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 Interval Prolongation in Patients Treated for COVID-19

2020 ◽  
Author(s):  
Parham Habibzadeh ◽  
Abdollah Sarami ◽  
Mahboobeh Yadollahie ◽  
Kourosh Hashemiasl ◽  
Arezoo Salahi ◽  
...  
Keyword(s):  
Serum Potassium ◽  
Cardiac Arrhythmias ◽  
Qt Interval ◽  
Serum Magnesium ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Qtc Prolongation ◽  
Effective Measure ◽  
Qt Interval Prolongation ◽  
Life Threatening

AbstractBackgroundMany of the drugs commonly used for the treatment of COVID-19 cause QT interval prolongation and increase the risk of life-threatening cardiac arrhythmias. It has been shown that maintaining serum potassium and magnesium levels above 4 and 3 mg/dL, respectively, would prevent the QTc prolongation.ObjectiveTo determine if keeping only the serum magnesium level above 3 mg/dL could be considered an effective measure to prevent QTc prolongation in patients with COVID-19 receiving these drugs.MethodsIn a retrograde observational study, QTc interval was measured in 14 patients diagnosed with COVID-19 before and 3 days after initiation of treatment with either hydroxychloroquine or lopinavir-ritonavir, while their serum magnesium levels were kept ≥3 mg/dL.ResultsThe baseline QTc interval of 412 (SD 36) ms significantly increased by an average of 34 (95% CI 13 to 55) ms after 3 days of treatment. 5 patients, mostly those with lower serum potassium levels, had QTc prolongation ≥60 ms.ConclusionAlthough it seems that the risk of fatal cardiac arrhythmias in this setting is not high, it is prudent to monitor the serum electrolytes, particularly potassium, in patients with COVID-19 who are treated with either hydroxychloroquine or lopinavir-ritonavir.

scholarly journals The Dog's Role in the Preclinical Assessment of QT Interval Prolongation

2003 ◽  
Vol 31 (1_suppl) ◽  
pp. 11-16 ◽  
Author(s):  
Michael R. Gralinski
Keyword(s):  
Cardiac Arrhythmias ◽  
Qt Interval ◽  
Safety Assessment ◽  
Safety Evaluation ◽  
Regulatory Agencies ◽  
Potential Drug ◽  
Interval Prolongation ◽  
Qt Interval Prolongation ◽  
Preclinical Species ◽  
Canine Models

During the development of a new therapeutic, few pharmacodyamic outcomes currently receive as much scrutiny as the effect of a potential medication on the electrocardiographic QT interval. The recent withdrawal from marketing of several drugs due to potential drug-related cardiac arrhythmias have greatly increased concern about drug-related changes on the QT interval. In order to reduce the incidence of these idiosyncratic episodes, regulatory agencies have suggested that sponsors use more rigorous methodology during the safety evaluation of new pharmaceuticals. Along with enhanced electrocardiographic assessments during clinical trials, advanced preclinical examinations of effect on QT interval and ventricular repolarization have become de rigueur. In this arena, the beagle dog is the preclinical species often associated with the most reliable predictivity for human safety assessment. To this end, canine models of cardiovascular safety assessment are discussed along with the relevance of these assays to human electrocardiography.

scholarly journals Postoperative QT Interval Prolongation in Patients Undergoing Noncardiac Surgery under General Anesthesia

2012 ◽  
Vol 117 (2) ◽  
pp. 321-328 ◽  
Author(s):  
Peter Nagele ◽  
Swatilika Pal ◽  
Frank Brown ◽  
Jane Blood ◽  
J. Philipp Miller ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Qt Interval ◽  
Serum Magnesium ◽  
Torsades De Pointes ◽  
Noncardiac Surgery ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Qt Interval Prolongation ◽  
Life Threatening ◽  
Qt Interval Duration

Background Abnormal cardiac repolarization, indicated by a prolongation of the QT interval, increases the risk for torsades de pointes, a potentially life-threatening arrhythmia. Many perioperatively administered drugs and conditions prolong the QT interval. Despite several reports of perioperative torsades de pointes, systematic evidence regarding perioperative QT interval prolongation is limited. Methods Serial postoperative 12-lead electrocardiograms were obtained from 469 adult patients undergoing major noncardiac surgery under general anesthesia. Heart rate corrected QT-interval duration (Fridericia formula) was the primary outcome. All perioperatively administered drugs were recorded. Emphasis was placed on absolute QTc prolongation greater than 500 ms and relative increases of 30 and 60 ms. Results At the end of surgery, 80% of the patients (345 of 429) experienced a significant QTc interval prolongation (ΔQTc 23 ± 26 ms (mean and SD), 95% CI 20-25 ms, P less than 0.001). Approximately 51% (219 of 429) had a QTc greater than 440 ms, and 4% (16 of 429) a QTc greater than 500 ms. In 39% (166 of 429), the ΔQTc was greater than 30 ms, in 8% (34 of 429) >60 ms, and in greater than 0.5% (2 of 429) >100 ms. No changes in ΔQTc occurred at subsequent time points. One patient developed torsades de pointes with a ΔQTc: 29 ms (0.4% incidence rate). Several drugs had a large effect on ΔQTc: isoflurane, methadone, ketorolac, cefoxitin, zosyn, unasyn, epinephrine, ephedrine, and calcium. Postoperative body temperature had a weak negative correlation with ΔQTc (r = -0.15, P = 0.02); serum magnesium, potassium, and calcium concentrations were not correlated. Conclusion Postoperative QT-interval prolongation is common. Several perioperatively administered drugs are associated with a substantial QT-interval prolongation. The exact cause and its clinical relevance are, however, unclear. Nevertheless, an association between postoperative QT prolongation and risk for torsades de pointes is likely.

QT interval prolongation and risk of life-threatening arrhythmias during toxoplasmosis prophylaxis with spiramycin in neonates

1997 ◽  
Vol 133 (1) ◽  
pp. 108-111 ◽  
Author(s):  
Marco Stramba-Badiale ◽  
Filippo Nador ◽  
Norberto Porta ◽  
Stefano Guffanti ◽  
Marco Frediani ◽  
...  
Keyword(s):  
Qt Interval ◽  
Interval Prolongation ◽  
Qt Interval Prolongation ◽  
Life Threatening

scholarly journals Life Threatening Severe QTc Prolongation in Patient with Systemic Lupus Erythematosus due to Hydroxychloroquine

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
John P. O’Laughlin ◽  
Parag H. Mehta ◽  
Brian C. Wong
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Qt Interval ◽  
Ventricular Arrhythmias ◽  
Interval Prolongation ◽  
Systemic Lupus ◽  
Qt Interval Prolongation ◽  
Life Threatening ◽  
Stage Renal Disease ◽  
End Stage

We present a case of a syncopal episode resulting from significant QT interval prolongation in a patient on hydroxychloroquine for the treatment of systemic lupus erythematosus and end stage renal disease. The patient had been treated with hydroxychloroquine for two years prior to presentation. After thorough workup for secondary causes of QT interval prolongation hydroxychloroquine was discontinued and the patient’s QT interval shortened. The patient was treated with mexiletine to prevent sudden ventricular arrhythmias, which was unique compared to other documented cases in which lidocaine was used. The patient was noted to have mild prolongation of the QT interval on electrocardiogram prior to initiation of hydroxychloroquine therapy which was exacerbated by its use and may have been caused due to toxicity from underlying renal failure.

scholarly journals The QT long syndrome: clinical and diagnostic aspect

2021 ◽  
Vol 69 (1) ◽  
Author(s):  
Constantin Martiniuc ◽  
◽  
Serghei Pisarenco ◽  
Iurie Simionica ◽  
◽  
...  
Keyword(s):  
Qt Interval ◽  
Torsade De Pointes ◽  
Qt Prolongation ◽  
Current Data ◽  
Polymorphic Ventricular Tachycardia ◽  
Interval Prolongation ◽  
Qt Interval Prolongation ◽  
Increased Risk ◽  
Wide Range ◽  
Life Threatening

QT interval prolongation is a predictor of the life-threatening cardiac arrhythmias — polymorphic ventricular tachycardia (torsade de pointes). Long QT syndrome may be congenital or acquired. It is known that a wide range of both antiarrhythmic and non-cardiac medications might lead to QT interval prolongation. List of drugs that cause QT prolongation is constantly growing and being updated. The review contains current data on the clinical significance of the control of QT interval duration within drug therapy. Clinical conditions associated with an increased risk of QT interval prolongation are described. Drugs that can induce QT prolongation are also discussed.

scholarly journals Risk of QT Prolongation through Drug-drug Interactions between Hydroxychloroquine and Concomitant Drugs Prescribed in Real-world Practice

2020 ◽  
Author(s):  
Byung Jin Choi ◽  
Yeryung Koo ◽  
Tae Young Kim ◽  
Wou Young Chung ◽  
Yun Jung Jung ◽  
...  
Keyword(s):  
Drug Interactions ◽  
Real World ◽  
Qt Interval ◽  
Qt Prolongation ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Qt Interval Prolongation ◽  
Life Threatening ◽  
Alternative Drugs

Abstract Background: Hydroxychloroquine has recently received attention as a treatment for COVID-19. However, hydroxychloroquine may prolong the QTc interval, thus increasing the risk of life-threatening arrhythmia. Many patients with COVID-19 have comorbidities, necessitating the use of several drugs simultaneously with hydroxychloroquine. However, the risk of QT prolongation due to drug-drug interactions (DDIs) between hydroxychloroquine and these co-medications has not been identified. Therefore, it is necessary to investigate the risk of QT interval prolongation due to DDIs between hydroxychloroquine and frequently used concurrent drugs.Methods and Results: Using 447,632 patients and 1,040,752 electrocardiograms, we investigated the risk of QT prolongation due to DDIs between hydroxychloroquine and 118 concurrent drugs frequently used in real-world practice. In the analysis, we observed that 11 drugs (trimebutine, tacrolimus, tramadol, rosuvastatin, ciclosporin, sulfasalazine, rofecoxib, diltiazem, piperacillin/tazobactam, and isoniazid) show DDIs with hydroxychloroquine in the direction of QT prolongation.Conclusions: We found 11 drugs that show significant (p <0.05) DDIs with hydroxychloroquine, thereby increasing the risk of QT prolongation in patients. It is necessary to consider prescribing alternative drugs that have less DDI when these drugs are concurrently administered with hydroxychloroquine. Further investigation is needed to assess more profoundly the risk of QT prolongation due to DDI with hydroxychloroquine of each drug that we found in this analysis.

scholarly journals Persistent bradycardia after hypoglycaemia: a case report and a brief literature review

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Beatrice Gasperini ◽  
Pierpaolo Lamanna ◽  
Rocco Serra ◽  
Roberto Montanari ◽  
Antonio Cherubini ◽  
...  
Keyword(s):  
Cardiac Arrhythmias ◽  
Qt Interval ◽  
Ventricular Arrhythmias ◽  
Clinical Case ◽  
Sinus Bradycardia ◽  
Qt Prolongation ◽  
Hypoglycaemic Episode ◽  
Supraventricular Arrhythmias ◽  
Interval Prolongation ◽  
Qt Interval Prolongation

Hypoglycaemia can cause cardiac arrhythmias such as QT interval prolongation and ventricular arrhythmias. Supraventricular arrhythmias and sinus bradycardia were rarely reported. We present the clinical case of an 84- year-old man who developed a persistent bradycardia after a hypoglycaemic episode. After restoration of normoglycaemia, bradycardia persisted for almost eighteen hours, without QT prolongation or any symptoms. Hypoglycaemia is an unusual cause of bradyarrhytmias mainly mediated by neurologic and endocrine systems. Our clinical case supports recent recommendations for more relaxed inpatient glycaemic targets in frail older adults who may be particularly vulnerable to hypoglycaemia and its consequences.

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