Qtc Prolongation
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Maria Shirvani ◽  
Babak Sayad ◽  
Lida Shojaei ◽  
Azadeh Amini ◽  
Foroud Shahbazi

Recently, remdesivir was approved by the United States Food and Drug Administration for patients with Coronavirus disease 2019 (COVID-19). We herein describe 3 patients with COVID-19 who showed significant bradycardia and QTc prolongation after remdesivir administration. Bradycardia did not respond to atropine treatment in 2 of the patients, one of whom received theophylline and the other required a temporary pacemaker. Fortunately, the patients’ heart rate and rhythm returned to normal after the discontinuation of remdesivir, albeit it lengthened their hospital stays. Careful monitoring during remdesivir infusion may decrease the risk of adverse cardiovascular side effects.

2021 ◽  
Vol 16 ◽  
Erinn Mangona ◽  
Elisa Sandonato ◽  
Todd N. Brothers ◽  
Jayne Pawasauskas

: Drug-induced QTc prolongation is a concerning electrocardiogram (ECG) abnormality. This cardiac disturbance carries a 10% risk of sudden cardiac death due to the malignant arrhythmia, Torsades de Pointes. The Arizona Center for Education and Research on Therapeutics (AzCERT) has classified QTc prolonging therapeutic classes such as antiarrhythmics, antipsychotics, anti-infectives, and others. AzCERT criteria categorizes medications into three risk categories: “known,” “possible,” and “conditional risk” of QTc prolongation and Torsades de Pointes. The list of QTc prolonging medications continues to expand as new drug classes are approved and studied. Risk factors for QTc prolongation can be delineated into modifiable or non-modifiable. A validated risk scoring tool may be utilized to predict the likelihood of prolongation in patients receiving AzCERT classified medication. The resultant risk score may be applied to a clinical decision support system which offers mitigation strategies. Mitigation strategies including discontinuation of possible offending agents with selection of an alternative agent, assessment of potential drug interactions or dose adjustments through pharmacokinetic and pharmacodynamic monitoring, and initiation of both ECG and electrolyte monitoring are essential to prevent a drug-induced arrhythmia. The challenges presented by the COVID-19 pandemic have led to the development of innovative continuous monitoring technology, increasing protection for both patients and healthcare workers. Early intervention strategies may reduce adverse events and improve clinical outcomes in patients identified to be at risk of QTc prolongation.

Banshi Saboo ◽  
Sujoy Ghosh ◽  
Mangesh Tiwaskar ◽  
Rajeev Chawla

Carrillo Noelle ◽  
Hammerman Susan ◽  
Klemisch Robert ◽  
Shelton Shelby ◽  
Monte Andrew

2021 ◽  
Dan D. Nguyen ◽  
Nazem Akoum ◽  
Jonathan Hourmozdi ◽  
Jordan M. Prutkin ◽  
Melissa Robinson ◽  

Dr Poonam Awatramani ◽  
Dr Rosemary V Busch Conn ◽  
H Mytrang

2021 ◽  
Vol 10 (34) ◽  
pp. 2934-2938
Sanjay Tukaram Thorat ◽  
Parikshit Gajanan Mankar ◽  
Niyati Kaila ◽  
Avanti Jaywant Damle ◽  
Radhika Ratanlal Bajaj ◽  

BACKGROUND The occurrence of QT interval prolongation is higher in subjects with type 2 diabetes mellitus (T2DM). Duration of QT interval corrected (QTc) for heart rate is independently related with severity of cardiovascular diseases in diabetics. This study was proposed to assess the QTc prolongation as a diagnostic tool for cardiovascular disease in T2DM patients. METHODS This study included 100 diabetic patients admitted in wards of a tertiary care center. A thorough clinical examination was carried out for all the patients. Patients were investigated for the fasting blood glucose level, glycated haemoglobin (HbA1c), lipid profile & electrocardiogram (ECG). Data was represented as percentage. Mean and standard deviation (SD) of quantitative variables were tabulated, t test was used for correlation and receiver operating characteristic (ROC) curve was used for evaluating area under curve. P < 0.05 was considered statistically significant. RESULTS Male preponderance was observed. All the study subjects had a prolonged period of diabetes with various metabolic complications. The area under the curve estimation of QTc > 400 ms with respect to HbA1c and duration of diabetes showed significant correlation between longer duration of diabetes and raised HbA1c associated with raised QTc interval (P < 0.05). CONCLUSIONS Diagnosis of prolonged QTc interval could be utilized for estimating cardiovascular risk in diabetes patients. It can be easily assessed on ECG besides being a noninvasive investigation which is also affordable in evaluating the cardiovascular risk in T2DM patients. KEY WORDS Blood Glucose, Cardiovascular Diseases, Electrocardiography, Glycated Haemoglobin A, Long QT Syndrome, Type 2 Diabetes Mellitus

2021 ◽  
Vol 12 ◽  
Haiyan Cao ◽  
Yongjie Zhou ◽  
Tao Li ◽  
Weiliang Yang ◽  
Siying Kong ◽  

Background: The QTc interval may be significantly prolonged in schizophrenia patients taking antipsychotics. Few studies have addressed QTc prolongation (QTP) in Chinese patients.Objectives: This study was designed to evaluate the prevalence of QTP and its clinical correlates in Chinese hospitalized patients with chronic schizophrenia.Methods: A total of 436 inpatients and 291 normal controls matched with age and sex were included. QTc prolongation was defined as 2 standard deviations (SD) above the mean value of normal controls. Positive and Negative Syndrome Scale (PANSS) and its five-factor model were used to evaluate psychopathological symptoms.Results: QTc interval was significantly longer in patients than in normal controls. The prevalence of QTP is 8.26% in Chinese hospitalized patients with chronic schizophrenia. More women than men displayed QTP. Compared with patients without QTP, the patients with QTP had significantly higher concrete/disorganized subscore, lower low density lipoprotein (LDL) and lower total protein (TP). Furthermore, binary logistic regression analysis showed that higher number of hospitalizations, higher concrete/disorganized subscore and lower LDL were risk factors for QTP. Correlation analysis indicated significant association between QTc interval and the following variables: sex, age, duration of illness, the number of hospitalizations, PANSS total score, fasting blood glucose (FPG). Finally, a multiple regression analysis showed that older age, antipsychotic polypharmacy, higher PANSS total score, and lower LDL were risk factors for QTP. Among them, LDL seemed to be a protective factor for QTP.Conclusions: QTc interval was longer in schizophrenia patients than in normal controls. The prevalence of QTP is 8.26% in Chinese hospitalized patients with chronic schizophrenia. Some clinical characteristics were risk factors for QTP. And LDL seemed to be a protective factor for QTP.

Lupus ◽  
2021 ◽  
pp. 096120332110345
Jacinta Renaldi ◽  
Fotios Koumpouras ◽  
Xuemei Dong

Objective Hydroxychloroquine (HCQ) is widely used in patients with systemic lupus erythematosus (SLE) due to its immunomodulatory properties. Antidepressants are commonly used in patients with fibromyalgia syndrome (FMS). Both HCQ and antidepressants are reported to cause QTc prolongation, which potentially increases the risk for a lethal ventricular arrhythmia that can result in sudden death. The objective of the study is to investigate the risk of QTc prolongation associated with HCQ use concomitantly with antidepressants in lupus patients with FMS. Methods Outpatient 12-lead electrocardiograms (ECGs) were extracted from an electronic medical record and QTc intervals were calculated using the Bazett’s formula. QTc intervals in 135 lupus patients treated with HCQ with or without antidepressants were analyzed. Results We found taking HCQ was associated with mild QTc prolongation, and the prolongation was not affected by the length of time of HCQ use or the accumulated dose of HCQ. Concurrent use of HCQ and antidepressants had not further increased QTc intervals in this cohort. However, four patients on HCQ alone and three patients on HCQ and antidepressants were found QTc interval more than 500 milliseconds and most of these patients had underlying cardiological conditions. Conclusions It is important to evaluate lupus patient with ECG before and after starting HCQ, though our study suggests that while HCQ use did prolong the QTc in some, but the overall prolongation was subclinical, with or without antidepressants. ECG monitoring therefore is essential to identify new changes potentially related to drug use.

2021 ◽  
Vol Publish Ahead of Print ◽  
Enrico Baldi ◽  
Roberto Rordorf ◽  
Lucrezia Masiello ◽  
Sabato D’Amore ◽  
Stefano Ghio ◽  

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