Arrhythmia risk in liver cirrhosis

Table 1 Factors associated with QT prolongation in liver cirrhosis

Factor	Example
Autonomic neuropathy	Plasma norepinephrine, diurnal variations
Liver dysfunction	Child-Pugh class, portal hypertension, pediatric end-stage liver disease score
Serum markers	Electrolytes, serum uric acid, serum bile salts, creatinine, plasma renin activity, aldosterone, atrial natriuretic factor, gonadal hormones, norepinephrine
Volume overload	Left ventricular end diastolic dimensions
Coronary heart disease	Risk factors: older age, male gender, smoking, arterial hypertension, diabetes mellitus
Left ventricular hypertrophy	-
Stressful events	Acute gastrointestinal bleeding
Drugs: excessive accumulation, impaired metabolization, distribution, or excretion	Erythromycin, fluoroquinolones, telipressin, sevoflurane

Table 2 Atrial fibrillation in patients with liver cirrhosis

Higher prevalence due to	Lower prevalence due to
Enlarged left atria (cirrhotic cardiomyopathy)	Accumulation of antiarrhythmic and anti-inflammatory substances
Electrolyte imbalances	Low prevalence of hypertension
Hepatorenal syndrome	Medication: diuretics, beta-blockers, ACE-inhibitors, statins
Serum bile acid concentration	Downregulation of beta-adrenergic receptors in the myocardium
Metabolic abnormalities
Inflammatory syndrome
Atrial interstitial fibrosis

ACE: Angiotensin-converting enzyme.

Table 3 Risk factors for arrhythmias after liver transplantation

Risk factor
Stress of major surgery
Advanced age
Comorbidities: low blood pressure, anemia, limitation of the cardiac reserve
Hydroelectrolytic and acid-base imbalances
Hypothermia
Secondary development of hypertension, diabetes mellitus, obesity