Probable Acquired QTc Prolongation and Subsequent Torsades de Pointes Attributable to Quetiapine

2017 ◽  
Vol 19 (6) ◽  
Author(s):  
Shaun Giancaterino ◽  
Susan Solimine
Keyword(s):  
Torsades De Pointes ◽  
Qtc Prolongation

scholarly journals QTc interval in patients with schizophrenia receiving antipsychotic treatment as monotherapy or polypharmacy

CNS Spectrums ◽  
2017 ◽  
Vol 23 (4) ◽  
pp. 278-283 ◽  
Author(s):  
Anja Elliott ◽  
Thibault Johan Mørk ◽  
Mikkel Højlund ◽  
Thomas Christensen ◽  
Rasmus Jeppesen ◽  
...  
Keyword(s):  
Small Sample Size ◽  
Torsades De Pointes ◽  
Small Sample ◽  
Polymorphic Ventricular Tachycardia ◽  
Antipsychotic Treatment ◽  
Qtc Interval ◽  
Qtc Prolongation ◽  
Worst Case ◽  
Clinical Interviews ◽  
Observational Cohort

ObjectiveAntipsychotics are associated with a polymorphic ventricular tachycardia, torsades de pointes, which, in the worst case, can lead to sudden cardiac death. The QT interval corrected for heart rate (QTc) is used as a clinical proxy for torsades de pointes. The QTc interval can be prolonged by antipsychotic monotherapy, but it is unknown if the QTc interval is prolonged further with antipsychotic polypharmaceutical treatment. Therefore, this study investigated the associations between QTc interval and antipsychotic monotherapy and antipsychotic polypharmaceutical treatment in schizophrenia, and measured the frequency of QTc prolongation among patients.MethodsWe carried out an observational cohort study of unselected patients with schizophrenia visiting outpatient facilities in the region of Central Jutland, Denmark. Patients were enrolled from January of 2013 to June of 2015, with follow-up until June of 2015. Data were collected from clinical interviews and clinical case records.ResultsElectrocardiograms were available for 65 patients, and 6% had QTc prolongation. We observed no difference in average QTc interval for the whole sample of patients receiving no antipsychotics, antipsychotic monotherapy, or antipsychotic polypharmaceutical treatment (p=0.29). However, women presented with a longer QTc interval when receiving polypharmacy than when receiving monotherapy (p=0.01). A limitation of this study was its small sample size.ConclusionsWe recommend an increased focus on monitoring the QTc interval in women with schizophrenia receiving antipsychotics as polypharmacy.

scholarly journals Pattern of antimalaria treatment and risk factors for torsades de pointes in admitted heart failure patients in Lagos-Nigeria

2014 ◽  
Vol 3 (5) ◽  
pp. 161
Author(s):  
Janet N. Ajuluchukwu ◽  
Emmanuel N. Anyika ◽  
Christiana A. Boyle
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Univariate Analysis ◽  
Length Of Hospital Stay ◽  
Torsades De Pointes ◽  
Malaria Treatment ◽  
Qtc Prolongation ◽  
Mean Values ◽  
Group 2 ◽  
Sulphadoxine Pyrimethamine

Background: In a malaria-holoendemic region, concurrent malaria complicating heart failure (HF) occurs; with higher morbidity and increased adverse drug-drug interactions. Aim: To characterise malaria treatment and risk factors of cardio-toxicity among HF patients. Objectives: To characterise the use of anti-malaria agents (AMA), compare risk factors of torsades de pointes (TdP) amongst AMA-users and non-users, and to assess length of hospital stay. Methods: Admitted HF patients were retrospectively studied, and grouped on the basis of malaria treatment. TdP risk factors- advanced age, bradycardia, hypokalemia, and QTc prolongation were compared in the two groups. Results: The 160 HF patients (mean ejection fraction 39.6% ± 12.6%, mean age 54.9 ± 14.6 years) included 82 males (51.3%), with predominant non-ischemic HF. Malaria treatment occurred in 32.5% (52), though diagnosis was presumptive in 48 (92.3%). All (100%) malaria prescriptions were artemisinin-based, but monotherapeutic in 6 (11.4%). Partner-drugs included sulphadoxine-pyrimethamine (SP) 26 (50%), and lumefantrine 7 (13.5%). TdP risk-factors of age 65 years, prolonged QTc, hypokalemia, and bradycardia occurred in 43 (26.9%), 63 (39.4%), 48 (30%), and 8 (5.0%) respectively. Group 1 (AMA treated) and group 2 patients were comparable on all mean values of risk factors. Nevertheless, affected proportions were significantly different for hypokalemia (X2 = 6.1), QTc prolongation (48.1% versus 35.2%, p < .05), and older age (38.5% versus, 21.3%, p < .05%). Conclusion: Though all HF patients similarly demonstrated risks of TdP, univariate analysis indicates a significantly higher proportion in malaria-treated patients; supporting further therapeutic caution in this patient subset.

Cardiovascular side effects, QT interval in patients treated with some selected antypsychotics. preliminary results

2011 ◽  
Vol 26 (S2) ◽  
pp. 1295-1295
Author(s):  
P. Wierzbinski ◽  
W. Kryszkowski ◽  
A. Florkowski ◽  
P. Galecki
Keyword(s):  
Side Effects ◽  
Ventricular Fibrillation ◽  
Qt Interval ◽  
Ventricular Arrhythmias ◽  
Potassium Level ◽  
First Generation ◽  
Torsades De Pointes ◽  
Qtc Prolongation ◽  
Cardiovascular Side Effects ◽  
Adult Psychiatry

IntroductionTreatment with antypsychotics is associated with cardiovascular side effects. This results from mechanism of action of antypsychotics. Arrhythmias are the serious side effects. Treatment with antipsychotics may prolong QTc and increase the risk of dangerous supraventricular and ventricular arrhythmias.ObjectivesThe main aims of the research are the following: If Any antypsychotics agents may prolong QT interval? If monotherapy with olanzapine, zyprasidone, arypiprazole and politherapy with perphenazine and olanzapine may induce any arrhythmias?MethodsData for this study were collected from 65 patients hospitalized in the Department of Adult Psychiatry and treated with olanzapine and perphenazine (n = 10) and with olanzapine (n = 20), aripiprazole (n = 20), ziprasidone (n = 15). All patients had 12 leads ECG two times: before admitting the drugs and during the treatment. All ECG were assessed on the presence of any abnormalities and QTc was calculated manually by using Bazzet formula.ResultsAmong treated patients no QTc prolongation was observed. There was no prolonged QTc over 450 ms in Male and 470 ms in female patients treated with antypsychotics in mono and politherapy. Potassium level in all patients was within the norm. Bradykardia (< 50/min) and tachykardia (>100/min) was not observed among participants.ConclusionsAtypical antypsychotics such as olanzapine, arypiprazole, zyiprasidon are cardiovascular safe drugs. They did not induce dangerous for life arrhythmias especially ventricular arrhythmia (known as torsades de pointes), which can progress to ventricular fibrillation and sudden death. Politherapy with olanzapine and first generation agents perphenazine is a safe combination and did not induce any cardiovascular side effects.

scholarly journals Reflex sympatho-vagal coactivation and concealed QTc prolongation: Lessons from hERG-blockers and long QT syndromes type 1 and type 2

2021 ◽  
Author(s):  
Pascal Champéroux ◽  
Raafat Fares ◽  
Sebastien Jude ◽  
Vincent Maleysson ◽  
Serge Richard ◽  
...  
Keyword(s):  
Stroke Volume ◽  
High Frequency ◽  
Torsades De Pointes ◽  
Pulse Contour ◽  
Contour Method ◽  
Qtc Prolongation ◽  
Compensatory Mechanisms ◽  
Drug Induced ◽  
Vagal Reflex ◽  
Pulse Contour Method

Background and Purposes: Several hERG blocking molecules known for their propensity in triggering Torsades de Pointes (TdP) were reported as increasing High Frequency QT oscillations (HFQT). This effect was found as reflecting a sympatho-vagal coactivation. The present work aims to characterise the mechanism(s) leading to this particular state of the autonomic nervous system. Experimental approach: Effects of 20 hERG blockers including 15 torsadogenic molecules were assessed by telemetry in beagle dogs. Electrocardiogram and stroke volume modelled from the pulse contour method were analysed at the first dose level causing either QTc prolongation and/or HFQT increase. Cardiac autonomic control was analysed using the High Frequency Autonomic Modulation (HFAM) model in dogs and in untreated genotyped LQT1 and LQT2 individuals, for comparison. Key results: The sympatho-vagal coactivation induced by torsadogenic molecules is elicited by reflex compensatory mechanisms in response to changes in stroke volume or cardiac output related to hemodynamic off-targets and/or QT prolongation. QTc prolongation was concealed or markedly blunted by the sympathetic component activation in a large proportion of tested torsadogenic drugs. Sympathetic reflex mechanisms in LQT patients similar to that found for dofetilide was also revealed in both patients exhibiting QTc prolongation and concealed QTc prolongation, irrespective to LQT type. Conclusions and implications: QTc prolongation and/or drug-induced hemodynamic side effects enhance beat to beat ventricular repolarisation variability via sympatho-vagal reflex compensatory mechanisms. Considering the sympathetic reflex component via analysis of HFQT oscillations dramatically improves prediction, sensitivity and specificity of drug induced Torsades de pointes risk assessment.

Torsades-de-Pointes associated with Taku-Tsubo cardiomyopathy following greatly reduced oxycodone use in an elderly woman

2018 ◽  
Vol 7 (2) ◽  
pp. 155-159 ◽  
Author(s):  
Harry W. Daniell, MD
Keyword(s):  
Qt Interval ◽  
Elderly Woman ◽  
Torsades De Pointes ◽  
Gene Activity ◽  
Related Gene ◽  
Qtc Prolongation ◽  
Standard Measurement ◽  
Corrected Qt Interval ◽  
Elderly Female

This article reports an elderly female oxycodone consumer who developed Torsades-de-Pointes soon after her opioid-associated rate-corrected QT interval (QTC; a standard measurement on electrocardiograms) prolongation had been augmented by the development of Taku-Tsubo cardiomyopathy (TC), a sequence that followed greatly reduced oxycodone ingestion. Factors that likely contributed to this sequence are discussed, including direct opioid-induced inhibition of human ether-a-go-go-related gene activity and of androgen formation plus QTc prolongation induced by the presence of TC.

QTc Prolongation and Torsades de Pointes

2020 ◽  
pp. 137-142
Author(s):  
Ankur Srivastava ◽  
James E. Littlejohn
Keyword(s):  
Qt Interval ◽  
Torsades De Pointes ◽  
Hemodynamic Instability ◽  
Polymorphic Ventricular Tachycardia ◽  
Stable Patient ◽  
Qtc Prolongation ◽  
Preventative Measures ◽  
Drug Classes ◽  
Alternative Medications ◽  
Primary Management

This chapter looks at QTc prolongation and torsades de pointes (Tdp). In cases of recurrent polymorphic ventricular tachycardia, Tdp should be an immediate consideration. Tdp appears like a “twisting of points” of the cardiac axis, which is most often due to acquired QTc prolongation. The QT interval is inversely related to heart rate; therefore, it is corrected (QTc) using formulas such as Bazett's, Fridericia, and Framingham. There are several congenital and acquired causes of QTc prolongation. The congenital long QT syndrome, Romano-Ward syndrome, and Jervell and Lange-Nielsen syndrome are commonly associated with QTc prolongation and Tdp. Drug classes such as anti-arrhythmics, antidepressants, antipsychotics, antibiotics, and antihistamines are the other common cause of acquired QTc prolongation. Primary management of QTc prolongation and Tdp consists of minimizing risk factors like alternative medications and correcting electrolyte abnormalities. In a hemodynamically stable patient with QTc prolongation, treatment should focus on discontinuing the possible offending medications and correcting electrolyte levels. Meanwhile, patients with Tdp and hemodynamic instability require emergent electrical cardioversion in conjunction with preventative measures.

Assessment of Sotalol and Dofetilide Dosing at a Large Academic Medical Center

2020 ◽  
Vol 25 (5) ◽  
pp. 438-443 ◽  
Author(s):  
Clara Ting ◽  
Rhynn Malloy ◽  
Danielle Knowles
Keyword(s):  
Dose Reduction ◽  
Medical Center ◽  
Academic Medical Center ◽  
Torsades De Pointes ◽  
Close Monitoring ◽  
Prescribing Practices ◽  
Qtc Prolongation ◽  
Medication Discontinuation ◽  
Baseline Incidence ◽  
Dosing Strategies

Background: Patients initiated on sotalol and dofetilide require inpatient monitoring and dose adjustments due to risks of corrected QT (QTc) prolongation and Torsades de pointes (TdP). Patients may receive higher initial doses than recommended due to close monitoring by specialized practitioners. The objective of this study was to describe prescribing practices of sotalol and dofetilide and to compare safety outcomes between standard and nonstandard dosing strategies. Methods: This was a single-center retrospective analysis of adult inpatients who underwent sotalol or dofetilide initiation between June 1, 2015, and August 1, 2018. The end points of this study included the percentage of patients who received standard and nonstandard dosing, incidence of QTc prolongation (≥500 milliseconds or ≥15% from baseline), incidence of TdP, and dose reduction or medication discontinuation. Results: A total of 379 patients (195 sotalol and 184 dofetilide) were included in this analysis. There were 110 (56.4%) patients in the sotalol group and 111 (58.4%) patients in the dofetilide group that received nonstandard initial dosing. Nonstandard dosing was associated with a greater incidence of QTc prolongation compared to standard dosing (57.5% vs 43.0%, P = .005). Only one patient in the nonstandard dosing group experienced TdP. Patients initiated on nonstandard dosing required dose reduction or therapy discontinuation (37.6% vs 23.4%, P = .003) more frequently. Conclusion: Higher than recommended initial doses of sotalol or dofetilide were associated with higher incidence of QTc prolongation and more frequent therapy modification.

scholarly journals Torsades de pointes in SARS-CoV-2 (COVID-19) pneumonia: medicine reconciliation and careful monitoring of QTc interval may help prevent cardiac complications

2021 ◽  
Vol 14 (3) ◽  
pp. e239963
Author(s):  
Waqas Aslam ◽  
Carla R Lamb ◽  
Nadia Ali
Keyword(s):  
Sinus Rhythm ◽  
Normal Sinus Rhythm ◽  
Torsades De Pointes ◽  
Normal Serum ◽  
Cardiac Complications ◽  
Qtc Interval ◽  
Careful Monitoring ◽  
Qtc Prolongation ◽  
Serum Electrolytes ◽  
Normal Sinus

Hydroxychloroquine has been widely prescribed to treat patients with COVID-19 pneumonia. A 73-year-0ld woman with COVID-19 pneumonia was treated with dexamethasone and hydroxychloroquine. Her home medications, citalopram and donepezil, were continued. The ECG prior to starting hydroxychloroquine showed normal sinus rhythm with prolonged corrected QT (QTc) of 497 ms, due to citalopram and donepezil therapy. Repeat ECG on days 3 and 4 of hydroxychloroquine therapy showed significantly prolonged QTc of 557 ms and 538 ms, respectively, despite normal serum electrolytes. All QT-prolonging medications including hydroxychloroquine were discontinued on day 4; however, she suffered a transient torsades de pointes lasting for about 15 s, which resolved before any intervention. QTc improved to 477 ms, after discontinuation of QT-prolonging medications. The patient had QTc prolongation and torsades de pointes due to therapy with multiple QT-prolonging medications. Medicine reconciliation and careful monitoring of QTc may help prevent cardiac complications in patients with COVID-19 treated with hydroxychloroquine.

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