Cor Vasa 2026, 68(4):427-439 | DOI: 10.33678/cor.2026.036

Ventricular Arrhythmias in Electrolyte Imbalance Julieta Leladze

Julieta Leladze
Department of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia

Aim: The aim of the study was to analyse the pathophysiological mechanisms, electrocardiographic manifestations, and therapeutic approaches related to ventricular arrhythmias caused by electrolyte imbalance, with emphasis on disturbances of potassium, magnesium, and calcium and their role in arrhythmogenesis and clinical risk assessment.

Methods: A systematic literature review was conducted following PRISMA 2020 guidelines. Scientific publications from 2019-2025 were searched in PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar. The research question was structured using the PICO framework focusing on adult patients with electrolyte disturbances and the development of ventricular arrhythmias. From 1,847 initially identified records, duplicates and irrelevant studies were excluded through multi-stage screening. Fifty-two publications met the inclusion criteria and were analysed. Data extraction included electrolyte concentrations, electrophysiological mechanisms, electrocardiographic indicators, therapeutic interventions, and clinical outcomes. Because of heterogeneity among the studies, thematic synthesis was applied instead of meta-analysis.

Results: Electrolyte disturbances were found to significantly influence myocardial electrophysiology and increase the risk of ventricular arrhythmias. Hypokalaemia contributes to arrhythmogenesis through dysfunction of potassium channels and prolongation of repolarisation, promoting early and delayed afterdepolarisations. Imbalances in magnesium and calcium affect L-type calcium channels and ryanodine receptors, creating conditions for polymorphic ventricular tachycardia, including torsades de pointes. The highest arrhythmogenic risk occurs in combined potassium and magnesium deficiency (K⁺ <2.8 mmol/L and © 2026, ČKS.

Keywords: Hypocalcaemia, Hypokalaemia, Hypomagnesaemia, Refractory period, Ryanodine receptors

Received: February 11, 2026; Revised: March 27, 2026; Accepted: April 6, 2026; Prepublished online: August 24, 2026; Published: August 31, 2026  Show citation

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Leladze J. Ventricular Arrhythmias in Electrolyte Imbalance Julieta Leladze. Cor Vasa. 2026;68(4):427-439. doi: 10.33678/cor.2026.036.
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    References

    1. Yaman NM, Balci KG, Ekici E, et al. Arrhythmia risk and laboratory markers. Angiology 2019;70:782. Go to original source... Go to PubMed...
    2. Masmoudi I, Dindane Z, Richter S, et al. Ventricular arrhythmias in the context of chronic kidney disease and electrolyte imbalance. Herzschr Elektrophys 2024;35:211-218. 438 Ventricular Arrhythmias in Electrolyte Imbalance Go to original source... Go to PubMed...
    3. Pintaningrum Y, Pramana KAAP. Acquired Long QT syndrome secondary to electrolyte imbalance: A case report. In: Proceedings of the 2nd Global Health and Innovation in conjunction with 6th ORL Head and Neck Oncology Conference. Dordrecht: Atlantis Press; 2021:252-256. Go to original source...
    4. Laslett DB, Cooper JM, Greenberg RM, et al. Electrolyte abnormalities in patients presenting with ventricular arrhythmia (from the LYTE-VT study). Am J Cardiol 2020;129:36-41. Go to original source... Go to PubMed...
    5. Tcholadze G, Pantsulaia I, Ratiani L, et al. Longitudinal impact of IL-6 on cardiovascular outcomes in COVID-19 patients: Comparative analysis during hospitalization and at six-month follow-up. Georg Biomed News 2025;3(1). Go to original source...
    6. Chutkerashvili T, Maskhulia L, Akhalkatsi L, et al. Role of exercise stress test in evaluating athletes with premature ventricular beats: A retrospective study. Georg Biomed News 2024;2(2). Go to original source...
    7. Tcholadze G, Pantsulaia I, Ratiani L, et al. The prognostic value of circulating cytokines and complete blood countbased inflammatory markers in COVID-19 patients with atrial fibrillation. Cardiol Res 2025;16:153-160. Go to original source... Go to PubMed...
    8. Pagava Z, Shaburishvili T, Klimiashvili Z, et al. Georgian trace in the study of the early stages of hypertension. Georg Biomed News 2025;3(3). Go to original source...
    9. Munawar S, Anderson CL, Reilly L, et al. Atomic-level investigation of KCNJ2 mutations associated with ventricular arrhythmic syndrome phenotypes. Sci Rep 2025;15:11290. Go to original source...
    10. Tse G, Li KHC, Cheung CKY, et al. Arrhythmogenic mechanisms in hypokalaemia: Insights from pre-clinical models. Front Cardiovasc Med 2021;8:620539. Go to original source... Go to PubMed...
    11. Gurung B, Tse G, Keung W, et al. Arrhythmic risk assessment of hypokalaemia using human pluripotent stem cell-derived cardiac anisotropic sheets. Front Cell Dev Biol 2021;9:681665. Go to original source...
    12. Shen R, Zuo D, Chen K, et al. K2P1 leak cation channels contribute to ventricular ectopic beats and sudden death under hypokalemia. FASEB J 2022;36:e22455. Go to original source... Go to PubMed...
    13. Borile G, Zaglia T, Lehnart SE, et al. Multiphoton imaging of Ca2+ instability in acute myocardial slices from a RyR2R2474S murine model of catecholaminergic polymorphic ventricular tachycardia. J Clin Med 2021;10:2821. Go to original source... Go to PubMed...
    14. Tsumoto K, Shimamoto T, Aoji Y, et al. Chained occurrences of early afterdepolarizations may create a directional triggered activity to initiate reentrant ventricular tachyarrhythmias. Comput Methods Programs Biomed 2025;261:108587. Go to original source... Go to PubMed...
    15. García-Cano L, Brouzet TA, García-Fernández A, et al. Diagnosis of catecholaminergic polymorphic ventricular tachycardia during late adulthood due to a rare genetic variant in RYR2: A case report. Int J Arrhythm 2021;22:13. Go to original source...
    16. Lerman BB, Markowitz SM, Cheung JW, et al. Ventricular tachycardia due to triggered activity. JACC Clin Electrophysiol 2023;10:379-401. Go to original source... Go to PubMed...
    17. Verkerk AO, Wilders R. Effects of acute hypernatremia on the electrophysiology of single human ventricular cardiomyocytes: An in silico study. Rev Cardiovasc Med 2024;25:194. Go to original source... Go to PubMed...
    18. Timilsina S, Pata R, Timilsina S, et al. Correction of hypernatremia due to pure dehydration could be a potential risk factor for transient atrial fibrillation. Cureus 2019;11:e5387. Go to original source... Go to PubMed...
    19. Braun MM, Barstow CH, Pyzocha NJ. Diagnosis and management of sodium disorders: Hyponatremia and hypernatremia. Am Fam Physician 2015;91:299-307.
    20. Castello LM, Gavelli F, Baldrighi M, et al. Hypernatremia and moderate-to-severe hyponatremia are independent predictors of mortality in septic patients at emergency department presentation: A subgroup analysis of the need-speed trial. Eur J Intern Med 2020;83:21-27. Go to original source... Go to PubMed...
    21. Yang F, Zhang X, Liu H, et al. Post-translational modifications of connexin 43 in ventricular arrhythmias after myocardial infarction. Mol Biol Rep 2024;51:329. Go to original source...
    22. Ma K, Ma G, Guo Z, et al. Regulatory mechanism of calcium/ calmodulin-dependent protein kinase II in the occurrence and development of ventricular arrhythmia. Exp Ther Med 2021;21:656. Go to original source...
    23. Kléber AG, Jin Q. Coupling between cardiac cells - An important determinant of electrical impulse propagation and arrhythmogenesis. Biophys Rev 2021;2:031301. Go to original source... Go to PubMed...
    24. Padget RL, Blair GA, North MD, et al. Adenovirus increases arrhythmia susceptibility during acute cardiac infection. FASEB J 2022;36(S1). Go to original source...
    25. Brown AP, Friedrichs GS, Tang H, et al. Electrophysiological changes in the rabbit ventricular wedge and human-induced pluripotent stem-cell derived cardiomyocytes translate to severe arrhythmia observed in a canine toxicology study. Int J Toxicol 2024;43:231-242. Go to original source... Go to PubMed...
    26. Liu W, Shao R, Jin L, et al. Prolonged ventricular repolarization acts as an independent predictor of sepsis prognosis: A cohort study and insights into intracardiac electrophysiology. Eur Heart J 2024;45(Suppl 1):ehae666.3031. Go to original source...
    27. Tsai C, Patel H, Horbal P, et al. Comparison of quantifiable electrocardiographic changes associated with severe hyperkalemia. Int J Cardiol 2023;391:131257. Go to original source... Go to PubMed...
    28. Khan U, Afzal U, Kask L, et al. Ion-Flux: The natural course of ECG changes in severe hypokalemia. Curr Probl Cardiol 2023;49:102158. Go to original source... Go to PubMed...
    29. Teymouri N, Mesbah S, Navabian SMH, et al. ECG frequency changes in potassium disorders: A narrative review. Am J Cardiovasc Dis 2022;12:112-124.
    30. Varga C, Kálmán Z, Szakáll A, et al. ECG alterations suggestive of hyperkalemia in normokalemic versus hyperkalemic patients. BMC Emerg Med 2019;19:33. Go to original source... Go to PubMed...
    31. Yang Y, Chen C, Duan P, et al. The ECG characteristics of patients with isolated hypomagnesemia. Front Physiol 2021;11:617374. Go to original source... Go to PubMed...
    32. Kulkarni K, Merchant FM, Kassab MB, et al. Cardiac alternans: Mechanisms and clinical utility in arrhythmia prevention. J Am Heart Assoc 2019;8:e013750. Go to original source...
    33. Hartley I, Gafni R, Roszko K, et al. Effects of encaleret on corrected QT interval in autosomal dominant hypocalcemia type 1: Early results from an ongoing phase 2B study. Circulation 2021;144(Suppl 1):14476. Go to original source...
    34. Reynard JT, Oshodi OM, Lai JC, et al. Electrocardiographic conduction and repolarization markers associated with sudden cardiac death: Moving along the electrocardiography waveform. Minerva Cardioangiol 2019;67:131-144. Go to original source... Go to PubMed...
    35. Bauer A, Sappler N, von Stülpnagel L, et al. Telemedical cardiac risk assessment by implantable cardiac monitors in patients after myocardial infarction with autonomic dysfunction (SMART-MI-DZHK9): A prospective randomised multicentre trial. Lancet Digit Health 2022;4(2):e105-e116. Go to original source... Go to PubMed...
    36. Willcox ME, Compton SJ, Bardy GH. Continuous ECG monitoring versus mobile telemetry: A comparison of arrhythmia diagnostics in human- versus algorithmicdependent systems. Heart Rhythm O2 2021;2:543-559. Go to original source...
    37. Picone C, Fusco R, Tonerini M, et al. Dose reduction strategies for pregnant women in emergency settings. J Clin Med 2023;12:1847. Go to original source...
    38. Lopes J, Saleiro C, Campos D, et al. Syncope in the emergency department: Can 24-hour Holter monitoring be of any help? Europace 2020;22(Suppl 1):euaa162.157. Go to original source...
    39. Banerjee A. Artificial intelligence enabled mobile health technologies in arrhythmias - An opinion article on recent findings. Front Cardiovasc Med 2025;12:1548554. Go to original source... Go to PubMed...
    40. Lee S, Zhou J, Liu T, et al. Temporal variability in electrocardiographic indices in subjects with Brugada patterns. Front Physiol 2020;11:953. Go to original source... Go to PubMed...
    41. Seyfrydova M, Rokyta R, Rajdl D, et al. Arrhythmias and laboratory abnormalities after an electrical accident: A singlecenter retrospective study of 333 cases. Clin Res Cardiol 2023;112:1835-1847. Go to original source...
    42. Actaiyeva LM, Abzaliyev KB, Abzaliyeva SA, Aldangarova GA. Characteristics of woman's heart with disorder of coronary circulation. Heart Vessels Transplant 2018;3(1). doi: 10.24969/ HVT.2018.85 Go to original source...
    43. Affronti A, Quintana E, Castellà M. Giant left atrium in previous mitral valve repair. Rev Esp Cardiol 2023;76:833. Go to original source...
    44. Tramontin C, Affronti A, Cirio EM. Diagnostic and surgical management of HeartMate 3 outflow graft obstruction due to two different mechanisms. Asian Cardiovasc Thorac Ann 2022;30:826-829. J. Leladze439 Go to original source... Go to PubMed...
    45. Amirnovin R, Lieu P, Imperial-Perez F, et al. Safety, efficacy, and timeliness of intravenous potassium chloride replacement protocols in a pediatric cardiothoracic intensive care unit. J Intensive Care Med 2018;35:371-377. Go to original source... Go to PubMed...
    46. Gaynor AR, Cornejo L. Disorders of magnesium II: Hypomagnesemia. In: Murtaugh R, ed. Critical Care 2021:24- Go to original source...
    47. Mustafa R, Befkadu A. Compliance to the ULHT trust protocol in the investigation and management of hypokalaemia. Clin Med 2024;24:100163. Go to original source...
    48. Beaulieu C, Kurczewski L. Characterization of the effect of prolonged therapeutic hypothermia on serum magnesium and potassium following neurological injury. Ther Hypothermia Temp Manag 2018;9:231-237. Go to original source... Go to PubMed...
    49. Podgórski R, Cieśla M, Podgórska D, et al. Plasma microRNA320a as a potential biomarker of physiological changes during training in professional volleyball players. J Clin Med 2022;11:263. Go to original source... Go to PubMed...
    50. Zilgarayeva A, Smailov N, Pavlov S, et al. Optical sensor to improve the accuracy of non-invasive blood sugar monitoring. Indones J Electr Eng Comput Sci 2024;34:1489-1498. Go to original source...
    51. Absatirova V, Shandaulov A, Khamchiyev K, et al. Changes in the pulmonary circulation due to gravitational loads in high altitude conditions. Clin Hemorheol Microcirc 2024;86:419-432. Go to original source...
    52. Imanov E, Dziuryi IV, Truba IP, Golovenko OS. Experience of performing systemic-to-pulmonary artery shunt in patients with univentricular heart physiology and depleted pulmonary blood flow. Ukr Zh Sertsevo-Sudynnoi Khir 2024;32:74-79. Go to original source...
    53. Imanov E, Dziuryi IV, Truba IP, Perepeka IA, Lazoryshynets VV. Bidirectional cavapulmonary anastomosis as a stage of hemodynamic correction of hypoplastic right heart syndrome. Ukr Zh Sertsevo-Sudynnoi Khir 2024;32:30-38. Go to original source...
    54. Affronti A, Ruel M, Gaudino MFL. Multiarterial coronary artery bypass grafting: is the radial artery fulfilling the unkept promise of the right internal thoracic artery? Curr Opin Cardiol 2019;34:628-636. Go to original source... Go to PubMed...
    55. Matsuura C, Kato T, Koyama K. Successful management of refractory torsades de pointes due to drug-induced long QT syndrome guided by point-of-care monitoring of ionized magnesium. Cureus 2021;13:e13939. Go to original source... Go to PubMed...
    56. Narang A, Ozcan C. Severe torsades de pointes with acquired QT prolongation. Eur Heart J Acute Cardiovasc Care 2016;8:775-776. Go to original source... Go to PubMed...
    57. Schoeller AB, Rudloff E, Waldner CL, et al. Preliminary evaluation of the efficacy of intravenous magnesium sulfate for the treatment of ventricular arrhythmias in 16 dogs. J Vet Emerg Crit Care 2020;30:687-692. Go to original source... Go to PubMed...
    58. Iqbal S, Fayyaz SM, Saeed Y, et al. Loperamide-induced cardiotoxicity: A case overlooked? BMJ Case Rep 2021;14:e243325. Go to original source...
    59. Messina A, Bella F, Maccarone G, et al. Astrocyte-mediated hippocampal damage in the pathogenesis of dysexecutive syndrome following COVID-19: a narrative review. J Psychiatr Res 2026;194:164-173. Go to original source... Go to PubMed...
    60. Nurusheva SS, Abisheva ST, Abisheva AB, et al. Late postCOVID syndrome: clinical complications beyond 12 weeks. J Clin Med Kaz 2024;21:9-13. Go to original source...
    61. Tixier R, Duchateau J, Klotz N, et al. Temporary rapid pacing to prevent ventricular fibrillation recurrence in electrical storm refractory to medical therapy. Arch Cardiovasc Dis Suppl 2018;11:80. Go to original source...
    62. Mitkowski P. Electrotherapy in acute cardiac conditions. In a Good Rythm 2019;1:4-7. Go to original source...
    63. Tulewicz-Marti EM, Lewandowski K, Szczubelek M, Rydzewska G. Management of anaemia in patients with inflammatory bowel disease - results of a questionnaire among Polish healthcare professionals. Przegl Gastroenterol 2021;16:89-94. Go to original source...
    64. Shllaku-Sefa H, Marku E, Kasmi G, Qordja M, Kasmi I, Marku N. Assessment of iron levels in settings of infections in patients with normal hemoglobin. Clin Lab 2025;71:2257-2262. Go to original source... Go to PubMed...
    65. Meter M, Borovac JA. A refractory electrical storm after acute myocardial infarction: The role of temporary ventricular overdrive pacing as a bridge to ICD implantation. Pathophysiology 2024;31:44-51. Go to original source... Go to PubMed...
    66. Proclemer A, Zecchin M, Zanotto G, et al. Italian pacemaker and defibrillator registry, Italian Association of Arrhythmology and Cardiac Pacing, 2022 report. Ital J Cardiol 2023;24(10). Go to original source... Go to PubMed...

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