[CME ECC 66: Torsade de Pointes: The Danger of a Rotating Heart Axis]

CME ECC 66: Torsade de Pointes: The Danger of a Rotating Heart Axis Abstract. Torsade de pointes tachycardia is a potentially life-threatening heart rhythm disorder, caused by prolongation of the QT-interval resulting in triggered activity. This QT-prolongation can be congenital or acquired. If acquired, it is mainly caused by pharmacological therapy. The hallmark of torsade de pointes is an undulating QRS axis with a twist of the QRS complex around the ECG's baseline. Often, this polymorphic ventricular tachycardia is self-limiting, but degeneration into ventricular fibrillation is possible, which makes torsade de pointes tachycardia dangerous. This article aims to provide insights into etiology, diagnostics, prevention and management of this heart rhythm disorder.

[CME ECG 66/Answers: Torsade de Pointes: The Danger of a Rotating Heart Axis]

CME ECG 66/Answers: Torsade de Pointes: The Danger of a Rotating Heart Axis Abstract. Torsade de pointes tachycardia is a potentially life-threatening heart rhythm disorder, caused by prolongation of the QT interval resulting in triggered activity. This QT prolongation can be congenital or acquired. If acquired, it is mainly caused by pharmacological therapy. The hallmark of torsade de pointes is an undulating QRS axis with a twist of the QRS complex around the ECG's baseline. Often, this polymorphic ventricular tachycardia is self-limiting, but degeneration into ventricular fibrillation is possible, which makes torsade de pointes tachycardia dangerous. This article aims to provide insights into etiology, diagnostics, prevention and management of this heart rhythm disorder.

Mutation of the Na+/K+-ATPase Atp1a1a.1 causes QT interval prolongation and bradycardia in zebrafish

The genetic underpinnings that orchestrate the vertebrate heart rate are not fully understood yet, but of high clinical importance, since diseases of cardiac impulse formation and propagation are common and severe human arrhythmias. To identify novel regulators of the vertebrate heart rate, we deciphered the pathogenesis of the bradycardia in the homozygous zebrafish mutant hiphop (hip) and identified a missense-mutation (N851K) in Na⁺/K⁺-ATPase α1-subunit (atp1a1a.1). N851K affects zebrafish Na⁺/K⁺-ATPase ion transport capacity, as revealed by in vitro pump current measurements. Inhibition of the Na⁺/K⁺-ATPase in vivo indicates that hip rather acts as a hypomorph than being a null allele. Consequently, reduced Na⁺/K⁺-ATPase function leads to prolonged QT interval and refractoriness in the hip mutant heart, as shown by electrocardiogram and in vivo electrical stimulation experiments. We here demonstrate for the first time that Na⁺/K⁺-ATPase plays an essential role in heart rate regulation by prolonging myocardial repolarization.