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Secondly ECG recordings in the emergency room revealed Garenoxacin-induced abnormal QT interval prolongation in a patient with multiple syncopal attacks

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Abstract

A 73-year-old woman first visited our emergency room with multiple syncopal attacks. Before admission, she had received an antibiotic (Garenoxacin) for 3 days from a local clinic. First electrocardiogram (ECG) showed no ST-segment deviation but mild QT interval prolongation with a positive U wave. Second ECG recording 3 h later showed slightly slower heart rate and revealed marked QTU interval prolongation suggesting the cause of her syncopal attacks. After cessation of Garenoxacin, the QTU interval prolongation shortened. However, both epinephrine infusion and treadmill exercise test reproduced similar QTU interval prolongation and T wave deformities. Later, genetic analysis demonstrated that this patient had a mutation in KCNH2 gene, and she was diagnosed as a type-2 long-QT syndrome which was accentuated by use of garenoxacin. At the emergency out-patient clinic, repetitive ECG recordings can be useful and should be considered in order to identify the cause of syncopal attacks in patients who were prescribed antibiotics and had mild QT interval abnormalities.

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References

  1. Brignole M, Hamdan MH (2012) New concepts in the assessment of syncope. J Am Coll Cardiol 59:1583–1591

    Article  PubMed  Google Scholar 

  2. Task force for the diagnosis and management of syncope, European Society of Cardiology (ESC), European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), Heart Rhythm Society (HRS), Moya A, Sutton R, Ammirati F, Blanc JJ, Brignole M, Dahm JB, Deharo JC, Gajek J, Gjesdal K, Krahn A, Massin M, Pepi M, Pezawas T, Ruiz Granell R, Sarasin F, Ungar A, van Dijk JG, Walma EP, Wieling W (2009) Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J 30:2631–2671

    Article  Google Scholar 

  3. Goldenberg I, Moss AJ (2008) Long-QT syndrome. J Am Coll Cardiol 51:2291–2300

    Article  PubMed  Google Scholar 

  4. Schwartz PJ, Ackerman MJ (2013) The long-QT syndrome: a transatlantic clinical approach to diagnosis and therapy. Eur Heart J 34:3109–3116

    Article  PubMed  Google Scholar 

  5. Bando S, Soeki T, Matsuura T, Niki T, Ise T, Yamaguchi K, Taketani Y, Iwase T, Yamada H, Wakatsuki T, Akaike M, Aiba T, Shimizu W, Sata M (2014) Congenital long-QT syndrome with compound mutations in the KCNH2 gene. Heart Vessels 29(4):554–559

    Article  PubMed  Google Scholar 

  6. Ayad RF, Assar MD, Simpson L, Garner JB, Schussler JM (2010) Causes and management of drug-induced long-QT syndrome. Proc (Bayl Univ Med Cent) 23:250–255

    Google Scholar 

  7. van Noord C, Eijgelsheim M, Stricker BH (2010) Drug- and non-drug-associated QT interval prolongation. Br J Clin Pharmacol 70:16–23

    Article  PubMed  PubMed Central  Google Scholar 

  8. Sesti F, Abbott GW, Wei J, Murray KT, Saksena S, Schwartz PJ, Priori SG, Roden DM, George AL Jr, Goldstein SA (2000) A common polymorphism associated with antibiotic-induced cardiac arrhythmia. Proc Natl Acad Sci U S A 97(19):10613–10618

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Anderson ME, Mazur A, Yang T, Roden DM (2001) Potassium current antagonist properties and proarrhythmic consequences of quinolone antibiotics. J Pharmacol Exp Ther 296(3):806–810

    CAS  PubMed  Google Scholar 

  10. Alexandrou AJ, Duncan RS, Sullivan A, Hancox JC, Leishman DJ, Witchel HJ, Leaney JL (2006) Mechanism of hERG K+ channel blockade by the fluoroquinolone antibiotics moxifloxacin. Br J Pharmacol 147:905–916

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Gajjar DA, Bello A, Ge Z, Christopher L, Grasela DM (2003) Multiple-dose safety and pharmacokinetic of oral garenoxacin in healthy subjects. Antimicrob Agents Chemother 47(7):2256–2263

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Moss AJ, Zareba W, Kaufman ES, Gartman E, Peterson DR, Benhorin J, Towbin JA, Keating MT, Priori SG, Schwartz PJ, Vincent GM, Robinson JL, Andrews ML, Feng C, Hall WJ, Medina A, Zhang L, Wang Z (2002) Increased risk of arrhythmic events in long-QT syndrome with mutations in the pore region of the human ether-a-go-go-related gene potassium channel. Circulation 105:794–799

    Article  CAS  PubMed  Google Scholar 

  13. Shimizu W, Horie M (2011) Phenotypic manifestations of mutations in genes encoding subunit of cardiac potassium channels. Circ Res 109:97–109

    Article  CAS  PubMed  Google Scholar 

  14. Shimizu W, Moss AJ, Wilde AA, Towbin JA, Ackerman MJ, January CT, Tester DJ, Zareba W, Robinson JL, Qi M, Vincent GM, Kaufman ES, Hofman N, Noda T, Kamakura S, Miyamoto Y, Shah S, Amin V, Goldenberg I, Andrews ML, McNitt S (2009) Genotype-phenotype aspects of type 2 long-QT syndrome. J Am Coll Cardiol 54(22):2052–2062

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Mihic A, Chauhan VS, Gao X, Oudit GY, Tsushima RG (2011) Trafficking defect and proteasomal degradation contribute to the phenotype of a novel KCNH2 long-QT syndrome mutation. PLoS ONE 6(3):e18273

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Liu L, Hayashi K, Kaneda T, Ino H, Fujino N, Uchiyama K, Konno T, Tsuda T, Kawashiri MA, Ueda K, Higashikata T, Shuai W, Kupershmidt S, Higashida H, Yamagishi M (2013) A novel mutation in the transmembrane nonpore region of the KCNH2 gene causes severe clinical manifestations of long-QT syndrome. Heart Rhythm 10(1):61–67

    Article  CAS  PubMed  Google Scholar 

  17. Schwartz PJ, Priori SG, Spazzolini C, Moss AJ, Vincent GM, Napolitano C, Denjoy I, Guicheney P, Breithardt G, Keating MT, Towbin JA, Beggs AH, Brink P, Wilde AA, Toivonen L, Zareba W, Robinson JL, Timothy KW, Corfield V, Wattanasirichaigoon D, Corbett C, Haverkamp W, Schulze-Bahr E, Lehmann MH, Schwartz K, Coumel P, Bloise R (2001) Genotype-phenotype correlation in the long-QT syndrome: gene-specific triggers for life-threatening arrhythmias. Circulation 103:89–95

    Article  CAS  PubMed  Google Scholar 

  18. Wong JA, Gula LJ, Klein GJ, Yee R, Skanes AC, Krahn AD (2010) Utility of treadmill testing in identification and genotype prediction in long-QT syndrome. Circ Arrhythm Electrophysiol 3(2):120–125

    Article  PubMed  Google Scholar 

  19. Clur SA, Chockalingam P, Filippini LH, Widyanti AP, Van Cruijsen M, Blom NA, Alders M, Hofman N, Wilde AA (2010) The role of the epinephrine test in the diagnosis and management of children suspected of having congenital long-QT syndrome. Pediatr Cardiol 31(4):462–468

    Article  PubMed  Google Scholar 

  20. Toyota N, Miyazaki A, Sakaguchi H, Shimizu W, Ohuchi H (2014) A high-risk patient with long-QT syndrome with no response to cardioselective beta-blockers. Heart Vessels. doi:10.1007/s00380-014-0530-7

    PubMed  Google Scholar 

  21. Vyas H, Hejlik J, Ackerman MJ (2006) Epinephrine QT stress testing in the evaluation of congenital long-QT syndrome: diagnostic accuracy of the paradoxical response. Circulation 113(11):1385–1392

    Article  CAS  PubMed  Google Scholar 

  22. Shimizu W, Noda T, Takaki H, Nagaya N, Satomi K, Kurita T, Suyama K, Aihara N, Sunagawa K, Echigo S, Miyamoto Y, Yoshimasa Y, Nakamura K, Ohe T, Towbin JA, Priori SG, Kamakura S (2004) Diagnostic value of epinephrine test for genotyping LQT1, LQT2, and LQT3 forms of congenital long-QT syndrome. Heart Rhythm 1(3):276–283

    Article  PubMed  Google Scholar 

  23. Hekkala AM, Viitasalo M, Väänänen H, Swan H, Toivonen L (2010) Abnormal repolarization dynamics revealed in exercise test in long-QT syndrome mutation carriers with normal resting QT interval. Europace 12(9):1296–1301

    Article  PubMed  Google Scholar 

  24. Schwartz PJ, Vanoli E, Crotti L, Spazzolini C, Ferrandi C, Goosen A, Hedley P, Heradien M, Bacchini S, Turco A, La Rovere MT, Bartoli A, George AL Jr, Brink PA (2008) Neural control of heart rate is an arrhythmia risk modifier in long-QT syndrome. J Am Coll Cardiol 51(9):920–929

    Article  PubMed  Google Scholar 

  25. Nagaoka I, Shimizu W, Mizusawa Y, Sakaguchi T, Itoh H, Ohno S, Makiyama T, Yamagata K, Makimoto H, Miyamoto Y, Kamakura S, Horie M (2010) Heart rate-dependent variability of cardiac events in type 2 congenital long-QT syndrome. Europace 12(11):1623–1629

    Article  PubMed  Google Scholar 

  26. Fossa AA (2008) The impact of varying autonomic states on the dynamic beat-to-beat QT-RR and QT-TQ interval relationships. Br J Pharmacol 154(7):1508–1515

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Fujiki A, Yoshioka R, Sakabe M (2015) Evaluation of repolarization dynamics using the QT-RR regression line slope and intercept relationship during 24-h Holter ECG. Heart Vessels 30(2):235–240

    Article  PubMed  Google Scholar 

  28. Goldenberg I, Mathew J, Moss AJ, McNitt S, Peterson DR, Zareba W, Benhorin J, Zhang L, Vincent GM, Andrews ML, Robinson JL, Morray B (2006) Corrected QT variability in serial electrocardiograms in long-QT syndrome: the importance of the maximum corrected QT for risk stratification. J Am Coll Cardiol 48(5):1047–1052

    Article  PubMed  Google Scholar 

  29. Schwartz PJ, Crotti L, Insolia R (2012) Long-QT syndrome: from genetics to management. Circ Arrhythm Electrophysiol 5(4):868–877

    Article  PubMed  PubMed Central  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Cardiology, Nagaoka Chuo General Hospital, Nagaoka, Japan

    Minoru Tagawa, Sachie Ochiai & Yuichi Nakamura

  2. Department of Cardiovascular Biology and Medicine, Niigata University School of Medicine, Niigata, Japan

    Akinori Sato

  3. School of Health Science, Niigata University School of Medicine, 2-746 Asahimachi, Chuou-ku, Niigata, 951-8518, Japan

    Masaomi Chinushi

Authors
  1. Minoru Tagawa
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  2. Sachie Ochiai
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  3. Yuichi Nakamura
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  4. Akinori Sato
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  5. Masaomi Chinushi
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Correspondence to Masaomi Chinushi.

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Tagawa, M., Ochiai, S., Nakamura, Y. et al. Secondly ECG recordings in the emergency room revealed Garenoxacin-induced abnormal QT interval prolongation in a patient with multiple syncopal attacks. Heart Vessels 31, 1200–1205 (2016). https://doi.org/10.1007/s00380-015-0693-x

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  • DOI: https://doi.org/10.1007/s00380-015-0693-x

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