QT Interval Prolongation in Patients with Systemic Sclerosis—Are the Holter ECG Recordings a Better Option for QT Interval Evaluation?

Background and Objectives: Cardiac involvement in systemic sclerosis has important consequences on patient survival. Myocardial fibrosis and microcirculation involvement can generate arrhythmic complications, which can be associated with a higher death risk. QT interval prolongation is considered as a risk factor for ectopic ventricular events and can be evaluated using standard short ECG recordings or 24-h Holter ECG recordings. Materials and Methods: 39 patients with systemic sclerosis were submitted to a standard ECG recording at admission and 24-h Holter ECG monitoring. Results: QT interval values resulted from Holter ECG monitoring are higher than the values generated by the short-term ECG recordings. Holter ECG monitoring permits the detection of ventricular ectopy in patients with no events on standard ECG. Conclusions: In patients with systemic sclerosis, 24-h Holter ECG recordings can realize a more precise evaluation of the extent of QTc interval prolongation and ventricular ectopic events associated with myocardial involvement.

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Absence of relevant QT interval prolongation in not critically ill COVID-19 patients

Scientific Reports ◽

10.1038/s41598-020-78360-9 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Juan Jiménez-Jáimez ◽

Rosa Macías-Ruiz ◽

Francisco Bermúdez-Jiménez ◽

Ricardo Rubini-Costa ◽

Jessica Ramírez-Taboada ◽

...

Keyword(s):

Critically Ill ◽

Qt Interval ◽

Treatment Initiation ◽

Qtc Interval ◽

Risk Markers ◽

Interval Prolongation ◽

Qt Interval Prolongation ◽

Qtc Interval Prolongation ◽

Ambulatory Patients ◽

Reported Data

AbstractSARS-CoV-2 is a rapidly evolving pandemic causing great morbimortality. Medical therapy with hydroxicloroquine, azitromycin and protease inhibitors is being empirically used, with reported data of QTc interval prolongation. Our aim is to assess QT interval behaviour in a not critically ill and not monitored cohort of patients. We evaluated admitted and ambulatory patients with COVID-19 patients with 12 lead electrocardiogram at 48 h after treatment initiation. Other clinical and analytical variables were collected. Statistical analysis was performed to assess the magnitude of the QT interval prolongation under treatment and to identify clinical, analytical and electrocardiographic risk markers of QT prolongation independent predictors. We included 219 patients (mean age of 63.6 ± 17.4 years, 48.9% were women and 16.4% were outpatients. The median baseline QTc was 416 ms (IQR 404–433), and after treatment QTc was prolonged to 423 ms (405–438) (P < 0.001), with an average increase of 1.8%. Most of the patients presented a normal QTc under treatment, with only 31 cases (14.1%) showing a QTc interval > 460 ms, and just one case with QTc > 500 ms. Advanced age, longer QTc basal at the basal ECG and lower potassium levels were independent predictors of QTc interval prolongation. Ambulatory and not critically ill patients with COVID-19 treated with hydroxychloroquine, azithromycin and/or antiretrovirals develop a significant, but not relevant, QT interval prolongation.

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Corrected QT interval prolongation during anesthetic induction for laryngeal mask airway insertion with or without cisatracurium

Journal of International Medical Research ◽

10.1177/0300060518764185 ◽

2018 ◽

Vol 46 (5) ◽

pp. 1990-2000 ◽

Cited By ~ 3

Author(s):

Chengluan Xuan ◽

Nan Wu ◽

Yanhui Li ◽

Xiaoting Sun ◽

Qunshu Zhang ◽

...

Keyword(s):

Laryngeal Mask Airway ◽

Operating Room ◽

Qt Interval ◽

Laryngeal Mask ◽

Laryngeal Mask Airway Insertion ◽

Qtc Interval ◽

Interval Prolongation ◽

Anesthetic Induction ◽

Qt Interval Prolongation ◽

Qtc Interval Prolongation

Objective This study was performed to observe the occurrence of corrected QT (QTc) interval prolongation during anesthetic induction for laryngeal mask airway insertion and the effects of cisatracurium administration on the QTc interval. Methods Eighty-eight patients were assigned to two groups: the cisatracurium administration group (n = 45) and non-cisatracurium administration group (n = 43). The QTc interval was continuously recorded by a 12-lead Holter electrocardiogram beginning in the hospital ward and continuing until after anesthetic induction. Results In the cisatracurium administration group, the QTc interval significantly increased from 417.9 ± 27.9 to 451.6 ± 32.5 ms after arrival in the operating room and significantly decreased to 432.4 ± 32.5 ms after a 15-minute rest; it significantly increased to 459.7 ± 23.8 ms again after propofol and fentanyl injection. However, the QTc interval decreased after cisatracurium injection. In the non-cisatracurium administration group, the QTc interval initially showed changes similar to those in the cisatracurium group until fentanyl and propofol were injected. Conclusions The QTc interval was significantly prolonged on arrival in the operating room and after propofol and fentanyl injection. The QTc interval did not significantly change by laryngeal mask airway insertion regardless of the administration of cisatracurium.

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Monitoring of QTc interval in patients with COVID-19. First experience with a portable EKG-recording device

EP Europace ◽

10.1093/europace/euab116.516 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

M Abellas Sequeiros ◽

C Lozano Granero ◽

C Garcia Sebastian ◽

E Franco Diez ◽

A Hernandez Madrid ◽

...

Keyword(s):

Qt Interval ◽

Intraclass Correlation ◽

Early Discharge ◽

Recording Device ◽

Qtc Interval ◽

Interval Prolongation ◽

Daily Monitoring ◽

Qt Interval Prolongation ◽

Qtc Interval Prolongation ◽

Group 2

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Off-label use of drugs with potential for QT interval prolongation was common in COVID-19 patients. We tested a portable EKG recording device to measure and monitor corrected QT (QTc) intervals in a cohort of COVID-19 patients treated with azithromycin, hydroxychloroquine, lopinavir/ritonavir, or combinations of these drugs. Methods and results Sixty-nine patients hospitalized with pneumonia and confirmed SARS-CoV 2 infection were included in an observational single-centre study. Six-lead EKG recordings were obtained using a KardiaMobile6L® at physicians’ discretion. In a subgroup of 16 patients with early discharge, a device was provided for at-home daily monitoring. Significant QTc interval prolongation was observed in patients taking a combination of 2 or 3 drugs (426 ± 33 vs 408 ± 33 ms, p = 0,002; and 435 ± 30 vs 394 ± 31 ms, p = 0,001, respectively). The use of the device prompted a change in the treatment of 9 patients (13%) because of prolongation of QTc interval and anticoagulation was started in one patient because of atrial fibrillation diagnosis. In the subgroup of patients with daily recording, QTc interval prolongation peaked at day 2 ± 1,8, with a shorter final QT interval than that recorded before drug initiation (350,0 ± 31,4 vs 381,0 ± 21,2; p = 0,019), pointing to a possible role of the disease itself in QT interval modification. To assess the consistency of measurements of QTc interval, a random sample of 120 EKG recordings were analyzed by two different physicians. Inter-operator intraclass correlation coefficient was 0,702, 95% CI (0,578-0,789). Conclusions Portable EKG-recording device was useful for QTc interval monitoring in COVID-19 patients receiving drugs with QTc prolonging potential, allowing physicians to adapt management. Significant QT prolongation was observed in these patients. Characteristics of the three groups.Group 1(one drug)N= 9 (13,0%)Group 2(two drugs)N= 37 (53,6%)Group 3(three drugs)N= 23 (33,3%)p-valueClinical characteristicsAge (years)55,0 ± 18,366,0 ± 16,258,0 ± 15,8p = 0,248Male sex (%)6 (66,7%)25 (67,6%)18 (78,3%)p = 0,643Dislipidaemia (%)5 (55,6%)9 (24,3%)7 (30,4%)p = 0,749Diabetes (%)7 (77,8%)4 (10,8%)5 (21,7%)p = 0,525Hypertension (%)3 (33,3%)16 (43,2%)8 (34,8%)p = 0,387Previous cardiopathy (%)6 (66,7%)11 (29,7%)3 (13,0%)p = 0,305COPD (%)7 (77,8%)6 (16,2%)1 (8,7%)p = 0,679COPDchronic obstructive pulmonary disease.Abstract Figure. Baseline and maximum QTc intervals

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SSRIs and QT interval prolongation management. A review

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1393 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S750-S750

Author(s):

A. Ballesteros ◽

H. Saiz ◽

Á.S. Rosero ◽

A. Portilla ◽

L. Montes ◽

...

Keyword(s):

Risk Factors ◽

Qt Interval ◽

Future Research ◽

Current Debate ◽

Qtc Interval ◽

Interval Prolongation ◽

Drug Induced ◽

Cross Sectional ◽

Qt Interval Prolongation ◽

Qtc Interval Prolongation

IntroductionIn 2011, the FDA issued an alert recommending not to prescribe citalopram high doses, due to QT prolongation risk. We explored the clinical background of QT interval prolongation related to serotonin selective reuptake inhibitors (SSRI) use and the clinical implications of safety issues.MethodologyA review was conducted to clarify the mechanisms associated with the occurrence of TdP when using SSRI and investigating therapeutic measures to avoid/minimize these effects. The literature search was conducted in PubMed data reviewing articles between 2001 and 2016.Results(1) Related to risk factors/intraclass differences: risk factors are increase in QTc interval ≥60 ms from the pretreatment value, advanced age, female sex, acute myocardial infarction and electrolytic abnormalities among others. Citalopram appears more likely than others to induce this phenomenon but its importance is under current debate. (2) Related to dose: drug-induced QTc interval prolongation and TdP was associated to citalopram in doses > 40 mg/day. However, psychotropic drug-induced sudden cardiac death may be an outlier in the absence of identified risk factors for QTc interval prolongation and TdP. (3) Related to poly-pharmacy/management: there is an additive effect when using SSRI and antipsychotics (EKG control is recommended in those cases). Cross-sectional studies showed that SSRI use was not associated with QT interval prolongation. This could be explained by the EKG intra-intersubject variability.ConclusionsThere is little evidence that drug-associated QTc interval prolongation by itself is sufficient to predict TdP. Future research needs to improve its precision to better understand the factors that facilitate/attenuate that progression. Clarifying this may lead to a safer SSRI use.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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QTc Prolongation Associated with Combination Therapy of Levofloxacin, Imipramine, and Fluoxetine

Annals of Pharmacotherapy ◽

10.1345/aph.1e513 ◽

2005 ◽

Vol 39 (3) ◽

pp. 543-546 ◽

Cited By ~ 31

Author(s):

Diane L Nykamp ◽

Casey L Blackmon ◽

Paul E Schmidt ◽

Andrea G Roberson

Keyword(s):

Combination Therapy ◽

Qt Interval ◽

Case Reports ◽

Plasma Concentrations ◽

Care Physician ◽

White Female ◽

Qtc Interval ◽

Interval Prolongation ◽

Qt Interval Prolongation ◽

Qtc Interval Prolongation

OBJECTIVE: To report QTc interval prolongation associated with combination therapy including levofloxacin, imipramine, and fluoxetine. CASE SUMMARY: A 49-year-old white female presented to the emergency department with fever, aches, and pains for the past 3 days. She was diagnosed and treated for pyelonephritis in the hospital. Therapy included intravenous levofloxacin 500 mg every 24 hours and ceftriaxone 2 g every 24 hours, along with her medications upon admission, including imipramine 50 mg at bedtime and fluoxetine 10 mg/day. She was discharged after 5 days and returned the next day with chest tightness and shortness of breath. Upon the second admission, a 12-lead electrocardiogram showed a QTc interval of 509 msec. Levofloxacin was discontinued and the QTc interval fell to 403 msec. The patient was discharged 3 days later and instructed to consult with her primary care physician about discontinuing imipramine. DISCUSSION: This adverse drug reaction is thought to be a pharmacodynamic additive effect among fluoxetine, imipramine, and levofloxacin. Fluoxetine is a potent inhibitor of CYP2D6, and imipramine is metabolized by CYP2D6. Therefore, fluoxetine is able to increase the plasma concentrations of imipramine, leading to QT interval prolongation. Taken with imipramine, levofloxacin can lead to even greater prolongation of the QT interval. Based on the Naranjo probability scale, levofloxacin was possibly associated with cardiac arrhythmias in our patient. CONCLUSIONS: The use of levofloxacin alone, or more often in concomitant therapy with other medications that are known to prolong the QT interval, may cause QT interval prolongation; however, additional studies/case reports are needed to validate this conclusion.

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Absence of relevant QT interval prolongation in not critically ill COVID-19 patients.

10.1101/2020.08.18.20177717 ◽

2020 ◽

Cited By ~ 1

Author(s):

Juan J Jaimez ◽

Rosa Macias ◽

Francisco Bermudez ◽

Ricardo Rubini ◽

Miguel Alvarez ◽

...

Keyword(s):

Critically Ill ◽

Qt Interval ◽

Treatment Initiation ◽

Qtc Interval ◽

Risk Markers ◽

Interval Prolongation ◽

Qt Interval Prolongation ◽

Qtc Interval Prolongation ◽

Ambulatory Patients ◽

Reported Data

Objectives. SARS-CoV-2 is a rapidly evolving pandemic causing great morbimortality. Medical therapy with hydroxicloroquine, azitromycin and protease inhibitors is being empirically used, with reported data of QTc interval prolongation. Our aim is to assess QT interval behaviour in a not critically ill and not monitored cohort of patients. Design. We evaluated admitted and ambulatory patients with COVID-19 patients with 12 lead electrocardiogram at 48 hours after treatment initiation. Other clinical and analytical variables were collected. Statistical analysis was performed to assess the magnitude of the QT interval prolongation under treatment and to identify clinical, analytical and electrocardiographic risk markers of QT prolongation independent predictors. Results. We included 219 patients (mean age of 63.6 +/- 17.4 years, 48.9% were women and 16.4% were outpatients. The median baseline QTc was 416 ms (IQR 404-433), and after treatment QTc was prolonged to 423 ms (405-438) (P < 0.001), with an average increase of 1.8%. Most of the patients presented a normal QTc under treatment, with only 31 cases (14,1 %) showing a QTc interval > 460 ms, and just one case with QTc > 500 ms. Advanced age, longer QTc basal at the basal ECG and lower potassium levels were independent predictors of QTc interval prolongation. Conclusions. Ambulatory and not critically ill patients with COVID-19 treated with hydroxychloroquine, azithromycin and/or antiretrovirals develop a significant, but not relevant, QT interval prolongation.

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QTc interval prolongation in systemic sclerosis: Correlations with clinical variables

International Journal of Cardiology ◽

10.1016/j.ijcard.2014.12.069 ◽

2015 ◽

Vol 182 ◽

pp. 20-22 ◽

Cited By ~ 7

Author(s):

E. Rosato ◽

A. Gigante ◽

M. Liberatori ◽

M.L. Gasperini ◽

L. Sardo ◽

...

Keyword(s):

Systemic Sclerosis ◽

Qtc Interval ◽

Interval Prolongation ◽

Clinical Variables ◽

Qtc Interval Prolongation

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Measurement of the QT interval and the risk associated with QTc interval prolongation: A review

The American Journal of Cardiology ◽

10.1016/0002-9149(93)90036-c ◽

1993 ◽

Vol 72 (6) ◽

pp. B23-B25 ◽

Cited By ~ 311

Author(s):

Arthur J. Moss

Keyword(s):

Qt Interval ◽

Qtc Interval ◽

Interval Prolongation ◽

Qtc Interval Prolongation

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Domperidone-Associated QT Interval Prolongation in Non-oncologic Pediatric Patients: A Review of the Literature

The Canadian Journal of Hospital Pharmacy ◽

10.4212/cjhp.v69i3.1560 ◽

2016 ◽

Vol 69 (3) ◽

Cited By ~ 2

Author(s):

Amy D Morris ◽

Jennifer Chen ◽

Elaine Lau ◽

Jennifer Poh

Keyword(s):

Qt Interval ◽

Cardiac Death ◽

Pediatric Patients ◽

Heart Diseases ◽

Torsades De Pointes ◽

Qtc Interval ◽

Interval Prolongation ◽

Medical Subject Headings ◽

Qt Interval Prolongation ◽

Mort Subite

ABSTRACTBackground: Domperidone is a prokinetic agent used to treat pediatric gastroesophageal reflux disease. Health Canada has issued warnings about an increased risk of domperidone-associated ventricular arrhythmias and sudden cardiac death. However, the supporting data referred only to adult patients; therefore, extrapolating the safety risks to pediatric patients is difficult.Objective: To summarize and evaluate the evidence for domperidone associated QT interval prolongation, ventricular arrhythmias, and sudden cardiac death to determine the safety of this drug for pediatric patients.Data Sources: Two databases (MEDLINE [1946 to August 2015] and Embase [1980 to August 2015]) were searched with the following Medical Subject Headings and keywords: “domperidone”, “arrhythmias, cardiac”, “death, sudden, cardiac”, “electrocardiography”, “heart diseases”, “long QT syndrome”, “tachycardia, ventricular”, “torsades de pointes”, and “ventricular fibrillation”. The search was limited to studies conducted in humans under 18 years of age and published in English.Study Selection and Data Extraction: Original research included in this review reported on the cardiac-related safety of domperidone in nononcologic patients under 18 years of age.Data Synthesis: Of the 5 studies meeting the inclusion criteria (n = 137 patients), one reported a statistically significant change in the corrected QT (QTc) interval, but the clinical significance was unclear. Most of the studies reported rare occurrences of pathological QTc intervals in a limited number of patients. However, confounding factors (e.g., abnormal electrolyte level or concurrent medications) were not consistently considered. Potential bias might have been alleviated by blinding of electrocardiogram (ECG) assessors; however, this was not consistently implemented. The designs of the included studies did not allow assessment of causality. The results should be interpreted with caution.Conclusions: Although the available evidence is limited, pathological QTc intervals were noted among a small number of infants, which supports the possibility of domperidone-associated risk of prolonged QTc interval. Because of the potential severity of QT interval prolongation, individual assessment and routine ECG monitoring should be implemented for patients receiving domperidone.RÉSUMÉContexte : La dompéridone est un agent gastroprocinétique utilisé pour traiter le reflux gastro-oesophagien chez l’enfant. Santé Canada a publié des mises en garde à propos d’un risque accru d’arythmies ventriculaires et de mort subite cardiaque associées à la dompéridone. Or, comme les données probantes ne concernent que l’adulte, il est difficile de généraliser les risques pour la santé à l’enfant.Objectif : Résumer et analyser les données probantes portant sur l’allongement de l’intervalle QT, les arythmies ventriculaires et la mort subite cardiaque associés à la dompéridone afin de déterminer le degré d’innocuité du médicament chez l’enfant.Sources des données : Deux bases de données (MEDLINE [1946 à août 2015] et EMBASE [1980 à août 2015]) ont été interrogées en utilisant les mots clés et les Medical Subject Headings (MeSH) suivants : « domperidone » dompéridone), « arrhythmias, cardiac » (arythmies cardiaques), « death, sudden, cardiac » (mort, subite, cardiaque),« electrocardiography » (électrocardiographie), « heart diseases » (cardiopathies), « long QT syndrome » (syndrome du QT long), « tachycardia, ventricular » (tachycardie, ventriculaire), « torsades de pointes » (torsades de pointes) et « ventricular fibrillation » (fibrillation ventriculaire). La recherche se limitait aux études publiées en anglais et effectuées chez l’humain de moins de 18 ans.Sélection des études et extraction des données : Les études retenues dans la présente revue abordaient l’innocuité cardiaque de la dompéridone chez les patients de moins de 18 ans qui ne sont pas atteints d’un cancer.Synthèse des données : Parmi les cinq études qui répondaient aux critères d’inclusion (n = 137 patients), une indiquait un changement statistiquement significatif dans l’intervalle QT corrigé (QTc), mais la signification clinique demeurait floue. La plupart des études signalaient de rares cas d’intervalles QTc pathologiques chez un nombre limité de patients. Cependant, des facteurs de confusion (déséquilibre électrolytique ou emploi concomitant de médicaments, par exemple) n’étaient pas systématiquement pris en compte. Il aurait été possible d’éviter de potentiels biais en tenant les lecteurs d’électrocardiogramme (ECG) dans l’ignorance du traitement, mais cette mesure n’était pas toujours mise en oeuvre. Les plans des études retenues ne permettaient pas d’évaluer la causalité. Il faut donc interpréter les résultats avec prudence.Conclusions : Bien qu’il n’y ait que peu de données probantes, des cas d’intervalles QTc pathologiques ont été relevés chez un petit nombre de nourrissons, ce qui vient appuyer le risque possible d’allongement de l’intervalle QTc associé à la dompéridone. À cause de la potentielle gravité de l’allongement de l’intervalle QT, une évaluation individuelle et une surveillance ECG systématique doit être mise en place pour les patients qui reçoivent de la dompéridone.

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Droperidol and Ondansetron-induced QT Interval Prolongation

Anesthesiology ◽

10.1097/aln.0b013e31817fd8c8 ◽

2008 ◽

Vol 109 (2) ◽

pp. 206-212 ◽

Cited By ~ 80

Author(s):

Beny Charbit ◽

Jean Claude Alvarez ◽

Eric Dasque ◽

Emuri Abe ◽

Jean Louis Démolis ◽

...

Keyword(s):

Qt Interval ◽

Plasma Concentrations ◽

Postoperative Nausea And Vomiting ◽

Pharmacokinetic Interaction ◽

Controlled Study ◽

Qtc Interval ◽

Interval Prolongation ◽

Double Blind ◽

Qt Interval Prolongation ◽

Controlled Conditions

Background Droperidol and ondansetron have previously been found to prolong the QT interval in the treatment of postoperative nausea and vomiting. However, this adverse effect has never been confirmed and compared with both drugs under controlled conditions. The objective was to study the effects of droperidol and ondansetron alone or in combination on QT interval duration in healthy subjects. Methods Sixteen healthy volunteers, eight males and eight females, were enrolled in this prospective, double-blind, randomized, placebo-controlled study. Subjects received 1 mg droperidol, 4 mg ondansetron, 1 mg droperidol plus 4 mg ondansetron, or a placebo, intravenously in a crossover design. Fridericia-corrected QT interval (QTcF) and plasma concentrations were measured repeatedly during 10 h at each study period. The primary endpoint was the maximal placebo time-matched and baseline-subtracted QTcF prolongation (DeltaDeltaQTcF). Results Compared with placebo, both droperidol and ondansetron significantly prolonged the QTcF interval. DeltaDeltaQTcF prolongation was 25 +/- 8 ms after droperidol, significantly greater than the 17 +/- 10-ms prolongation with ondansetron (P = 0.014). The combination of droperidol and ondansetron significantly increased the mean maximal DeltaDeltaQTcF by 28 +/- 10 ms. The combination induced greater QTcF prolongation compared with ondansetron alone (P = 0.001), but not with droperidol alone (P = 0.33). There was no significant pharmacokinetic interaction between droperidol and ondansetron. Conclusions Under controlled conditions, both droperidol and ondansetron either alone or in combination induced significant marked QTc interval prolongation. However, the combination of both drugs did not significantly increase QTc prolongation compared with that induced by droperidol alone.

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