Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Apr 8, 2015; 7(4): 662-672
Published online Apr 8, 2015. doi: 10.4254/wjh.v7.i4.662
Arrhythmia risk in liver cirrhosis
Ioana Mozos
Ioana Mozos, Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, 300173 Timisoara, Romania
Author contributions: Mozos I reviewed the literature and wrote the manuscript.
Conflict-of-interest: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Ioana Mozos, MD, PhD, Associate Professor, Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, T. Vladimirescu Street 14, 300173 Timisoara, Romania.
Telephone: +40-745-610004 Fax: +40-256-490626
Received: August 23, 2014
Peer-review started: August 24, 2014
First decision: October 14, 2014
Revised: December 4, 2014
Accepted: January 15, 2015
Article in press: January 19, 2015
Published online: April 8, 2015

Interactions between the functioning of the heart and the liver have been described, with heart diseases affecting the liver, liver diseases affecting the heart, and conditions that simultaneously affect both. The heart is one of the most adversely affected organs in patients with liver cirrhosis. For example, arrhythmias and electrocardiographic changes are observed in patients with liver cirrhosis. The risk for arrhythmia is influenced by factors such as cirrhotic cardiomyopathy, cardiac ion channel remodeling, electrolyte imbalances, impaired autonomic function, hepatorenal syndrome, metabolic abnormalities, advanced age, inflammatory syndrome, stressful events, impaired drug metabolism and comorbidities. Close monitoring of cirrhotic patients is needed for arrhythmias, particularly when QT interval-prolonging drugs are given, or if electrolyte imbalances or hepatorenal syndrome appear. Arrhythmia risk may persist after liver transplantation due to possible QT interval prolongation, persistence of the parasympathetic impairment, post-transplant reperfusion and chronic immunosuppression, as well as consideration of the fact that the transplant itself is a stressful event for the cardiovascular system. The aims of the present article were to provide a review of the most important data regarding the epidemiology, pathophysiology, and biomarkers of arrhythmia risk in patients with liver cirrhosis, to elucidate the association with long-term outcome, and to propose future research directions.

Keywords: Arrhythmia, Atrial fibrillation, Cirrhotic cardiomyopathy, Electrocardiography, Liver cirrhosis, Liver transplantation, Sudden cardiac death, Tpeak-Tend interval, Ventricular tachycardia, Long-QT syndrome

Core tip: Arrhythmias and electrocardiographic changes occur in several non-cardiac diseases, including liver cirrhosis. Supraventricular and ventricular arrhythmias, including atrial fibrillation and flutter, and premature atrial and ventricular contractions, have been reported in cirrhotic patients. It is questionable whether the prevalence of atrial fibrillation and flutter is high in patients with liver cirrhosis, or if liver cirrhosis protects against supraventricular arrhythmias.