scholarly journals Ciprofloxacin does not Prolong the QTc Interval: A Clinical Study in ICU Patients and Review of the Literature

2017 ◽  
Vol 20 (1) ◽  
pp. 360 ◽  
Author(s):  
Charlotte Heemskerk ◽  
Evelien Woldman ◽  
Marieke Pereboom ◽  
Ruud Van der Hoeven ◽  
Aukje Mantel-Teeuwisse ◽  
...  
Keyword(s):  
Qt Interval ◽  
Torsade De Pointes ◽  
Qtc Interval ◽  
Test Results ◽  
Interval Prolongation ◽  
Icu Patients ◽  
Increased Risk ◽  
Qtc Interval Prolongation ◽  
Student’S T ◽  
Student’S T Test

Purpose. Ciprofloxacin may prolong the QT interval and increase the risk of Torsade de Pointes (TdP). Intravenous administration of ciprofloxacin in patients with additional risks may elevate the risk of QTc interval prolongation. We prospectively assessed whether intravenous ciprofloxacin prolongs the QT interval in patients with additional co-morbidities and risk factors. We also reviewed the literature on the QT prolonging effect or TdP inducing effect of ciprofloxacin. Methods. ICU Patients who were treated with intravenous ciprofloxacin as part of their therapy were recruited. ECG was recorded within 60 min before start and in the last 30 min of 1 h infusion, or within 30 min after the end of ciprofloxacin infusion. QT interval was corrected for the heart rate using both Bazett’s and Fridericia’s formula. The changes were analyzed using the paired Student’s t-test. Results. Ten patients were included in the study (average age 74-y, 6 males). The average baseline QTc interval corrected with Bazett’s formula was 448 ms that was shortened during or after ciprofloxacin infusion by 3 ms and 2 ms based on Bazett’s  (p=0.67) and Fridericia’s (p=0.68) formula, respectively. No observational study  or cohort study thus far has shown that ciprofloxacin has a QT prolonging effect or increases the risk of TdP or (cardiovascular) mortality.  Conclusion. Based on our results and the results of previous studies, it is unlikely that ciprofloxacin has a clinically relevant QT prolonging effect or an increased risk of TdP. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

scholarly journals Drug-induced QT interval prolongation in cancer patients

2011 ◽  
Vol 4 (4) ◽  
pp. 223
Author(s):  
Torben K. Becker ◽  
Sai-Ching J. Yeung
Keyword(s):  
Cancer Patients ◽  
Qt Interval ◽  
Alkylating Agents ◽  
Torsade De Pointes ◽  
Interval Prolongation ◽  
Drug Induced ◽  
Vascular Disruption ◽  
Qt Interval Prolongation ◽  
Increased Risk ◽  
Multiple Drugs

Cancer patients are at an increased risk for QT interval prolongation and subsequent potentially fatal Torsade de pointes tachycardia due to the multiple drugs used for treatment of malignancies and the associated symptoms and complications. Based on a systematic review of the literature, this article analyzes the risk for prolongation of the QT interval with antineoplastic agents and commonly used concomitant drugs. This includes anthracyclines, fluorouracil, alkylating agents, and new molecularly targeted therapeutics, such as vascular disruption agents. Medications used in the supportive care can also prolong QT intervals, such as methadone, 5-HT3-antagonists and antihistamines, some antibiotics, antifungals, and antivirals. We describe the presumed mechanism of QT interval prolongation, drug-specific considerations, as well as important clinical interactions. Multiple risk factors and drug–drug interactions increase this risk for dangerous arrhythmias. We propose a systematic approach to evaluate cancer patients for the risk of QT interval prolongation and how to prevent adverse effects.

scholarly journals Absence of relevant QT interval prolongation in not critically ill COVID-19 patients

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Juan Jiménez-Jáimez ◽  
Rosa Macías-Ruiz ◽  
Francisco Bermúdez-Jiménez ◽  
Ricardo Rubini-Costa ◽  
Jessica Ramírez-Taboada ◽  
...  
Keyword(s):  
Critically Ill ◽  
Qt Interval ◽  
Treatment Initiation ◽  
Qtc Interval ◽  
Risk Markers ◽  
Interval Prolongation ◽  
Qt Interval Prolongation ◽  
Qtc Interval Prolongation ◽  
Ambulatory Patients ◽  
Reported Data

AbstractSARS-CoV-2 is a rapidly evolving pandemic causing great morbimortality. Medical therapy with hydroxicloroquine, azitromycin and protease inhibitors is being empirically used, with reported data of QTc interval prolongation. Our aim is to assess QT interval behaviour in a not critically ill and not monitored cohort of patients. We evaluated admitted and ambulatory patients with COVID-19 patients with 12 lead electrocardiogram at 48 h after treatment initiation. Other clinical and analytical variables were collected. Statistical analysis was performed to assess the magnitude of the QT interval prolongation under treatment and to identify clinical, analytical and electrocardiographic risk markers of QT prolongation independent predictors. We included 219 patients (mean age of 63.6 ± 17.4 years, 48.9% were women and 16.4% were outpatients. The median baseline QTc was 416 ms (IQR 404–433), and after treatment QTc was prolonged to 423 ms (405–438) (P < 0.001), with an average increase of 1.8%. Most of the patients presented a normal QTc under treatment, with only 31 cases (14.1%) showing a QTc interval > 460 ms, and just one case with QTc > 500 ms. Advanced age, longer QTc basal at the basal ECG and lower potassium levels were independent predictors of QTc interval prolongation. Ambulatory and not critically ill patients with COVID-19 treated with hydroxychloroquine, azithromycin and/or antiretrovirals develop a significant, but not relevant, QT interval prolongation.

scholarly journals Corrected QT interval prolongation during anesthetic induction for laryngeal mask airway insertion with or without cisatracurium

2018 ◽  
Vol 46 (5) ◽  
pp. 1990-2000 ◽  
Author(s):  
Chengluan Xuan ◽  
Nan Wu ◽  
Yanhui Li ◽  
Xiaoting Sun ◽  
Qunshu Zhang ◽  
...  
Keyword(s):  
Laryngeal Mask Airway ◽  
Operating Room ◽  
Qt Interval ◽  
Laryngeal Mask ◽  
Laryngeal Mask Airway Insertion ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Anesthetic Induction ◽  
Qt Interval Prolongation ◽  
Qtc Interval Prolongation

Objective This study was performed to observe the occurrence of corrected QT (QTc) interval prolongation during anesthetic induction for laryngeal mask airway insertion and the effects of cisatracurium administration on the QTc interval. Methods Eighty-eight patients were assigned to two groups: the cisatracurium administration group (n = 45) and non-cisatracurium administration group (n = 43). The QTc interval was continuously recorded by a 12-lead Holter electrocardiogram beginning in the hospital ward and continuing until after anesthetic induction. Results In the cisatracurium administration group, the QTc interval significantly increased from 417.9 ± 27.9 to 451.6 ± 32.5 ms after arrival in the operating room and significantly decreased to 432.4 ± 32.5 ms after a 15-minute rest; it significantly increased to 459.7 ± 23.8 ms again after propofol and fentanyl injection. However, the QTc interval decreased after cisatracurium injection. In the non-cisatracurium administration group, the QTc interval initially showed changes similar to those in the cisatracurium group until fentanyl and propofol were injected. Conclusions The QTc interval was significantly prolonged on arrival in the operating room and after propofol and fentanyl injection. The QTc interval did not significantly change by laryngeal mask airway insertion regardless of the administration of cisatracurium.

scholarly journals Monitoring of QTc interval in patients with COVID-19. First experience with a portable EKG-recording device

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
M Abellas Sequeiros ◽  
C Lozano Granero ◽  
C Garcia Sebastian ◽  
E Franco Diez ◽  
A Hernandez Madrid ◽  
...  
Keyword(s):  
Qt Interval ◽  
Intraclass Correlation ◽  
Early Discharge ◽  
Recording Device ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Daily Monitoring ◽  
Qt Interval Prolongation ◽  
Qtc Interval Prolongation ◽  
Group 2

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Off-label use of drugs with potential for QT interval prolongation was common in COVID-19 patients. We tested a portable EKG recording device to measure and monitor corrected QT (QTc) intervals in a cohort of COVID-19 patients treated with azithromycin, hydroxychloroquine, lopinavir/ritonavir, or combinations of these drugs. Methods and results Sixty-nine patients hospitalized with pneumonia and confirmed SARS-CoV 2 infection were included in an observational single-centre study. Six-lead EKG recordings were obtained using a KardiaMobile6L® at physicians’ discretion. In a subgroup of 16 patients with early discharge, a device was provided for at-home daily monitoring. Significant QTc interval prolongation was observed in patients taking a combination of 2 or 3 drugs (426 ± 33 vs 408 ± 33 ms, p = 0,002; and 435 ± 30 vs 394 ± 31 ms, p = 0,001, respectively). The use of the device prompted a change in the treatment of 9 patients (13%) because of prolongation of QTc interval and anticoagulation was started in one patient because of atrial fibrillation diagnosis. In the subgroup of patients with daily recording, QTc interval prolongation peaked at day 2 ± 1,8, with a shorter final QT interval than that recorded before drug initiation (350,0 ± 31,4 vs 381,0 ± 21,2; p = 0,019), pointing to a possible role of the disease itself in QT interval modification. To assess the consistency of measurements of QTc interval, a random sample of 120 EKG recordings were analyzed by two different physicians. Inter-operator intraclass correlation coefficient was 0,702, 95% CI (0,578-0,789). Conclusions Portable EKG-recording device was useful for QTc interval monitoring in COVID-19 patients receiving drugs with QTc prolonging potential, allowing physicians to adapt management. Significant QT prolongation was observed in these patients. Characteristics of the three groups.Group 1(one drug)N= 9 (13,0%)Group 2(two drugs)N= 37 (53,6%)Group 3(three drugs)N= 23 (33,3%)p-valueClinical characteristicsAge (years)55,0 ± 18,366,0 ± 16,258,0 ± 15,8p = 0,248Male sex (%)6 (66,7%)25 (67,6%)18 (78,3%)p = 0,643Dislipidaemia (%)5 (55,6%)9 (24,3%)7 (30,4%)p = 0,749Diabetes (%)7 (77,8%)4 (10,8%)5 (21,7%)p = 0,525Hypertension (%)3 (33,3%)16 (43,2%)8 (34,8%)p = 0,387Previous cardiopathy (%)6 (66,7%)11 (29,7%)3 (13,0%)p = 0,305COPD (%)7 (77,8%)6 (16,2%)1 (8,7%)p = 0,679COPDchronic obstructive pulmonary disease.Abstract Figure. Baseline and maximum QTc intervals

scholarly journals Changes In QTc Interval Duration Among Heroin Addicts On Methadone Treatment

2015 ◽  
Vol 16 (3) ◽  
pp. 217-228
Author(s):  
Mirjana Jovanovic ◽  
Mladen Divnic ◽  
Milan Jovanovic ◽  
Sasa Babic ◽  
Katarina Nikic Djuricic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Illicit Drugs ◽  
Methadone Treatment ◽  
Torsade De Pointes ◽  
Diagnostic Methods ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Safety Level ◽  
Co Morbidity ◽  
Qtc Interval Prolongation

AbstractThis paper aimed to collect and unite facts known about the effect of methadone treatment on QTc interval prolongation that could determine precipitating factors in the development of heart arrhythmias and their consequences (Torsade de Pointes and sudden cardiac death), and to raise the methadone treatment safety level.Studies conducted up to now clearly demonstrate that methadone therapy evokes changes in the heart’s electrical conduction, but those studies also show that QTc interval prolongation could be precipitated by other factors. The most often present risk factors in our research were dose of methadone, co-medication, and co-morbidity, but other relevant risk factors were gender, age, misuse of illicit drugs, therapy length and tobacco use.Active participation in modern treatment processes and implementation of knowledge acquired recently into daily practice, such as setting up reutilized questionnaires and diagnostic methods to expose higher risk for complications and providing broader therapeutic range for cases of drug replacement necessity, will enhance therapy safety level and bring us to the next step of resocialization of these patients, which needs to remain the final goal of treatment.

scholarly journals Effect of Hydroxychloroquine and Azithromycin on QT Interval Prolongation and Other Cardiac Arrhythmias in COVID-19 Confirmed Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-7 ◽  
Author(s):  
Seyed Parsa Eftekhar ◽  
Sohrab Kazemi ◽  
Mohammad Barary ◽  
Mostafa Javanian ◽  
Soheil Ebrahimpour ◽  
...  
Keyword(s):  
High Risk ◽  
Qt Interval ◽  
Therapy Group ◽  
Torsade De Pointes ◽  
Cardiac Monitoring ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Qt Interval Prolongation ◽  
Significant Difference ◽  
The Mean

Background. Hydroxychloroquine with or without azithromycin was one of the common therapies at the beginning of the COVID-19 pandemic. They can prolong QT interval, cause torsade de pointes, and lead to sudden cardiac death. We aimed to assess QT interval prolongation and its risk factors in patients who received hydroxychloroquine with or without azithromycin. Methods. This study was a retrospective cohort study. One hundred seventy-two confirmed COVID-19 patients were included in this study, hospitalized at Babol University of Medical Sciences hospitals between March 5, 2020, and April 3, 2020. Patients were divided into two groups: hydroxychloroquine alone and hydroxychloroquine with azithromycin. Electrocardiograms were used for outcome assessment. Results. 83.1% of patients received hydroxychloroquine plus azithromycin vs. 16.9% of patients who received only hydroxychloroquine. The mean age of patients was 59.2 ± 15.4 .The mean of posttreatment QTc interval in the monotherapy group was shorter than the mean of posttreatment QTc interval in the combination therapy group, but it had no significant statistical difference ( 462.5 ± 43.1 milliseconds vs. 464.3 ± 59.1 milliseconds; p = 0.488 ). Generally, 22.1% of patients had a prolonged QTc interval after treatment. Male gender, or baseline QTc ≥ 450 milliseconds, or high-risk Tisdale score increased the likelihood of prolonged QTc interval. Due to QTc prolongation, fourteen patients did not continue therapy after four days. Conclusions. Hospitalized patients treated by hydroxychloroquine with or without azithromycin had no significant difference in prolongation of QT interval and outcome. The numbers of patients with prolonged QT intervals in this study emphasize careful cardiac monitoring during therapy, especially in high-risk patients.

Drug-Induced QTc-Interval Prolongation in the Intensive Care Unit: Incidence and Predictors

2010 ◽  
Vol 23 (1) ◽  
pp. 19-24 ◽  
Author(s):  
Tien M. H. Ng ◽  
Keith M. Olsen ◽  
Megan A. McCartan ◽  
Susan E. Puumala ◽  
Katie M. Speidel ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Beta Blockers ◽  
Qtc Interval ◽  
Qtc Prolongation ◽  
Drug Induced ◽  
Icu Patients ◽  
End Point ◽  
Increased Risk ◽  
Qtc Interval Prolongation

There is a paucity of information regarding QTc prolongation in critically ill patients. A prospective observational study was conducted to assess the incidence and predictors of QTc prolongation associated with medications in intensive care unit (ICU) patients. Consecutive adult patients prescribed prespecified QTc-prolonging medications were assessed for development of the combined incidence of QTc >500 ms at anytime and QTc increase >60 ms above baseline. Over 3 months, 200 consecutive patients (63 ± 18 years; 52% female; 73% Caucasian; baseline QTc 447.3 ± 51.5 ms) were evaluated. The primary end point occurred in 48% of the patients (QTc >500 ms 40%, QTc increase >60 ms 29%). The majority of patients experienced a QTc >470 or 450 ms (60.5%). Mean increase in QTc at 48 hours was 20 ± 35 ms. Upon multivariate analysis, length of stay [odds ratio 1.30, 95% confidence interval (1.15, 1.47)] and baseline QTc [1.01 (1.01, 1.02)] were associated with an increased risk for the primary end point, while beta-blockers [0.41 (0.20, 0.81)] were associated with a risk reduction. In conclusion, increased risk of proarrhythmia, as assessed by QTc prolongation, occurs in the majority of ICU patients when prescribed medications with electrophysiologic properties. Increased vigilance is warranted. The possible protective effect of beta-blockers requires confirmation.

scholarly journals Sudden cardiac death and antipsychotics. Part 1: Risk factors and mechanisms

2006 ◽  
Vol 12 (1) ◽  
pp. 35-44 ◽  
Author(s):  
Nasser Abdelmawla ◽  
Alex J. Mitchell
Keyword(s):  
Cardiac Disease ◽  
Qt Interval ◽  
Torsade De Pointes ◽  
High Dose ◽  
Qtc Interval ◽  
Clear Explanation ◽  
Increased Risk ◽  
Approximate Relationship ◽  
Mental Health Difficulties ◽  
Therapeutic Doses

Mortality from causes other than suicide is higher than expected in schizophrenia. Cardiovascular causes are most common, accounting for the majority of the 5% of sudden and unexpected deaths. Most cases have no clear explanation on post-mortem examination (‘sudden unexplained deaths’) and are thought to result from fatal arrhythmias. Prospective studies show that people with prolongation of the QT interval beyond 500 ms are at increased risk of serious arrhythmias such as ventricular tachycardia and torsade de pointes. In about 1 in 10 cases, the torsade is fatal. Most antipsychotics prolong the QTc interval in overdose but some prolong it even at therapeutic doses. Droperidol, sertindole and ziprasidone extend the QT interval by an average of 15–35 ms; quetiapine, haloperidol and olanzapine by 5 ms, to 15 ms. There is only an approximate relationship between QT prolongation and risk of sudden death, and the risk related to antipsychotics is thought to increase in people with pre-existing cardiac disease, those taking multiple QT-acting drugs and those taking antipsychotics at high dose for long periods. There is little evidence of an association with route of administration. More data are required to clarify to what extent people with mental health difficulties who die suddenly have pre-existing cardiac disease.

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