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https://www.readbyqxmd.com/read/30497731/the-role-of-mexiletine-in-the-management-of-long-qt-syndrome
#1
REVIEW
Guoliang Li, Li Zhang
Congenital long QT syndrome (LQTS) is a hereditary cardiac disorder characterized by QT-interval prolongation and T-wave abnormalities on electrocardiogram (ECG), and is associated with an increased risk of torsade de pointes and sudden cardiac death. Beta-blocker medication is effective in most patients except those with a very slow heart rate. Increased late sodium currents (INa-L) can result in bradycardia-dependent QT prolongation. Mexiletine, an inhibitor of INa-L, is not only effective in treating type-3 LQTS, but also shows the promise in managing LQTS patients of other genotypes with markedly prolonged QT interval at slow heart rates...
November 2018: Journal of Electrocardiology
https://www.readbyqxmd.com/read/30400791/the-arrhythmogenic-cardiotoxicity-of-the-quinoline-and-structurally-related-antimalarial-drugs-a-systematic-review
#2
Ilsa L Haeusler, Xin Hui S Chan, Philippe J Guérin, Nicholas J White
BACKGROUND: Several quinoline and structurally related antimalarial drugs are associated with cardiovascular side effects, particularly hypotension and electrocardiographic QT interval prolongation. A prolonged QT interval is a sensitive but not specific risk marker for the development of Torsade de Pointes-a potentially lethal polymorphic ventricular tachyarrhythmia. The increasing use of quinoline and structurally related antimalarials in mass treatments to eliminate malaria rapidly highlights the need to review their cardiovascular safety profiles...
November 7, 2018: BMC Medicine
https://www.readbyqxmd.com/read/30366516/qtc-and-anti-tuberculosis-drugs-a-perfect-storm-or-a-tempest-in-a-teacup-review-of-evidence-and-a-risk-assessment
#3
I Monedero-Recuero, L Hernando-Marrupe, A Sánchez-Montalvá, V Cox, M Tommasi, J Furin, C-Y Chiang, M Quelapio, K G Koura, A Trébucq, X Padanilam, G Dravniece, A Piubello
<h2>SUMMARY</h2>Multidrug-resistant (MDR) and extensively drug-resistant tuberculosis (XDR-TB) are global concerns, with stagnant treatment success rates of roughly 54&percnt; and 30&percnt;, respectively. Despite adverse events associated with several DR-TB drugs, newly developed drugs and shorter regimens are bringing hope; recent concern has focused on drugs that prolong the corrected QT interval (QTc). QTc prolongation is a risk factor for torsades de pointe (TdP), a potentially lethal cardiac arrhythmia...
October 26, 2018: International Journal of Tuberculosis and Lung Disease
https://www.readbyqxmd.com/read/30227792/cochlear-implantation-in-children-with-congenital-long-qt-syndrome-introduction-of-an-evidence-based-pathway-of-care
#4
Victoria Scott-Warren, Anju Bendon, Iain A Bruce, Lise Henderson, Jacques Diacono
Congenital long QT syndrome (cLQTS) is an inherited cardiac ion channelopathy characterized by a long corrected-QT interval on the ECG, associated with a risk of syncope and sudden death as a result of arrhythmias. The archetypal arrhythmia associated with cLQTS is torsade de pointes which may degenerate into ventricular fibrillation. Children with Jervell and Lange-Neilsen syndrome have the combination of cLQTS and congenital sensorineural deafness and may present for cochlear implantation (CI). Sympathetic stimulation and administration of QT-prolonging medications may trigger arrhythmias in children with cLQTS and thus the perioperative period is a time of increased risk of adverse events, with deaths reported in the CI literature...
November 2018: Cochlear Implants International
https://www.readbyqxmd.com/read/30214811/late-presentation-of-torsades-de-pointes-related-to-fluoxetine-following-a-multiple-drug-overdose
#5
Jan Albert Nicolaas Groot, Leonore Ten Bokum, Hubertus Laurentius Antonius van den Oever
Background: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) commonly used in the treatment of depression. While most intoxications with SSRI's have favorable outcomes and do not require interventions other than strict observation of vital signs and heart rhythm, clinicians should be aware of the life-threatening complications that may occur. Case presentation: A 61-year-old woman presented to the emergency department after an intentional multiple drug overdose...
2018: Journal of Intensive Care
https://www.readbyqxmd.com/read/30121123/update-on-the-ecg-component-of-the-cipa-initiative
#6
REVIEW
Jose Vicente
The Comprehensive in vitro Proarrhythmia Assay (CiPA) initiative is validating a new paradigm for assessing proarrhythmic potential of drugs that goes beyond hERG block and QT prolongation. Based on in vitro data of the drug's effects on multiple cardiac ion channel currents, CiPA's in silico model of the human cardiomyocyte will classify drugs as low, intermediate or high risk for torsade de pointes. Under CiPA, early phase 1 ECG data will be used to determine if there are unexpected ion channel effects in humans compared to the in vitro ion channel data...
August 7, 2018: Journal of Electrocardiology
https://www.readbyqxmd.com/read/30009377/fragmented-endocardial-signals-and-early-afterdepolarizations-during-torsades-de-pointes-tachycardia
#7
Guo-Liang Li, Ardan M Saguner, Guy H Fontaine, Robert Frank
BACKGROUND: Bradycardia-induced torsade de pointes (TdP) tachycardia in patients with spontaneous high-degree atrioventricular block (AVB) is common. The aim of this study was to analyze endocardial recordings during TdP in spontaneous high-degree AVB in humans to better understand the electrophysiological mechanisms underlying this phenomenon. METHODS: The study group consisted of 5 patients with typical episodes of TdP during spontaneous high-degree AVB. A standard (USCI) temporary bipolar endocardial catheter positioned at the apex of the right ventricle (RV) and bipolar chest leads from two precordial leads V1 and V4 were used to record the tracings during TdP...
July 16, 2018: Cardiology Journal
https://www.readbyqxmd.com/read/29951153/electrical-storm-in-an-infant-with-short-coupled-variant-of-torsade-de-pointes
#8
Hiroaki Kise, Seiko Ohno, Yosuke Kono, Masashi Yoshizawa, Daisuke Harama, Asami Okafuji, Takako Toda, Keiichi Koizumi, Minako Hoshiai, Kanji Sugita, Minoru Horie
A 10-month-old infant experienced cardiac arrest caused by ventricular fibrillation (VF). His electrocardiogram (ECG) at rest was within the normal range. Amiodarone was indispensable due to its refractoriness to defibrillation. After implantable cardioverter defibrillator (ICD) implantation, ICD shock was delivered. ICD recordings documented VF and ventricular tachycardia (VT) triggered by premature ventricular contractions with an extremely short coupling interval (240 ms), which were controlled by verapamil...
June 2018: Journal of Arrhythmia
https://www.readbyqxmd.com/read/29942126/significance-of-prolonged-qtc-in-acute-exacerbations-of-copd-requiring-hospitalization
#9
Oliver Van Oekelen, Kristina Vermeersch, Stephanie Everaerts, Bert Vandenberk, Rik Willems, Wim Janssens
Background: A prolonged QT interval is associated with increased risk of Torsade de Pointes and cardiovascular death. The prevalence and clinical relevance of QT prolongation in acute exacerbations of COPD (AECOPD), with high risk for cardiac morbidity and mortality, is currently unclear. Methods: A dual cross-sectional study strategy was therefore designed. A retrospective study evaluated 140 patients with an AECOPD requiring hospitalization, half of which had prolonged QTc on the admission ECG...
2018: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/29931253/sudden-cardiac-death-in-young-athletes-with-long-qt-syndrome-the-role-of-genetic-testing-and-cardiovascular-screening
#10
Umile Giuseppe Longo, Laura Risi Ambrogioni, Mauro Ciuffreda, Nicola Maffulli, Vincenzo Denaro
Introduction: Sudden cardiac death (SCD) of young athletes during competition or training is a tragic event. The long QT syndrome (LQTS) is an arrythmogenic disorder characterized by prolonged ventricular repolarization leading to torsade de pointes evident at electrocardiogram (ECG). Implantable cardioverter defibrillator is an option to revert ventricular fibrillation to sinus rhythm, although the implantation may result in denial of sports participations to the athlete. The authors reviewed the current literature on LQTS in young athletes, to clarify the role of different screening technologies to prevent SCD...
September 1, 2018: British Medical Bulletin
https://www.readbyqxmd.com/read/29926671/-anti-arrhythmic-effects-of-taurine-magnesium-coordination-compound-on-torsades-de-pointes
#11
Yan Li, Kai Sun, Meng-Yao An, Ying-Ying Pan, Tao Sun, Yong-Qiang Yin, Yi Kang, Jian-Shi Lou
OBJECTIVES: To investigate the effect of taurine magnesium coordination compound (TMCC) on torsades de pointes (TdP) in isolated guinea pig hearts. METHODS: Healthy male guinea pigs weighting 250~300 g were randomly divided into 4 groups:①TdP model group ( n =7):Isolated hearts were perfused by normal K-H solution 20 minutes, then perfused by slowly activated delayed rectifier potassium current(IKs) blocker 10 μ mol/L Chromanol 293B under hypokalemic solution(1...
February 8, 2018: Chinese Journal of Applied Physiology
https://www.readbyqxmd.com/read/29923812/the-identification-of-torsades-de-pointes-via-ceeg-a-case-report-on-a-patient-with-physiologically-provoked-nonepileptic-events
#12
Andrew Todd Ham, Jill Mackey, Gary Semb
Continuous electroencephalography (CEEG) is chiefly performed at The Medical University of South Carolina (MUSC) for identifying seizures, including its refined use within the epilepsy monitoring unit (EMU) as a differentiator between epileptic and psychogenic etiologies. CEEG also provides critical data that carry implications outside the bounds of both epilepsy and psychogenic events, such as the characterization of unorthodox clinical phenomena that are of physiological (though nonepileptic) origins. Although nonepileptic events (NEEs) are primarily linked with psychogenic phenomena (conversion disorder, malingering) that can mimic epileptic activity, they, like seizures, have diverse semiologies and etiologies...
2018: Neurodiagnostic Journal
https://www.readbyqxmd.com/read/29850230/electrocardiogram-changes-of-donepezil-administration-in-elderly-patients-with-ischemic-heart-disease
#13
Deguo Wang, Yong Wu, Ancai Wang, Yueyun Chen, Ting Zhang, Nengwei Hu
Objective: Donepezil, a widely used cholinesterase inhibitor for treating Alzheimer's disease, has been reported to induce bradyarrhythmias and torsade de pointes. In this study, we aimed at determining electrocardiogram changes of donepezil administration in elderly patients with ischemic heart disease, who tend to suffer from cognitive disorders. Methods: Sixty patients with ischemic heart disease and mild cognitive impairment were treated with donepezil (5 mg/day) and followed up for at least four weeks...
2018: Cardiology Research and Practice
https://www.readbyqxmd.com/read/29609088/milrinone-associated-cardiomyopathy-and-arrhythmia-in-cerebral-vasospasm
#14
Eva M Wu, Tarek Y El Ahmadieh, Benjamin Kafka, Matthew T Davies, Salah G Aoun, Jonathan A White
BACKGROUND: Milrinone is an inotropic and vasodilatory drug proven safe for use in treatment of cerebral vasospasm. Despite its reported safety profile, its use is not free of side effects. Milrinone-associated cardiomyopathy and arrhythmia can occur in patients with cerebral vasospasm. CASE DESCRIPTION: This is a retrospective chart review of a patient who presented with aneurysmal subarachnoid hemorrhage and developed clinical vasospasm twice over a period of 2 weeks...
June 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29520534/quantitative-approach-for-cardiac-risk-assessment-and-interpretation-in-tuberculosis-drug-development
#15
Sebastian Polak, Klaus Romero, Alexander Berg, Nikunjkumar Patel, Masoud Jamei, David Hermann, Debra Hanna
Cardiotoxicity is among the top drug safety concerns, and is of specific interest in tuberculosis, where this is a known or potential adverse event of current and emerging treatment regimens. As there is a need for a tool, beyond the QT interval, to quantify cardiotoxicity early in drug development, an empirical decision tree based classifier was developed to predict the risk of Torsades de pointes (TdP). The cardiac risk algorithm was developed using pseudo-electrocardiogram (ECG) outputs derived from cardiac myocyte electromechanical model simulations of increasing concentrations of 96 reference compounds which represented a range of clinical TdP risk...
June 2018: Journal of Pharmacokinetics and Pharmacodynamics
https://www.readbyqxmd.com/read/29514866/intramyocardial-block-in-patients-with-atrioventricular-block
#16
Guoliang Li, Ardan M Saguner, Deniz Akdis, Guy H Fontaine
Atrioventricular (AV) block has been extensively studied. However, conduction inside the myocardium in patients with AV block has not been reported. In this study, we aimed to demonstrate the presence of intramyocardial block in patients with AV block. Five consecutive patients with spontaneous high-grade AV block and Torsades de pointes (TdP) were prospectively studied with standard United States Catheter Instruments (USCI) endocardial temporary catheter located at the right ventricle (RV) apex. The morphology of endocardial potentials observed in the basic QRS complexes as well as during episodes of TdP was studied...
June 2018: Journal of Investigative Medicine: the Official Publication of the American Federation for Clinical Research
https://www.readbyqxmd.com/read/29473523/drug-induced-qt-interval-prolongation-in-the-intensive-care-unit
#17
Cecilia Villa Etchegoyen, Guillermo Alberto Keller, Sebastian Mrad, Sixuan Cheng, Guillermo Di Girolamo
BACKGROUND: The most common acquired cause of Long QT syndrome (LQTS) is drug induced QT interval prolongation. It is an electrophysiological entity, which is characterized by an extended duration of the ventricular repolarization. Reflected as a prolonged QT interval in a surface ECG, this syndrome increases the risk for polymorphic ventricular tachycardia (Torsade de Pointes) and sudden death. METHOD: Bibliographic databases as MEDLINE and EMBASE, reports and drug alerts from several regulatory agencies (FDA, EMEA, ANMAT) and drug safety guides (ICH S7B, ICH E14) were consulted to prepare this article...
2017: Current Clinical Pharmacology
https://www.readbyqxmd.com/read/29427819/significance-of-t-wave-inversion-triggered-by-spontaneous-atrial-premature-beats-in-patients-with-long-qt-syndrome
#18
Nobuhiro Takasugi, Mieko Takasugi, Hiroko Goto, Takashi Kuwahara, Takashi Nakashima, Tomoki Kubota, Hiromitsu Kanamori, Masanori Kawasaki, Kazuhiko Nishigaki, Shinya Minatoguchi, Richard L Verrier
BACKGROUND: In patients with the long QT syndrome (LQTS), a sudden increase in heart rate can cause T-wave alternans (TWA) with beat-to-beat alternating polarity of T wave. We hypothesized that LQTS patients at high risk for torsades de pointes (TdP) may exhibit momentary atrial or sinoatrial premature beat-induced T-wave inversion (APB-TWI). OBJECTIVE: The purpose of this study was to assess the association of APB-TWI with TdP history and with microvolt TWA. METHODS: Twenty-four-hour continuous 12-lead electrocardiograms (ECGs) were recorded in 18 healthy subjects and 39 consecutive patients with LQTS types 1 (n = 21), 2 (n = 4), 3 (n = 4), and unidentified (n = 10)...
June 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/29405316/acquired-long-qt-syndrome-and-torsade-de-pointes
#19
REVIEW
Nabil El-Sherif, Gioia Turitto, Mohamed Boutjdir
Since its initial description by Jervell and Lange-Nielsen in 1957, the congenital long QT syndrome (LQTS) has been the most investigated cardiac ion channelopathy. Although congenital LQTS continues to remain the domain of cardiologists, cardiac electrophysiologists, and specialized centers, the by far more frequent acquired drug-induced LQTS is the domain of all physicians and other members of the health care team who are required to make therapeutic decisions. This report will review the electrophysiological mechanisms of LQTS and torsade de pointes, electrocardiographic characteristics of acquired LQTS, its clinical presentation, management, and future directions in the field...
April 2018: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/29380488/validation-and-clinical-utility-of-the-herg-ic50-c-max-ratio-to-determine-the-risk-of-drug-induced-torsades-de-pointes-a-meta-analysis
#20
David F Lehmann, William D Eggleston, Dongliang Wang
BACKGROUND: Use of the QT interval corrected for heart rate (QTc) on the electrocardiogram (ECG) to predict torsades de pointes (TdP) risk from culprit drugs is neither sensitive nor specific. The ratio of the half-maximum inhibitory concentration of the hERG channel (hERG IC50) to the peak serum concentration of unbound drug (Cmax ) is used during drug development to screen out chemical entities likely to cause TdP. PURPOSE: To validate the use of the hERG IC50:Cmax ratio to predict TdP risk from a culprit drug by its correlation with TdP incidence...
March 2018: Pharmacotherapy
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