Published online Apr 8, 2015. doi: 10.4254/wjh.v7.i4.662
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.
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.