Cardiac electrophysiological abnormalities in patients with cirrhosis

Abnormalities in cardiac electrophysiology are well documented in patients with liver cirrhosis. The mechanisms underlying their occurrence are not fully understood, although it is likely that some of these defects have common pathophysiogical alterations at molecular level. In order to attribute the electrophysiological abnormalities found in a patient to cirrhosis, it is important to exclude other causes of cardiac disease, such as ischemic, valvular, restrictive or congenital heart disease, as well as conduction abnormalities, arterial hypertension, lung disease or the use of anti-arrhythmic drugs. Patients who are actively drinking alcohol may have cardiac abnormalities due to alcohol abuse, and, as with cardiac abnormalities in patients with hemochromatosis, it may be difficult, if not impossible, to attribute an electrophysiologial abnormality to cirrhosis per se in these contexts. This review will deal with the three abnormalities of cardiac electrophysiology most frequently encountered in cirrhosis: (1) chronotropic incompetence; (2) electromechanical uncoupling, and (3) electrocardiographic QT interval prolongation. © 2006 European Association for the Study of the Liver.