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Secondary QT Prolongation, Torsades de Pointes and Risk of Sudden Death

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405 papers 1000+ followers An extensive review of drugs and medical conditions contributing to the risk of QT prolongation
By Faye Kehler Family Physician and GP Anesthetist since 1987 interested in all aspects of Medicine
Elyce T Sheehan, Jarrod D Frizzell, Jude Gabaldon, Michael B West
A 91-year-old woman presented to the emergency department by ambulance after her family found her minimally responsive. Telemetry monitoring demonstrated episodes of non-sustained polymorphic ventricular tachycardia (PMVT) associated with significantly prolonged repolarization. Her medical history revealed that she was taking quinine or a derivative in three different forms: hydroxychloroquine, quinine sulfate (for leg cramps), and her gin mixed with tonic water (containing quinine). The present case is illustrative of classic etiologies and findings of acquired long QT syndrome, and serves as an important reminder for providers to take a complete medication history, including use of duplicative and alternative medicines and type of alcohol consumption...
October 2016: Journal of General Internal Medicine
Eli D Ehrenpreis, Grigory Roginsky, Aimee Alexoff, Dylan G Smith
INTRODUCTION: Domperidone, a peripheral D2 dopamine receptor antagonist, has efficacy for treatment of nausea, dyspepsia, and gastroparesis. Domperidone prolongs the QT interval (QTc), and may cause life-threatening arrhythmias. METHODS: Electronic medical records for all patients receiving domperidone in the NorthShore University HealthSystem from January 1, 2008 to December 1, 2013 were reviewed. All concomitant medications were noted. The coadministration of QT-interacting medications was determined...
May 13, 2016: Journal of Clinical Gastroenterology
Simone Schächtele, Thomas Tümena, Karl-Günter Gaßmann, Martin F Fromm, Renke Maas
BACKGROUND: Drug-induced QT-interval prolongation is associated with occurrence of potentially fatal Torsades de Pointes arrhythmias (TdP). So far, data regarding the overall burden of QT-interval prolonging drugs (QT-drugs) in geriatric patients are limited. OBJECTIVE: This study was performed to assess the individual burden of QT-interval prolonging drugs (QT-drugs) in geriatric polymedicated patients and to identify the most frequent and risky combinations of QT-drugs...
2016: PloS One
Alessandro Mantovani, Antonio Rigamonti, Stefano Bonapace, Bruna Bolzan, Matteo Pernigo, Giovanni Morani, Lorenzo Franceschini, Corinna Bergamini, Lorenzo Bertolini, Filippo Valbusa, Riccardo Rigolon, Isabella Pichiri, Giacomo Zoppini, Enzo Bonora, Francesco Violi, Giovanni Targher
OBJECTIVE: Recent studies have suggested that nonalcoholic fatty liver disease (NAFLD) is associated with an increased risk of heart rate-corrected QT interval prolongation and atrial fibrillation in patients with type 2 diabetes. Currently, no data exist regarding the relationship between NAFLD and ventricular arrhythmias in this patient population. RESEARCH DESIGN AND METHODS: We retrospectively analyzed the data of 330 outpatients with type 2 diabetes without preexisting atrial fibrillation, end-stage renal disease, or known liver diseases who had undergone 24-h Holter monitoring for clinical reasons between 2013 and 2015...
August 2016: Diabetes Care
Alexander J Scott, Adrian J Dunlop, Amanda Brown, Craig Sadler, Geoffrey K Isbister
INTRODUCTION AND AIMS: Drug induced QT prolongation occurs in patients with substance use disorders from prescription medications that prolong the QT, such as methadone. Knowing the prevalence of QT prolongation in this population is important for prescribers. This study aimed to investigate the prevalence of QT prolongation in patients with current substance use disorders. DESIGN AND METHODS: We undertook a retrospective review of electrocardiograms (ECG) from patients with substance use disorders from an urban general hospital with a large drug and alcohol service and toxicology unit...
May 30, 2016: Drug and Alcohol Review
Sarah Kline Krammes, Todd Jacobs, John M Clark, R Esther Lutes
OBJECTIVE: Ondansetron improves the success of oral rehydration in children with gastroenteritis. In postoperative adults, ondansetron has been shown to prolong the corrected QT (QTc). The aim of the study was to evaluate the effect of ondansetron on the QT at peak effect and at 1-hour postpeak effect in pediatric patients. METHODS: This was an observational study looking at patients aged 6 months to 18 years receiving intravenous ondansetron for nausea, vomiting, or the inability to take fluids in the emergency department...
June 2, 2016: Pediatric Emergency Care
Michael H Chiu, Nawaf S Al-Majed, Ryan Stubbins, Dylan Pollmann, Roopinder K Sandhu
BACKGROUND: Glycopyrronium bromide has recently been approved as a once daily maintenance inhalation therapy for moderate to severe chronic obstructive pulmonary disease (COPD). Efficacy and safety trial data have found rare cases of significant QT prolongation. To our knowledge, we describe the first case report of QT prolongation >600 ms with initiation of glycopyrronium bromide in a real world setting. CASE PRESENTATION: A 78-year-old female with moderate COPD recently started on glycopyrronium bromide, presented to Emergency Department (ED) with syncope...
2016: BMC Research Notes
Bert Vandenberk, Eline Vandael, Tomas Robyns, Joris Vandenberghe, Christophe Garweg, Veerle Foulon, Joris Ector, Rik Willems
BACKGROUND: Drug safety precautions recommend monitoring of the corrected QT interval. To determine which QT correction formula to use in an automated QT-monitoring algorithm in our electronic medical record, we studied rate correction performance of different QT correction formulae and their impact on risk assessment for mortality. METHODS AND RESULTS: All electrocardiograms (ECGs) in patients >18 years with sinus rhythm, normal QRS duration and rate <90 beats per minute (bpm) in the University Hospitals of Leuven (Leuven, Belgium) during a 2-month period were included...
June 2016: Journal of the American Heart Association
Dominik W Choromanski, Sapan Amin, Maria M Zestos
Long QT syndrome (LQTS) is a rare condition that in certain circumstances can lead to severe and potentially lethal cardiac arrhythmia known as Torsade de Pointes (TdP). Inhalational anesthetics are among many medications and conditions known to prolong QT and thus potentially predispose the patient to TdP. Although studies have shown that sevoflurane should be safe for the healthy patients, the situation is unclear in patients with LQTS. We present a case of 14-year-old Caucasian female with the diagnosis of LQTS who developed TdP during sevoflurane inhalational induction...
February 2016: Middle East Journal of Anesthesiology
Sangita Trivedi, Brenda Schiltz, Rakesh Kanipakam, Johan Martijn Bos, Michael J Ackerman, Yves Ouellette
OBJECTIVES: There is no evidence regarding the effect of ondansetron on the QT interval in pediatric patients in the ICU. This study aimed to describe the effect of ondansetron on the corrected QT interval in patients cared for in the PICU. DESIGN: Retrospective cohort, consecutive enrollment study. SETTING: Single-center, tertiary-level, medical/surgical PICU. PATIENTS: All patients less than 8 years old who received ondansetron over an 11-month period were included...
July 2016: Pediatric Critical Care Medicine
Amy D Morris, Jennifer Chen, Elaine Lau, Jennifer Poh
BACKGROUND: Domperidone is a prokinetic agent used to treat pediatric gastroesophageal reflux disease. Health Canada has issued warnings about an increased risk of domperidone-associated ventricular arrhythmias and sudden cardiac death. However, the supporting data referred only to adult patients; therefore, extrapolating the safety risks to pediatric patients is difficult. OBJECTIVE: To summarize and evaluate the evidence for domperidone-associated QT interval prolongation, ventricular arrhythmias, and sudden cardiac death to determine the safety of this drug for pediatric patients...
May 2016: Canadian Journal of Hospital Pharmacy
Nauzer Forbes, Mohan Cooray, Raed Al-Dabbagh, Yuhong Yuan, Frances Tse, Louis W C Liu, Ted Xenodemetropoulos
Background. In 2012, Health Canada released a warning regarding domperidone use, based on associations with life-threatening arrhythmias and death. Objective. This study aimed to compare the appropriateness of domperidone prescribing patterns before the advisory to those afterward. Methods. Two retrospective reviews were conducted for patients prescribed domperidone during quarters in 2005 and 2012. Outcomes included appropriateness of indication, dosing regimens, monitoring of electrolytes, baseline electrocardiogram performance and characteristics, presence of left ventricular dysfunction, and coprescription of QT-prolonging medications...
2016: Canadian Journal of Gastroenterology & Hepatology
Tiziano Acciavatti, Giovanni Martinotti, Massimo di Giannantonio
No abstract text is available yet for this article.
May 2016: Journal of Clinical Psychiatry
Tessa Novick, Blaithin A McMahon, Adam Berliner, Bernard G Jaar
No abstract text is available yet for this article.
March 2016: European Journal of Clinical Pharmacology
Dan M Roden
Drugs used to treat cardiovascular disease as well as those used in the treatment of multiple other conditions can occasionally produce exaggerated prolongation of the QT interval on the electrocardiogram and the morphologically distinctive polymorphic ventricular tachycardia ('torsades de pointes'). This syndrome of drug-induced long QT syndrome has moved from an interesting academic exercise to become a key element in the development of any new drug entity. The prevailing view, which has driven both clinical care and drug regulation, holds that cardiac repolarization represents a balance between inward currents (primarily through calcium and sodium channels) and outward currents (primarily through rapid and slowed delayed rectifier potassium channels) and that block of the rapid delayed rectifier (IKr ) is the primary mechanism whereby drugs prolong individual action potentials, manifest on the surface electrocardiogram as QT interval prolongation...
May 1, 2016: Journal of Physiology
Nobuhiro Takasugi, Hiroko Goto, Mieko Takasugi, Richard L Verrier, Takashi Kuwahara, Tomoki Kubota, Hiroyuki Toyoshi, Takashi Nakashima, Masanori Kawasaki, Kazuhiko Nishigaki, Shinya Minatoguchi
BACKGROUND: Prevalence of microvolt T-wave alternans (TWA) and the strength of its association with torsade de pointes (TdP) history have not been fully investigated in patients with long QT syndrome (LQTS). METHODS AND RESULTS: Twenty-four-hour continuous 12-lead ECGs were recorded in 10 healthy subjects (5 men; median age, 21.5 years) and 32 patients (13 men; median age, 13 years) with LQTS types 1 (n=18), 2 (n=4), 3 (n=4), and unidentified (n=6). Peak TWA was determined by the Modified Moving Average method...
February 2016: Circulation. Arrhythmia and Electrophysiology
Andrew M Davis
No abstract text is available yet for this article.
February 2016: Circulation. Arrhythmia and Electrophysiology
Tal Lorberbaum, Kevin J Sampson, Raymond L Woosley, Robert S Kass, Nicholas P Tatonetti
INTRODUCTION: Drug-induced prolongation of the QT interval on the electrocardiogram (long QT syndrome, LQTS) can lead to a potentially fatal ventricular arrhythmia known as torsades de pointes (TdP). Over 40 drugs with both cardiac and non-cardiac indications are associated with increased risk of TdP, but drug-drug interactions contributing to LQTS (QT-DDIs) remain poorly characterized. Traditional methods for mining observational healthcare data are poorly equipped to detect QT-DDI signals due to low reporting numbers and lack of direct evidence for LQTS...
May 2016: Drug Safety: An International Journal of Medical Toxicology and Drug Experience
Rachael A Lee, Allison Guyton, Danielle Kunz, Gary R Cutter, Craig J Hoesley
BACKGROUND: Azithromycin is used in the inpatient setting for a variety of conditions. In 2013, the US Food and Drug Administration released a warning regarding risk for corrected QT (QTc) prolongation and subsequent arrhythmias. Knowledge of inpatient prescribing patterns of QTc prolonging medications with respect to patient risk factors for adverse cardiovascular events can help recognize safe use in light of these new warnings. OBJECTIVE: To assess inpatient prescribing patterns, risk factors for QTc prolongation, and relationship between drug-drug interactions and cardiac monitoring in patients receiving azithromycin...
January 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Kevin J Friesen, Shawn C Bugden
BACKGROUND: Citalopram is the most commonly prescribed antidepressant in Canada. Concerns have been raised about its cardiac safety, and a dose-dependent prolongation of the QT interval has been documented. Drug interactions involving concomitant use of other medications that prolong the QT interval or increase citalopram levels by interfering with its metabolism increase the cardiac risk. Regulatory bodies (Health Canada and the US Food and Drug Administration) issued warnings and required labeling changes in 2011/2012, suggesting maximum citalopram doses (<40 mg for those <65 years; <20 mg for those ≥65 years) and avoiding drug interactions that increase cardiac risk...
2015: Drug, Healthcare and Patient Safety
2015-12-19 23:36:34
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