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Young WJ, Warren HR, Mook-Kanamori DO, Ramírez J, van Duijvenboden S, Orini M, Tinker A, van Heemst D, Lambiase PD, Jukema JW, Munroe PB, Noordam R. Genetically Determined Serum Calcium Levels and Markers of Ventricular Repolarization: A Mendelian Randomization Study in the UK Biobank. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2021; 14:e003231. [PMID: 33887147 PMCID: PMC8208093 DOI: 10.1161/circgen.120.003231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 04/02/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND ECG markers of ventricular depolarization and repolarization are associated with an increased risk of arrhythmia and sudden cardiac death. Our prior work indicated lower serum calcium concentrations are associated with longer QT and JT intervals in the general population. Here, we investigate whether serum calcium is a causal risk factor for changes in ECG measures using Mendelian randomization (MR). METHODS Independent lead variants from a newly performed genome-wide association study for serum calcium in >300 000 European-ancestry participants from UK Biobank were used as instrumental variables. Two-sample MR analyses were performed to approximate the causal effect of serum calcium on QT, JT, and QRS intervals using an inverse-weighted method in 76 226 participants not contributing to the serum calcium genome-wide association study. Sensitivity analyses including MR-Egger, weighted-median estimator, and MR pleiotropy residual sum and outlier were performed to test for the presence of horizontal pleiotropy. RESULTS Two hundred five independent lead calcium-associated variants were used as instrumental variables for MR. A decrease of 0.1 mmol/L serum calcium was associated with longer QT (3.01 ms [95% CI, 2.03 to 3.99]) and JT (2.89 ms [1.91 to 3.87]) intervals. A weak association was observed for QRS duration (secondary analyses only). Results were concordant in all sensitivity analyses. CONCLUSIONS These analyses support a causal effect of serum calcium levels on ventricular repolarization, in a middle-aged population of European-ancestry where serum calcium concentrations are likely stable and chronic. Modulation of calcium concentration may, therefore, directly influence cardiovascular disease risk.
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Affiliation(s)
- William J. Young
- Clinical Pharmacology Department, William Harvey Research Institute (W.J.Y., H.R.W., J.R., S.v.D., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust (W.J.Y., M.O., P.D.L.)
| | - Helen R. Warren
- Clinical Pharmacology Department, William Harvey Research Institute (W.J.Y., H.R.W., J.R., S.v.D., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
- NIHR Barts Cardiovascular Biomedical Research Unit (H.R.W., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
| | - Dennis O. Mook-Kanamori
- Department of Clinical Epidemiology (D.O.M.-K.), Leiden University Medical Center, the Netherlands
- Department of Public Health and Primary Care (D.O.M.-K.), Leiden University Medical Center, the Netherlands
| | - Julia Ramírez
- Clinical Pharmacology Department, William Harvey Research Institute (W.J.Y., H.R.W., J.R., S.v.D., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
- Institute of Cardiovascular Sciences, University of College London, United Kingdom (J.R., S.v.D., M.O., P.D.L.)
| | - Stefan van Duijvenboden
- Clinical Pharmacology Department, William Harvey Research Institute (W.J.Y., H.R.W., J.R., S.v.D., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
- Institute of Cardiovascular Sciences, University of College London, United Kingdom (J.R., S.v.D., M.O., P.D.L.)
| | - Michele Orini
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust (W.J.Y., M.O., P.D.L.)
- Institute of Cardiovascular Sciences, University of College London, United Kingdom (J.R., S.v.D., M.O., P.D.L.)
| | - Andrew Tinker
- Clinical Pharmacology Department, William Harvey Research Institute (W.J.Y., H.R.W., J.R., S.v.D., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
- NIHR Barts Cardiovascular Biomedical Research Unit (H.R.W., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
| | - Diana van Heemst
- Department of Internal Medicine (D.v.H., R.N.), Leiden University Medical Center, the Netherlands
| | - Pier D. Lambiase
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust (W.J.Y., M.O., P.D.L.)
- Institute of Cardiovascular Sciences, University of College London, United Kingdom (J.R., S.v.D., M.O., P.D.L.)
| | - J. Wouter Jukema
- Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands
- Netherlands Heart Institute, Utrecht, the Netherlands (J.W.J.)
| | - Patricia B. Munroe
- Clinical Pharmacology Department, William Harvey Research Institute (W.J.Y., H.R.W., J.R., S.v.D., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
- NIHR Barts Cardiovascular Biomedical Research Unit (H.R.W., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
| | - Raymond Noordam
- Department of Internal Medicine (D.v.H., R.N.), Leiden University Medical Center, the Netherlands
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Riggins J, Douglas T, deSouza IS. Ventricular tachycardia as a consequence of triggered activity. Am J Emerg Med 2020; 44:480.e5-480.e7. [PMID: 33221113 DOI: 10.1016/j.ajem.2020.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 11/27/2022] Open
Abstract
One of the less frequent underlying mechanisms of ventricular tachycardia (VT) is triggered activity. Triggered activity refers to an extrasystole due to a premature depolarization that occurs when the amplitude of an early or delayed afterdepolarization brings the cardiac membrane to its threshold potential. Hydrochlorothiazide and hydroxyzine can prolong repolarization and QT interval and are associated with early afterdepolarizations. Cyclic AMP-mediated, delayed afterdepolarizations can occur as a result of catecholaminergic surge. Delayed afterdepolarization is classically associated with outflow tract (OT) tachycardia, a type of VT that is uniquely defined by its termination with adenosine. We present a case of triggered OT tachycardia for which intravenous amiodarone through its antiadrenergic effect may have been effective. Infusions of magnesium and a cardioselective, β-receptor antagonist that does not prolong repolarization may have been more appropriate given the concurrent, acquired prolonged QT syndrome. After initial stabilization, considering the underlying VT mechanism may prompt the clinician to select the most appropriate, further treatment.
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Affiliation(s)
- John Riggins
- Department of Emergency Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA; Department of Emergency Medicine, Kings County Hospital Center, Brooklyn, NY, USA
| | - Taylor Douglas
- Department of Emergency Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA; Department of Emergency Medicine, Kings County Hospital Center, Brooklyn, NY, USA
| | - Ian S deSouza
- Department of Emergency Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA; Department of Emergency Medicine, Kings County Hospital Center, Brooklyn, NY, USA.
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Abstract
Ventricular tachycardia is commonly seen in medical practice. It may be completely benign or portend high risk for sudden cardiac death. Therefore, it is important that clinicians be familiar with and able to promptly recognize and manage ventricular tachycardia when confronted with it clinically. In many cases, curative therapy for a given ventricular arrhythmia may be provided after a thorough understanding of the underlying substrate and mechanism. In this article, the authors broadly review the current classification of the different ventricular arrhythmias encountered in medical practice, provide brief background regarding the different mechanisms, and discuss practical diagnosis and management scenarios.
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Affiliation(s)
- Soufian T AlMahameed
- Heart and Vascular Research Center, MetroHealth Campus of Case Western Reserve University, 2500 MetroHealth Medical Drive, Cleveland, OH 44109, USA.
| | - Ohad Ziv
- Heart and Vascular Research Center, MetroHealth Campus of Case Western Reserve University, 2500 MetroHealth Medical Drive, Cleveland, OH 44109, USA
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