scholarly journals QTc Prolongation in Patients Acutely Admitted to Hospital for Psychosis and Treated with Second Generation Antipsychotics

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Erik Johnsen ◽  
Kristina Aanesen ◽  
Sanjeevan Sriskandarajah ◽  
Rune A. Kroken ◽  
Else-Marie Løberg ◽  
...  
Keyword(s):  
Antipsychotic Drugs ◽  
Statistical Significance ◽  
Torsade De Pointes ◽  
Positive Association ◽  
Qtc Interval ◽  
Qtc Prolongation ◽  
Chi Square ◽  
Exact Test ◽  
Second Generation Antipsychotics ◽  
Qtc Interval Prolongation

QTc interval prolongation is a side effect of several antipsychotic drugs, with associated risks of torsade de pointes arrhythmias and sudden cardiac death. There is an ongoing debate of whether or not electrocardiogram (ECG) assessments should be mandatory in patients starting antipsychotic drugs. To investigate QTc prolongation in a clinically relevant patient group 171 adult patients acutely admitted to an emergency ward for psychosis were consecutively recruited. ECGs were recorded at baseline and then at discharge or after 6 weeks at the latest (discharge/6 weeks), thus reflecting the acute phase treatment period. The mean QTc interval was 421.1 (30.4) ms at baseline and there was a positive association between the QTc interval and the agitation score whereas the QTc interval was inversely associated with the serum calcium level. A total of 11.6% had abnormally prolonged QTc intervals and another 14.3% had borderline prolongation. At discharge/6 weeks, the corresponding proportions were reduced to 4.2% and 5.3%, respectively. The reduction of the proportion with prolonged QTc intervals reached statistical significance (chi-square exact test:P=0.046). The finding of about one-quarter of the patients with borderline or prolonged QTc intervals could indicate mandatory ECG recordings in this population. This trial is registered with ClinicalTrials.gov ID:NCT00932529.

Minimizing the Risks Associated with Significant QTc Prolongation in People with Schizophrenia: A Consensus Statement by The Cardiac Safety in Schizophrenia Group

2002 ◽  
Vol 10 (2) ◽  
pp. 115-124 ◽  
Author(s):  
David Ames ◽  
John Camm ◽  
Peter Cook ◽  
Peter Falkai ◽  
Charles Gury ◽  
...  
Keyword(s):  
Antipsychotic Drugs ◽  
Consensus Statement ◽  
Morbidity And Mortality ◽  
Team Approach ◽  
Qtc Interval ◽  
Cardiac Safety ◽  
Interval Prolongation ◽  
Qtc Prolongation ◽  
Schizophrenia Group ◽  
Qtc Interval Prolongation

Cardiac Safety in Schizophrenia Group Objectes: This study was designed to help identify and clarify issues associated with cardiac safety in schizophrenia, particularly QTc interval prolongation; to raise awareness among psychiatrists of the cardiac issues involved in prescribing for schizophrenia and help psychiatrists minimise the potential cardiac risks associated with treating schizophrenia. Methods: The currently available literature on cardiac dysfunction associated with antipsychotic treatments was reviewed by an independent panel of international psychiatric and cardiology experts. Following individual review, a joint meeting was held and a consensus statement produced. Results: Prolongation of QTc interval is relatively common among antipsychotic drugs although there is marked variation in the extent to which the different agents exert their effect. If a patient is considered to be at high risk of significantly prolonged QTc interval (e.g. increasing age, female gender, comorbid cardiovascular disease) prescription of an antipsychotic drug with low QTc prolonging potential is recommended. Evaluation of a patient's risk factors for significant QTc prolongation is an important part of patient assessment at presentation. To significantly reduce the risk of morbidity and mortality from prolonged QTc interval a team approach involving the hospital emergency psychiatric care team, the office-based psychiatrist, the primary care physician, the cardiologist and the pharmacist is advocated. Conclusions: Significant QTc interval prolongation caused by some antipsychotics is a risk factor that may lead to sudden death in patients with schizophrenia receiving these medications. Not all antipsychotic drugs prolong QTc interval. Careful clinical and pharmacological management of the patient with schizophrenia can significantly reduce the risks of morbidity and mortality from QTc interval prolongation.

Use of SAMe-TT₂R₂ Score to Predict the Quality of Anticoagulation Control in Patients with Atrial Fibrillation Receiving Warfarin in Thailand

2020 ◽  
Vol 103 (6) ◽  
pp. 548-552
Keyword(s):  
Atrial Fibrillation ◽  
Therapeutic Range ◽  
Statistical Significance ◽  
Discrimination Performance ◽  
Poor Quality ◽  
Chi Square ◽  
Exact Test ◽  
Time In Therapeutic Range ◽  
Anticoagulation Control

Objective: To predict the quality of anticoagulation control in patients with atrial fibrillation (AF) receiving warfarin in Thailand. Materials and Methods: The present study retrospectively recruited Thai AF patients receiving warfarin for three months or longer between June 2012 and December 2017 in Central Chest Institute of Thailand. The patients were classified into those with SAMe-TT₂R₂ of 2 or less, and 3 or more. The Chi-square test or Fisher’s exact test was used to compare the proportion of the patients with poor time in therapeutic range (TTR) between the two groups of SAMe-TT₂R₂ score. The discrimination performance of SAMe-TT₂R₂ score was demonstrated with c-statistics. Results: Ninety AF patients were enrolled. An average age was 69.89±10.04 years. Most patients were persistent AF. An average CHA₂DS₂-VASc, SAMe-TT₂R₂, and HAS-BLED score were 3.68±1.51, 3.26±0.88, and 1.98±0.85, respectively. The present study showed the increased proportion of AF patients with poor TTR with higher SAMe-TT₂R₂ score. The AF patients with SAMe-TT₂R₂ score of 3 or more had a larger proportion of patients with poor TTR than those with SAMe-TT₂R₂ score of 2 or less with statistical significance when TTR was below 70% (p=0.03) and 65% (p=0.04), respectively. The discrimination performance of SAMe-TT₂R₂ score was demonstrated with c-statistics of 0.60, 0.59, and 0.55 when TTR was below 70%, 65% and 60%, respectively. Conclusion: Thai AF patients receiving warfarin had a larger proportion of patients with poor TTR when the SAMe-TT₂R₂ score was higher. The score of 3 or more could predict poor quality of anticoagulation control in those patients. Keywords: Time in therapeutic range, Poor quality of anticoagulation control, Warfarin, SAMe-TT₂R₂, Labile INR

Abstract 12640: Energy Drinks Prolong Early Repolarization (J-T Peak ) Phase in a Healthy Population

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Samuel R Kaplan ◽  
Ghufran Syed ◽  
Teri Kozik
Keyword(s):  
Torsade De Pointes ◽  
Energy Drinks ◽  
Energy Drink ◽  
Healthy Population ◽  
Specific Marker ◽  
Qtc Interval ◽  
Qtc Prolongation ◽  
Early Repolarization ◽  
Increased Risk ◽  
Energy Drink Consumption

Introduction: Energy drinks continue to be the fastest growing beverage market with sales expected to reach $60 billion in the next few years, yet have demonstrated adverse cardiovascular effects such as prolongation of the QTc interval on EKG. While QTc prolongation observed with certain drugs has long been used as an indicator of increased risk of torsade de pointes, recent data has identified the early repolarization interval J-T peak (JTp) as a more specific marker for proarrhythmic potential. Drugs that selectively block the human ether-a-go-go related (hERG) potassium ion channel prolong QTc by prolonging both early repolarization (JTp) and late repolarization (T peak -T end [Tpe] interval), and are associated with an increased risk of torsade. In contrast, drugs that additionally block inward late sodium and L-type calcium prolong QTc by prolonging Tpe but not JTp, and have demonstrated reduced risk of torsade. In 2018, the C-Energy-X study demonstrated QTc prolongation in 22 healthy subjects (mean age 28 ± 7yrs) who consumed energy drink while at rest and following short periods of exercise. Our study provides a secondary analysis of this data in terms of its effect on JTp, a potentially more specific marker for torsade risk. Methods: Using H-Scribe software, two evaluators independently measured JTp and RR intervals from C-Energy-X subjects pre- and post-energy drink consumption in the rest and exercise phases. Values were corrected for heart rate using the linear correction formula JTpc=JTp + 0.150(1-RR), where RR is R-to-R interval. Mean JTpc values from each phase were analyzed using a paired sample two-tailed t -test. Results: In the resting phase following energy drink consumption (PCr), there was a statistically significant increase in JTpc intervals for 77% of subjects by a mean of 10.5ms (baseline=234 ± 21.3ms; PCr=245 ± 22.0ms; p =0.015). In the exercise phase following energy drink consumption (PCe), 64% of subjects increased JTpc intervals by a mean of 0.8ms which was not significant (baseline=225 ± 15.7ms; PCe=226 ± 17.9ms; p =0.845). Conclusion: In the resting phase, energy drink consumption was associated with statistically significant prolongation of JTpc, suggesting a theoretical increased risk of torsade de pointes.

Risk of QTc interval prolongation among cancer patients treated with tyrosine kinase inhibitors.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 3033-3033
Author(s):  
Anan Abdelmoti Abu Rmilah ◽  
Grace Lin ◽  
Joerg Herrmann
Keyword(s):  
Tyrosine Kinase ◽  
Cancer Patients ◽  
Tyrosine Kinase Inhibitors ◽  
Kinase Inhibitors ◽  
Complication Rates ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Qtc Prolongation ◽  
Qtc Interval Prolongation ◽  
Life Threatening

3033 Background: QTc interval prolongation can lead to life-threatening complications such as torsade de pointes (TdP), ventricular tachycardia (VT), and sudden cardiac death (SCD). It can occur with various tyrosine kinase inhibitors (TKIs) but comparative analyses on the incidence and complication rates are scarce. We thus conducted a comprehensive analysis of TKI use and QTc prolongation in clinical practice. Methods: We retrospectively reviewed the electronic medical records of all cancer patients who were treated with TKI between 01/2005 and 12/2018 at our institution. QTc prolongation was defined as a QTc ≥ 450 ms or 460 ms among male or female patients, respectively. For each type of TKIs, we determined the administration rate and incidence of QTc interval prolongation. We also studied the frequency of QTc prolongation ≥ 500 ms, rate of increase of the QTc interval by ≥ 60 ms, and the development of complications (VT, TdP and SCD). Results: In the present study, we analyzed the data of 685 cancer patients (431 male and 254 female), including 299 patients with RCC, 188 with chronic leukemia, 55 with acute leukemia, 65 with thyroid cancer, 48 with lung cancer and 39 with GIST. These patients received 902 TKI administrations and QTc prolongation was reported in 1/3 of these (289 administrations). The highest frequency was seen with imatinib, nilotinib and dasatinib (30, 40 and 50%). Among cases of QTc prolongation, a QTc interval ≥ 500 ms was documented in 53 (18.3%) and QTc progression ≥ 60 ms in 72 (25%). Complications were found in 14 cases (5%) including VT in 9, TdP in 2 and SCD in 3 administrations. Conclusions: The current findings suggest that TKI therapy leads to QTc prolongation in 1/3 of patients on average and most commonly with the Bcr-Abl TKIs, imatinib, nilotinib and dasatinib. While SCD is rare (1%) it can still evolve and in 5% of all QTc prolongations with TKIs are potentially life-threatening. These data support recommendations for serial ECGs in cancer patients undergoing TKI therapy. [Table: see text]

scholarly journals Effects of Methadone on Corrected Q-T Interval Prolongation in Critically Ill Children

2018 ◽  
Vol 23 (2) ◽  
pp. 119-124 ◽  
Author(s):  
Travis S. Heath ◽  
Rachel G. Greenberg ◽  
Susan R. Hupp ◽  
David A. Turner ◽  
Christoph P. Hornik ◽  
...  
Keyword(s):  
Critically Ill ◽  
Tertiary Care ◽  
Substantial Effect ◽  
Critically Ill Children ◽  
Admission Diagnosis ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Qtc Prolongation ◽  
Qtc Interval Prolongation ◽  
Before And After

OBJECTIVES This study aimed to determine the association between methadone use and corrected Q-T interval (QTc) prolongation in critically ill children METHODS A retrospective cohort study of critically ill children receiving methadone at a tertiary care pediatric hospital was conducted. Patients younger than 19 years who had been admitted to the intensive care unit between January 1, 2009, and June 21, 2013, who had received methadone while inpatients, and who had had electrocardiograms (ECGs) performed within 30 days before and after methadone initiation were included. The primary outcome was the net change in QTc interval between baseline and postmethadone ECGs. Secondary outcomes included percent change in QTc interval and the proportion of patients whose QTc intervals changed from normal to prolonged following methadone initiation. We also evaluated potential predictors of QTc interval prolongation, including age, sex, admission diagnosis category, exposure to other QTc-prolonging medications, presence of congenital heart disease or known arrhythmias, and methadone daily dose and route of administration. RESULTS Sixty-four patients met the inclusion criteria. The median (25th, 75th percentiles) change in QTc interval following methadone initiation was −8 msec (−34, 13.5 msec; p = 0.19). Five patients (8%) had a baseline normal QTc interval that became prolonged after methadone initiation. We identified no statistically significant predictors of QTc prolongation after methadone initiation. CONCLUSIONS In this dedicated pediatric safety study, methadone initiation did not result in prolongation of the QTc interval. Although these findings suggest methadone initiation may not have a substantial effect of QTc prolongation in critically ill children, a controlled, prospective evaluation in this population remains warranted.

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 Hydroxychloroquine and QTc: beyond COVID-19

2020 ◽  
Vol 6 (4) ◽  
Author(s):  
Alberto Castagna ◽  
Francesco Vetta ◽  
Giuseppe Attisani ◽  
Raffaele Costa ◽  
Carmen Ruberto ◽  
...  
Keyword(s):  
Focal Point ◽  
Elderly Subjects ◽  
Cardiac Repolarization ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Qtc Prolongation ◽  
Antiviral Effects ◽  
Qtc Interval Prolongation ◽  
Electrocardiogram Monitoring ◽  
Potential Use

Hydroxychloroquine is an antimalarial drug also known for its anti-inflammatory and antiviral effects, which have raised the interest of many researchers for its potential use in COVID-19 patients. It is known that this drug, being able to influence the cardiac repolarization phase with QTc interval prolongation, can be potentially harmful, chiefly in elderly subjects with frailty syndrome, several comorbidities and polypharmacotherapy. Therefore, although electrocardiogram monitoring of QTc prolongation is the focal point for reducing the arrhythmic risk of these patients, in order to identify the most exposed patients, the traditional Comprehensive Geriatric Assessment should be combined with a multiparametric risk score for QTc prolongation.

Role of Co-occurring Alcohol and Substances Abuse on QTc Interval Prolongation Among Psychiatric Patients: A Cross-sectional National Survey

2017 ◽  
Vol 41 (S1) ◽  
pp. S201-S202
Author(s):  
M. Corbo ◽  
T. Acciavatti ◽  
F. Fiori ◽  
R. Santacroce ◽  
A. Aguglia ◽  
...  
Keyword(s):  
National Survey ◽  
Psychotropic Drugs ◽  
Polymorphic Ventricular Tachycardia ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Qtc Prolongation ◽  
Cross Sectional ◽  
Star Network ◽  
Qtc Interval Prolongation

IntroductionQTc interval prolongation is considered a risk factor for fatal polymorphic ventricular tachycardia, which can result in sudden cardiac death. Most psychotropic drugs have a dose-dependent potential to prolong the QTc interval. However, other factors require appropriate consideration, including: age; gender; other medications; electrolyte abnormalities; severe comorbid conditions, such as co-occurring alcohol or substances abuse/dependence.ObjectivesThe objective was to study the potential mediating roles of alcohol/substances abuse on QTc prolongation.AimsThe Italian research group STAR Network, in collaboration with the Young Italian Psychiatrists Association, aimed to evaluate the frequency of QTc interval prolongation in a sample of patients under treatment with psychotropic drugs through a cross-sectional national survey.MethodsA sample of 2411 unselected patients were enrolled after performing an ECG during the recruitment period. Sociodemographic and clinical characteristics were collected from medical records. Collected data underwent statistical analysis.ResultsA total of 11.2% of patients reported alcohol abuse, and only 8.9% psychotropic substances. According to the threshold, less than 20% of patients had a borderline value of QTc, and 1% a pathological value. Patients with co-occurring alcohol misuse and drug abuse were more likely to have longer QTc interval.ConclusionsThe present study describes the frequency of QTc prolongation in real-world clinical practice. Before prescribing a psychotropic drug, the physician should carefully assess its risks and benefits to avoid this type of adverse reaction, particularly when additional risk factors are present. The potential role of alcohol and substances on QTc length could be particularly useful in emergency settings.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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