ECG-based estimation of dispersion of APD restitution as a tool to stratify sotalol-induced arrhythmic risk

J Electrocardiol. 2015 Sep-Oct;48(5):867-73. doi: 10.1016/j.jelectrocard.2015.06.006. Epub 2015 Jun 6.

Abstract

Background: Increased spatial dispersion of restitution properties has been associated to arrhythmic risk. An ECG-based index quantifying restitution dispersion, DRest, is evaluated in patients who experienced Torsades de Pointes (TdP) under sotalol challenge and compared with the response in healthy subjects.

Methods and results: ECG recordings were analyzed for quantification of DRest and QTc, among others biomarkers. DRest provides improved discrimination following sotalol administration between TdP and healthy subjects ([min-max]: [0.18-0.22] vs [0.02-0.12]), compared to other biomarkers including QTc ([436-548ms] vs [376-467ms]). Results in healthy subjects are in agreement with simulations of sotalol effects on a human tissue electrophysiological model.

Conclusions: This case study supports the potential of DRest for improved arrhythmia risk stratification even with QTc values below 450ms.

Keywords: APD restitution; Rate adaptation; cardiotoxicity; sotalol.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Arrhythmia Agents / adverse effects
  • Diagnosis, Computer-Assisted / methods*
  • Electrocardiography / methods*
  • Humans
  • Reproducibility of Results
  • Risk Assessment / methods
  • Sensitivity and Specificity
  • Sotalol / adverse effects*
  • Torsades de Pointes / chemically induced*
  • Torsades de Pointes / diagnosis*
  • Torsades de Pointes / prevention & control
  • Treatment Outcome

Substances

  • Anti-Arrhythmia Agents
  • Sotalol