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.

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 .

QT INTERVAL IN TEMPORAL LOBE EPILEPSY VERSUS NON TEMPORAL LOBE EPILEPSY

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed A Gaber ◽  
Yousry A Abdelhamed ◽  
Mona M Wahid Eldin ◽  
Islam M Bastawy ◽  
Maram S Nasef
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Qt Interval ◽  
Case Series ◽  
Electrode Placement ◽  
Interval Prolongation ◽  
Temporal Epilepsy ◽  
Qt Interval Prolongation ◽  
Significant Prolongation ◽  
Significant Difference

Abstract Introduction Background SUDEP is leading cause of mortality in patients with chronic refractory epilepsy. Despite several epidemiological studies, case series , monitored and witnessed SUDEP the exact mechanism is not proposed Objective This work was carried out to assess QT interval prolongation in epilepsy and whether there’s a difference in QT interval prolongation between temporal epilepsy and non-temporal epilepsy. Patients and methods This study was conducted on 100 patients, 50 aged and sex matched healthy controls who underwent a prolonged (6 to 24 hours) 22 channel computerized EEG monitor with 10-20 system electrode placement and 12 lead electrocardiogram (25 millisecond speed). QT, QTd and QTc using Bazzet’s formulae were calculated. Results The results showed statistically significant difference prolongation of QT interval in epilepsy particularly temporal lobe epilepsy. Conclusion Significant prolongation of QT interval in epilepsy patients (11% suffered pathological prolonged QT). Marked prolongation of QTc and QTd in temporal lobe epilepsy over non temporal group.

scholarly journals 1148-222 Pheochromocytomas and QT interval prolongation: A case series of 50 patients

2004 ◽  
Vol 43 (5) ◽  
pp. A141 ◽  
Author(s):  
Patrick T Fitzgerald ◽  
William F Young ◽  
Michael J Ackerman
Keyword(s):  
Qt Interval ◽  
Case Series ◽  
Interval Prolongation ◽  
Qt Interval Prolongation

scholarly journals Neuroendocrine Tumor, Well Differentiated, of the Breast: A Relatively High-Grade Case in the Histological Subtype

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Shogo Tajima ◽  
Hajime Horiuchi
Keyword(s):  
Neuroendocrine Tumor ◽  
Neuron Specific Enolase ◽  
Left Breast ◽  
World Health ◽  
Routine Practice ◽  
High Grade ◽  
Well Differentiated ◽  
Health Organization ◽  
Almost All ◽  
Neuroendocrine Carcinomas

Primary neuroendocrine carcinoma of the breast is a rare entity, comprising <1% of breast carcinomas. Described here is the case of a 78-year-old woman who developed an invasive tumor in the left breast measuring 2.0 cm x 1.5 cm x 1.2 cm. The tumor was composed of only endocrine elements in the invasive part. It infiltrated in a nested fashion with no tubular formation. Intraductal components were present both inside and outside of the invasive portion. Almost all carcinoma cells consisting of invasive and intraductal parts were positive for synaptophysin and neuron-specific enolase. According to the World Health Organization classification 2012, this tumor was subclassified as neuroendocrine tumor, well-differentiated. Among the subgroup, this tumor was relatively high-grade because it was grade 3 tumor with a few mitotic figures. Vascular and lymphatic permeation and lymph node metastases were noted. In the lymph nodes, the morphology of the tumor was similar to the primary site. No distant metastasis and no relapse was seen for one year after surgery. The prognosis of neuroendocrine carcinomas is thought to be worse than invasive mammary carcinomas, not otherwise specified. Therefore, immunohistochemistry for neuroendocrine markers is important in the routine practice to prevent overlooking neuroendocrine carcinomas.

The pre-clinical assessment of QT interval prolongation: a comparison of in vitro and in vivo methods

1998 ◽  
Vol 17 (12) ◽  
pp. 677-680 ◽  
Author(s):  
A Stewart Davis
Keyword(s):  
Clinical Assessment ◽  
Action Potential Duration ◽  
Qt Interval ◽  
Qt Prolongation ◽  
New Drugs ◽  
Interval Prolongation ◽  
In Vitro Methods ◽  
Qt Interval Prolongation

The literature was searched for in vivo dog studies reporting QT prolongation and in vitro studies reporting increased myocardial action potential duration, which indicates the potential to prolong QT interval, for nine non-cardiac drugs that have been reported to produce QT prolongation in man. The drugs were: astemizole; terfenadine; erythromycin; sparfloxacin; cisapride; probucol; terodiline; risperidone and sertindole. 1 There were reports of the appropriate finding with in vitro methods for six of the drugs and with in vivo methods for seven of the drugs. No reports were found concerning the remaining drugs with each method. This indicates that both methods are effective and each method would have correctly identified the drugs in question as having the potential to prolong the QT interval in man in all cases for which studies were reported. 2 This suggests that, if properly conducted, either method alone is sufficient for the pre-clinical assessment of QT interval prolongation. This does not support the routine use of both methods before the administration of new drugs to man.

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 Experience with Hydroxychloroquine and Azithromycin in the COVID-19 Pandemic: Implications for QT Interval Monitoring

2020 ◽  
Author(s):  
Archana Ramireddy ◽  
Harpriya Chugh ◽  
Kyndaron Reinier ◽  
Joseph Ebinger ◽  
Eunice Park ◽  
...  
Keyword(s):  
Qt Interval ◽  
Case Series ◽  
Torsades De Pointes ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Qtc Prolongation ◽  
Qt Interval Prolongation ◽  
Significant Prolongation ◽  
Risk Indices ◽  
Increase Risk

ABSTRACTBackgroundDespite a paucity of clinical evidence, hydroxychloroquine and azithromycin are being administered widely to patients with verified or suspected COVID-19. Both drugs may increase risk of lethal arrhythmias associated with QT interval prolongation.MethodsWe performed a case series of COVID-19 positive/suspected patients admitted between 2/1/2020 and 4/4/2020 who were treated with azithromycin, hydroxychloroquine or a combination. We evaluated baseline and post-medication QT interval (QTc, Bazett’s) using 12-lead ECGs. Critical QTc prolongation was defined as: a) maximum QTc ≥500 ms (if QRS <120 ms) or QTc ≥550 (if QRS ≥120 ms) and b) increased QTc of ≥60 ms. Tisdale score and Elixhauser comorbidity index were calculated.ResultsOf 490 COVID-19 positive/suspected patients, 314 (64%) received either/both drugs, and 98 (73 COVID-19 positive, 25 suspected) met study criteria (age 62±17 yrs, 61% male). Azithromycin was prescribed in 28%, hydroxychloroquine in 10%, and both in 62%. Baseline mean QTc was 448±29 ms and increased to 459±36ms (p=0.005) with medications. Significant prolongation was observed only in men (18±43 ms vs -0.2±28 ms in women, p=0.02). 12% of patients reached critical QTc prolongation. In a multivariable logistic regression, age, sex, Tisdale score, Elixhauser score, and baseline QTc were not associated with critical QTc prolongation (p>0.14). Changes in QTc were highest with the combination compared to either drug, with many-fold greater prolongation with the combination vs. azithromycin alone (17±39 vs. 0.5±40 ms, p=0.07). No patients manifested torsades de pointes.ConclusionsOverall, 12% of patients manifested critical QTc interval prolongation, and traditional risk indices failed to flag these patients. With the drug combination, QTc prolongation was several-fold higher compared to azithromycin alone. The balance between uncertain benefit and potential risk when treating COVID-19 patients with these drugs should be carefully assessed prior to use.

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.

scholarly journals Сardiotoxicity of chloroquine and hydroxychloroquine in the treatment of COVID-19 infection

2020 ◽  
Vol 22 (10) ◽  
pp. 15-21
Author(s):  
Marina V. Leonova ◽  
◽  
◽  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Ventricular Arrhythmia ◽  
Qt Interval ◽  
Torsade De Pointes ◽  
Connective Tissue Diseases ◽  
World Health ◽  
Interval Prolongation ◽  
Qt Interval Prolongation ◽  
Increased Risk

The cardiotoxicity of aminoquinolines presents as QT interval prolongation and life-threatening ventricular arrhythmia, torsade de pointes (TdP). A scientific re-view of studies and meta-analyzes on the rate and risk of cardiotoxicity of aminoquinolines (chloroquine and hydroxychloroquine) is presented. The mechanism of development of QT syndrome during the use of aminoquinolines is associated with inhibition of the hERG gene open potassium channels 1A and 1A/1B, which are involved in the repolarization process, as well as inhibition of potassium, calcium and If-channels of the heart, which leads to an impaired conduction and bradycardia. In 3 systematic review of data (1962–2018) of analysis of cardiotoxic side effects of chloroquine, hydroxychloroquine, mefloquine in the treat-ment of malaria and connective tissue diseases, isolated cases of death due to QT interval prolongation/TdP arrhythmia were revealed, however, data on the rate of detecting QT interval prolongation was not enough. In the face of the COVID-19 novel coronavirus pandemic emergency, aminoquinolines are being re-purposed by the Food and Drug Administration – FDA (repurposing) to treat severe acute respiratory syndrome in hospitalized patients. Chloroquine and hy-droxychloroquine were intended to be administered in short courses with QT monitoring. However, the first data of clinical trials have revealed an increased risk for hospital mortality in patients with COVID-19. In the first systematic review of studies in COVID-19 (14 clinical trials, n=1515), a clinically significant QT interval prolongation (QT≥500 ms or change of more than 60 ms) in 10% of patients receiving chloroquine/hydroxychloroquine, and isolated cases of fatal arrhythmia was revealed. Subsequent studies showed that the incidence of QT interval prolongation during the use of chloroquine/hydroxychloroquine ranges from 10 to 23%, with isolated cases of ventricular arrhythmia TdP, but there is a significant increase in mortality (relative risk – RR 1.3–1.50) and sudden cardiac arrest (RR 1.91), especially in combination with azithromycin (RR>2.0). The FDA and the World Health Organization have limited the use of drugs for COVID-19. Perspectives for further treatment of COVID-19 infection are associated with remdesivir and favipiravir.

Sign in / Sign up

Export Citation Format

Share Document