HIV and Ventricular Arrhythmia Susceptibility: Insights from Cardiac Patch Monitoring

Victor Nauffal,Wendy S Post,Gregory D Kirk,Hiroshi Ashikaga,Katherine C Wu

doi:10.4172/2165-7920.10001045

Abstract

The use of novel adhesive patch electrocardiographic monitoring for extended time periods has the potential to improve our detection and pathophysiologic understanding of ambient arrhythmias. Here we present a case of torsade de pointes in an HIV-infected individual highlighting the multiple mechanisms that may contribute to increased ventricular arrhythmia susceptibility and sudden cardiac death risk in such people.

Highlights

As life-expectancy increases for individuals living with human immunodeficiency virus (HIV), chronic illnesses such as cardiovascular disease are increasingly prevalent [1]
We highlight an ambulatory case of torsades de pointes (TdP) that encompasses the potential complexity of risk prevention amongst those with HIV and the potential role of cardiac patch monitoring in understanding arrhythmic risk in cohorts
The participant endorsed chest pain and palpitations but no syncope or lightheadedness on the day of these events and was otherwise in her usual state of health. She failed to follow-up with subsequent clinical appointments. This case encapsulates the myriad cardiovascular risks associated with HIV infection including premature coronary artery disease, scarmediated monomorphic ventricular tachycardia, as well as TdP

Summary

Introduction

As life-expectancy increases for individuals living with human immunodeficiency virus (HIV), chronic illnesses such as cardiovascular disease are increasingly prevalent [1]. The study protocol includes cardiac magnetic resonance imaging (CMR) and ambulatory cardiac arrhythmia patch monitoring (ZIO Patch, iRhythm Technologies) Her medical history included a long history of polysubstance use (heroin, cocaine and alcohol), opiate dependence (intermittently maintained on methadone treatment), medication non-adherence, smoking and prior ST elevation myocardial infarction (MI) at the age of 42 years. Resting electrocardiogram (ECG) revealed a newly prolonged corrected QT interval (QTc) of 560 ms as compared to 464 ms on an ECG two year earlier and old anteroseptal infarct pattern (Figure 1, Panel A) Analysis of her ZIO Patch data over the four days that she wore the device revealed frequent ventricular ectopy constituting 14.9% of the overall recorded beats.

Findings

Discussion

Conclusion