Prevalence, Management, and Clinical Consequences of QT Interval Prolongation During Treatment With Arsenic Trioxide

2014 ◽  
Vol 32 (33) ◽  
pp. 3723-3728 ◽  
Author(s):  
Gail J. Roboz ◽  
Ellen K. Ritchie ◽  
Rebecca F. Carlin ◽  
Michael Samuel ◽  
Leanne Gale ◽  
...  
Keyword(s):  
Arsenic Trioxide ◽  
Qt Interval ◽  
Interval Prolongation ◽  
Cardiac Events ◽  
Electrocardiographic Monitoring ◽  
Qt Interval Prolongation ◽  
Qt Intervals ◽  
Clinical Consequences ◽  
Study Population ◽  
Clinically Significant

Purpose Arsenic trioxide (ATO) is a highly effective agent for the treatment of acute promyelocytic leukemia (APL). QT interval prolongation is common with ATO and can pose a barrier to effective administration. The objective of this study was to characterize the prevalence, management, and clinical consequences of QT prolongation in a large cohort of patients treated with ATO. Patients and Methods We analyzed 3,011 electrocardiograms from 113 patients with non-APL acute myeloid leukemia and myelodysplastic syndrome who were treated on a previously reported clinical trial. QT intervals were assessed using four different correction formulas, and data were correlated with clinical parameters and treatment with ATO. Results There were no clinically significant cardiac events in the study population. Of those receiving ATO therapy, 29 patients (26%) had rate-uncorrected QT values above 470 ms and 13 (12%) had values exceeding 500 ms. With the commonly used Bazett rate correction formula, 102 patients (90%) had QTc greater than 470 ms, including 74 (65%) above 500 ms. By using alternative rate correction formulas, only 24% to 32% of patients had rate-corrected QT intervals above 500 ms. Conclusion QT interval prolongation is common with ATO treatment, but clinically significant arrhythmias are rare and can be avoided with appropriate precautions. Use of the Bazett correction may result in unnecessary interruptions in ATO therapy, and alternative rate correction formulas should be considered for routine electrocardiographic monitoring.

scholarly journals Pharmacological predictors of heart rate and conductivity disorders in juvenile myoclonic epilepsy

2021 ◽  
Vol 13 (2) ◽  
pp. 168-179
Author(s):  
N. A. Shnayder ◽  
M. M. Petrova ◽  
K. V. Petrov ◽  
R. F. Nasyrova
Keyword(s):  
Cardiac Arrhythmias ◽  
Qt Interval ◽  
Heart Rhythm ◽  
Juvenile Myoclonic Epilepsy ◽  
Myoclonic Epilepsy ◽  
Interval Prolongation ◽  
Unexpected Death ◽  
Electrocardiographic Monitoring ◽  
Qt Interval Prolongation ◽  
Life Threatening

Juvenile myoclonic epilepsy (JME) is the most common form of genetic generalized epilepsy. Patients with JME are at risk of life-threatening heart rhythm and conduction disorders as well as sudden death syndrome due to several potential mechanisms: genetic, clinical, neuroanatomical, pharmacological, psychological, comorbid. This lecture reviews important elements of knowledge about the pharmacological predictors of cerebral-cardiac syndrome and sudden unexpected death in epilepsy. The arrhythmogenic potential of antiepileptic drugs most often used in JME (valproic acid, levetiracetam, lamotrigine, topiramate and zonisamide) is considered, none of which can be classified as class A (drug without risk of QT interval prolongation or TdP) regarding a risk of QT interval prolongation and cardiac arrhythmias. Patients with JME require dynamic video-electroencephalographic monitoring and 24-hour electrocardiographic monitoring to reduce a risk of life-threatening cardiac arrhythmias.

scholarly journals QT Prolongation in Critically Ill Patients With SARS-CoV-2 Infection

2022 ◽  
Vol 27 ◽  
pp. 107424842110694
Author(s):  
Wasim S. El Nekidy ◽  
Khalid Almuti ◽  
Hazem ElRefaei ◽  
Bassam Atallah ◽  
Lana M. Mohammad ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Qt Interval ◽  
Interval Prolongation ◽  
Qtc Prolongation ◽  
Factors Associated ◽  
Qt Interval Prolongation ◽  
History Of ◽  
Clinically Significant

Background: Several reports linked the use of repurposed drugs such as hydroxychloroquine (HCQ), azithromycin, lopinavir/ritonavir, and favipiravir with QT interval prolongation in patients with SARS-CoV2 infection. Little is known about the risk factors for QT interval prolongation in this population. We sought to describe the prevalence and identify the main risk factors associated with clinically significant corrected QT (QTc) prolongation in this population. Methods: We conducted a retrospective analysis of critically ill patients who were admitted to our intensive care unit (ICU), had at least one electrocardiogram performed during their ICU stay, and tested positive for SARs-CoV-2. Clinically significant QTc interval prolongation was defined as QTc >500 milliseconds (ms). Results: Out of the 111 critically ill patients with SARS-CoV-2 infection, QTc was significantly prolonged in 47 cases (42.3%). Patients with a clinically significant QTc prolongation had significantly higher proportions of history of cardiac diseases/surgery (22 [46.8%] vs. 10 [15.6%], P < .001), hypokalemia (10 [21.3] vs. 5 [7.8%], P = .04), and male gender (95% vs. 82.8%, P = .036) than patients with QTc ≤500 ms, respectively. A total of 46 patients (41.4%) received HCQ, 28 (25.2%) received lopinavir/ritonavir, and 5 (4.5%) received azithromycin. Multivariate logistic regression analysis showed that a history of cardiac disease was the only independent factor associated with clinically significant QTc prolongation ( P = .004 for the likelihood-ratio test). Conclusion: The prevalence of clinically significant QTc prolongation in critically ill patients with SARS-CoV-2 infection was high and independent of drugs used. Larger prospective observational studies are warranted to elucidate independent risk factors associated with clinically significant QTc prolongation in this study population.

Adverse Cardiac Events Related to Hydroxychloroquine Prophylaxis and Treatment of COVID-19

2020 ◽  
Vol 2 (1) ◽  
pp. 24-26 ◽  
Author(s):  
Rehile Zengin ◽  
Zeynep Tugce Sarıkaya ◽  
Nalan Nalan Karadag ◽  
Caglar Cuhadaroglu ◽  
Önder Ergönül ◽  
...  
Keyword(s):  
Cardiac Arrhythmias ◽  
Qt Interval ◽  
Case Reports ◽  
World Health ◽  
Interval Prolongation ◽  
Cardiac Events ◽  
Qt Interval Prolongation ◽  
Adverse Cardiac Events ◽  
The World ◽  
Health Organization

Coronavirus disease 2019 (COVID-19) was recognized as pandemic by the World Health Organization (WHO) on March 11, 2020. The disease is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2/2019-nCoV). The measures to contain the spread of the disease such as, social-distancing, hand hygiene, contact thracing, and isolation of persons suspected or confirmed to have infection have been considered to be largely effective. Although no specific drugs for COVID-19 have been proven to be effective currently for either prophylaxis or treatment. However, hydroxychloroquine (HCQ) was suggested as one of the choices of drug, despite the lack of evindence based information. We present three case reports of cardiovascular adverse effects, with respect to its propensity to cause QT interval prolongation and potentially serious cardiac arrhythmias. Keywords: hydroxychloroquine , cardiac , adverse , prophylaxis , treatment , covid-19 .

N C I D E N C E O F H I G H G R A D E Q T C F P R O L O N G A T I O N A N D I T S M A N A G E M E N T A M O N G P A T I E N T S U N D E R G O I N G T R E A T M E N T F O R D R U G R E S I S T A N T T U B E R C U L O S I S ( D R - T B ) : C A S E S E R I E S .

2021 ◽  
Vol 15 (2s) ◽  
pp. 38-41
Author(s):  
Meseret Asfaw ◽  
Davd Lee Holtzman ◽  
Gene F. Kwan ◽  
lawrence T. Oyewusi ◽  
carole D. Mitnick ◽  
...  
Keyword(s):  
Qt Interval ◽  
Case Series ◽  
New Drugs ◽  
World Health ◽  
High Grade ◽  
Interval Prolongation ◽  
Qt Interval Prolongation ◽  
Clinically Significant ◽  
Health Organization ◽  
Almost All

Background: The World Health Organization (WHO) has approved the use of two new drugs, namely Bedaquiline (Bdq) and Delamanid (Dlm), for treatment of Drug Resistant Tuberculosis (DR-TB). One of the concerns raised with the use of these drugs was QT-interval prolongation. This condition could be serious and life threatening. Hence, knowing the magnitude and its management is very important. This case series identifies the incidence and discusses the management of clinically significant QT-interval prolongation amongst a cohort of patients who have been on these medicines. Materials and Methods: Patients with reports of high grade QT-Interval prolongation (i.e. Grade-3 and Grade-4) were identified from the cohort of 265 patients enrolled on bedaquiline and/or delamanid and discussion is made on the pattern, severity and management of each cases identified. Results: Only 4 (1.5%) out of all 265 patients enrolled on Bedaquiline and/or Delamanid have developed high grade QT-Interval prolongation. And all are managed without permanent discontinuation of both drugs. Conclusion: The Incidence of clinically significant QTcF-interval prolongation among DR-TB patients taking bedaquiline and /or delamanid in Lesotho is low. And almost all cases can be managed with more frequent Electrocardiogram (ECG) monitoring and management of other possible causes of QT-interval prolongation without the need to stop one or both drugs permanently.

QT interval prolongation and risk for cardiac events in genotyped LQTS-index children

2008 ◽  
Vol 168 (9) ◽  
pp. 1107-1115 ◽  
Author(s):  
H. Wedekind ◽  
D. Burde ◽  
S. Zumhagen ◽  
V. Debus ◽  
G. Burkhardtsmaier ◽  
...  
Keyword(s):  
Qt Interval ◽  
Interval Prolongation ◽  
Cardiac Events ◽  
Qt Interval Prolongation

scholarly journals Piperaquine Population Pharmacokinetics and Cardiac Safety in Cambodia

2017 ◽  
Vol 61 (5) ◽  
Author(s):  
Pattaraporn Vanachayangkul ◽  
Chanthap Lon ◽  
Michele Spring ◽  
Sommethy Sok ◽  
Winita Ta-aksorn ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Qt Interval ◽  
Randomized Clinical Trials ◽  
Serum Magnesium ◽  
Population Pharmacokinetic ◽  
Sample Collection ◽  
Interval Prolongation ◽  
Baseline Serum ◽  
Electrocardiographic Monitoring ◽  
Qt Interval Prolongation

ABSTRACT Despite the rising rates of resistance to dihydroartemisinin-piperaquine (DP), DP remains a first-line therapy for uncomplicated malaria in many parts of Cambodia. While DP is generally well tolerated as a 3-day DP (3DP) regimen, compressed 2-day DP (2DP) regimens were associated with treatment-limiting cardiac repolarization effects in a recent clinical trial. To better estimate the risks of piperaquine on QT interval prolongation, we pooled data from three randomized clinical trials conducted between 2010 and 2014 in northern Cambodia. A population pharmacokinetic model was developed to compare exposure-response relationships between the 2DP and 3DP regimens while accounting for differences in regimen and sample collection times between studies. A 2-compartment model with first-order absorption and elimination without covariates best fit the data. The linear slope-intercept model predicted a 0.05-ms QT prolongation per ng/ml of piperaquine (5 ms per 100 ng/ml) in this largely male population. Though the plasma half-life was similar in both regimens, peak and total piperaquine exposures were higher in those treated with the 2DP regimen. Furthermore, the correlation between the plasma piperaquine concentration and the QT interval prolongation was stronger in the population receiving the 2DP regimen. Neither the time since the previous meal nor the baseline serum magnesium or potassium levels had additive effects on QT interval prolongation. As electrocardiographic monitoring is often nonexistent in areas where malaria is endemic, 2DP regimens should be avoided and the 3DP regimen should be carefully considered in settings where viable alternative therapies exist. When DP is employed, the risk of cardiotoxicity can be mitigated by combining a 3-day regimen, enforcing a 3-h fast before and after administration, and avoiding the concomitant use of QT interval-prolonging medications. (This study used data from three clinical trials that are registered at ClinicalTrials.gov under identifiers NCT01280162, NCT01624337, and NCT01849640.)

scholarly journals Drug-Induced QT Interval Prolongation

2021 ◽  
Vol 1 (2) ◽  
Author(s):  
Domina Petric
Keyword(s):  
Qt Interval ◽  
Qt Prolongation ◽  
Database Search ◽  
Confirmatory Test ◽  
Correct Interpretation ◽  
Interval Prolongation ◽  
Drug Induced ◽  
Qt Interval Prolongation ◽  
Common Causes ◽  
Clinical Consequences

The correct measurement of the QT interval (using the QT correction formulas, preferably Fridericia and Framingham) as well as a correct interpretation of the causes and of the clinical consequences of a QT prolongation is very important in clinical practice. Drug-induced long QT syndrome (DILQTS) is one of the most common causes of LQTS. In the diagnosis and management of the DILQTS, it can be useful to follow the three-step rule presented in this article: detailed pharmacological anamnesis and correct ECG interpretation; database search and clinical interpretation; confirmatory test.

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