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European Journal of Clinical Pharmacology

, Volume 74, Issue 12, pp 1645–1651 | Cite as

Acquired drug-induced long QTc: new insights coming from a retrospective study

  • Renato De Vecchis
  • Carmelina Ariano
  • Giuseppina Di Biase
  • Michel Noutsias
Pharmacoepidemiology and Prescription
  • 172 Downloads

Abstract

Introduction

Several drug classes (antiarrhythmics, antimicrobials, antidepressants, phenothiazines, opiates, prokinetics of digestive tract, etc.) have been related to ventricular hyperkinetic arrhythmias such as torsade de pointes (TdP). TdPs are usually heralded by an abnormal prolongation of heart rate-corrected QT interval on the electrocardiogram, so-called drug-induced long heart rate-corrected QT (diLQTc). We do not know to what extent the drug-induced QTc prolongation is able to predict malignant arrhythmias. Thus, we have retrospectively examined the clinical history of patients with diLQTc.

Methods

The case record, concerning the period January 2008–December 2017, was collected from two hospitals. diLQTc was defined as drug-induced heart rate-corrected QT of ≥ 450 ms or ≥ 470 ms, respectively in male or female patients. The primary purpose was to verify whether in diLQTc patients the length of this electrocardiographic segment was associated with the risk of symptoms or events (TdP, ventricular fibrillation).

Results

Seventy-three validated cases of diLQTc were gathered. Among them, the QTc duration was not able to predict the occurrence of symptoms or events (odds ratio, 0.998; 95% CI, 0.984 to 1.013; p = 0.8821). Likewise, a diQTc lasting longer than 500 ms compared to diQTc comprised between 450 and 500 ms was not associated with an increased risk of arrhythmic events.

Conclusions

In our diLQTc patients, QTc duration did not predict occurrence of symptoms, or arrhythmic events. Thus, other determinants should be postulated to clarify why sometimes diQTc prolongation propitiates ventricular malignant arrhythmias whereas in other cases this arrhythmogenic effect is lacking.

Keywords

Drug-induced long-QT syndrome Torsade de pointes QT corrected for heart rate Prediction of cardiovascular events 

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Preventive Cardiology and Rehabilitation UnitDSB 29 “S. Gennaro dei Poveri Hospital”NapoliItaly
  2. 2.Division of Geriatrics“Casa Sollievo della Sofferenza” HospitalSan Giovanni RotondoItaly
  3. 3.Division of GeriatricsClinic “S. Maria del Pozzo”Somma VesuvianaItaly
  4. 4.Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital HalleMartin-Luther-University Halle-WittenbergHalleGermany

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