The usefulness of T-wave peak to T-wave end interval in identifying malignant arrhythmias in patients with Chagas disease.

INTRODUCTION: Abnormal ventricular repolarization has been proposed as a marker of arrhythmogenesis, and cardiovascular morbidity and mortality. However, little is known about the influence of the interval between the peak and the end of the T wave (Tp-Te) on the inducibility of sustained ventricular arrhythmias (VA) in patients with Chagas disease (CD). METHODS: Using a case-control design, chagasics undergoing electrophysiological study (EPS) in the last three years were matched by age and sex. Cases represented those with positive EPS and controls those with no inducible VA. Tp-Te>100 ms was considered abnormal. Logistic regression analysis was performed to assess the association between Tp-Te and a positive EPS, after adjusting for confounders. RESULTS: A total of 105 patients (mean age 56 years, 52.4% male) were included: 41 (39%) had a positive EPS; 85.4% with inducible VA (n=35) had non-sustained ventricular tachycardia on the Holter monitoring, compared to 62.5% with negative EPS (n=40, p<0.001). While ventricular aneurysm (adjusted OR=5.3, 95% CI: 1.11-24.96, p=0.03) and coronary artery disease (adjusted OR=8.8, 95% CI: 1.45-53.15, p=0.01) were associated with an increased risk of malignant arrhythmias, a greater ejection fraction (adjusted OR=0.96, 95% CI: 0.93-0.99, p<0.01) was associated with a lower risk of VA. Prolonged Tp-Te trended to be associated with an increased risk of induced VA (p=0.07). CONCLUSIONS: Ventricular aneurysm, coronary artery disease, and ejection fraction are associated with inducible VA. Prolonged TP-Te may have a modest role in the identification of patients with CD who are at high risk for VA. Further studies are warranted to validate our results and to correlate them with clinical outcomes.

The usefulness of T-wave peak to T-wave endInterval in identifying malignant arrhythmias in patients with chagas disease

Introduction: Abnormal ventricular repolarization has been proposed as a marker of arrhythmogenesis, andcardiovascular morbidity and mortality. However, little is known about the influence of the interval betweenthe peak and the end of the T wave (Tp-Te) on the inducibility of sustained ventricular arrhythmias (VA) inpatients with Chagas disease (CD).Methods: Using a case-control design, chagasics undergoing electrophysiological study (EPS) in the lastthree years were matched by age and sex. Cases represented those with positive EPS and controls thosewith no inducible VA. Tp-Te>100 ms was considered abnormal. Logistic regression analysis was performedto assess the association between Tp-Te and a positive EPS, after adjusting for confounders.Results: A total of 105 patients (mean age 56 years, 52.4% male) were included: 41 (39%) had a positiveEPS; 85.4% with inducible VA (n=35) had non-sustained ventricular tachycardia on the Holter monitoring,compared to 62.5% with negative EPS (n=40, p<0.001). While ventricular aneurysm (adjustedOR=5.3, 95% CI: 1.11-24.96, p=0.03) and coronary artery disease (adjusted OR=8.8, 95% CI: 1.45-53.15, p=0.01) were associated with an increased risk of malignant arrhythmias, a greater ejection fraction(adjusted OR=0.96, 95% CI: 0.93-0.99, p<0.01) was associated with a lower risk of VA. Prolonged Tp-Tetrended to be associated with an increased risk of induced VA (p=0.07).Conclusions: Ventricular aneurysm, coronary artery disease, and ejection fraction are associated with inducibleVA. Prolonged TP-Te may have a modest role in the identification of patients with CD who are at highrisk for VA. Further studies are warranted to validate our results and to correlate them with clinical outcomes.

Gastroesophageal reflux and atrial fibrillation: is there any correlation?

Atrial fibrillation (AF), gastroesophageal reflux disease (GERD) and hiatal hernias are commonly seen in clinical practice. GERD and hiatal hernias have been proposed to be a possible cause of AF. In this paper, we will briefly review GERD, AF and hiatal hernias, consider the available literature covering the association between these diseases and provide further insight into the topic in general.