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01-08-2014 | Commentary

What Causes Some Patients with Drug-Induced QT Interval Prolongation to Develop Torsades de Pointes but Not Others? The Elusive Missing Link

Author: James E. Tisdale

Published in: Drugs & Aging | Issue 8/2014

Excerpt

Cardiac arrest due to torsades de pointes (TdP) is an uncommon but potentially catastrophic event associated with QT interval-prolonging drugs [1]. Numerous medications that may cause TdP are available for use in clinical practice, and include drugs for management of cardiovascular diseases, primarily arrhythmias, but also noncardiovascular agents from multiple classes, including anti-infectives, antipsychotics, antidepressants, methadone, and many more [2]. The risk of TdP increases as the heart rate-corrected QT (QT_c) interval increases [3‐6], particularly when it exceeds 500 ms [5, 6]. Numerous independent risk factors for QT_c interval prolongation and TdP have been identified, and include female sex, hypokalemia, hypomagnesemia, acute myocardial infarction, sepsis, supratherapeutic concentrations of QT_c interval-prolonging drugs, rapid intravenous infusion of QT_c interval-prolonging drugs, concomitant administration of two or more QT_c interval-prolonging drugs, concomitant administration of a loop diuretic, bradycardia, heart failure with reduced ejection fraction (HFrEF), pretreatment QT_c interval prolongation, and ion channel polymorphisms [7, 8]. …

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Title: What Causes Some Patients with Drug-Induced QT Interval Prolongation to Develop Torsades de Pointes but Not Others? The Elusive Missing Link
Author: James E. Tisdale
Publication date: 01-08-2014
Publisher: Springer International Publishing
Published in: Drugs & Aging / Issue 8/2014
Print ISSN: 1170-229X
Electronic ISSN: 1179-1969
DOI: https://doi.org/10.1007/s40266-014-0199-8

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