torsade de Pointes: Clinical and Experimental Observations
HABBAB, M. A., & El‐Sherif, N. (1992) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.1992.tb03082.x · Cited by 65 · see citing works
Shimizu, W., Ohe, T., Kurita, T., TOKUDA, T., & Shimomura, K. (1994) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.1994.tb01183.x · Cited by 48 · see citing works
Self-citationMechanism of Ventricular Arrhythmias in the Long QT Syndrome: On Hermeneutics
El-Sherif, N. (2001) · Journal of Cardiovascular Electrophysiology · doi:10.1046/j.1540-8167.2001.00973.x · Cited by 28 · see citing works
Role of Early Afterdepolarization in Familial Long QTU Syndrome and Torsade de Pointes
ZHOU, J., Zheng, L., & LIU, W. (1992) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.1992.tb03041.x · Cited by 24 · see citing works
QRS Alteration-induced Torsade de Pointes in a Patient With an Artificial Pacemaker and Hypokalemia
Kurita, T., Ohe, T., Maeda, K., et al. (1996) · Japanese Circulation Journal-english Edition · doi:10.1253/jcj.60.189 · Cited by 13 · see citing works
Self-citationLong QT Syndrome and Torsade de Pointes
El-Sherif, N., Turitto, G., & Boutjdir, M. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-809657-4.99793-x · Cited by 8 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
European guidelines on managing adverse effects of medication for ADHD
(for the European Guidelines Group), Graham, J., Banaschewski, T., Buitelaar, J., Coghill, D., Danckaerts, M., Dittmann, R. W., Döpfner, M., Hamilton, R., Hollis, C., et al. (2011) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-010-0140-6 · Cited by 374 · see citing works
Safety and efficacy of ibutilide in cardioversion of atrial flutter and fibrillation
Nair, M., George, L. K., & Koshy, S. K. G. (2011) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2011.01.080096 · Cited by 44 · see citing works
- Authors
- NODA, T., SHIMIZU, W., SATOMI, K., SUYAMA, K., KURITA, T., AIHARA, N., & KAMAKURA, S.
- Corresponding author
- NODA, T
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2004-12
- Volume
- 25
- Issue
- 23
- Pages
- 2149-2154
- ISSN
- 0195-668X (ISSN-L)
- OpenAlex
- W2175776907
- Cited by
- 83
- References
- 29
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 3 · 2023: 1 · 2022: 4 · 2021: 7 · 2020: 1 · 2019: 7 · 2017: 3 · 2016: 2 · 2015: 5 · 2014: 3 · 2013: 4 · 2012: 2
- FWCI
- 3.92
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- congenital long QT syndrome, torsades de pointes, premature ventricular contractions, T-wave alternans, cycle length
- MeSH terms
- Adolescent, Adult, Child, Child, Preschool, Electrocardiography, Female, Humans, Infant, Long QT Syndrome, Male, Middle Aged, Torsades de Pointes, Ventricular Premature Complexes
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
