CLINICAL SIGNIFICANCE OF DRUGINDUCED INTERVALS QT AND QTC PROLONGATION
https://doi.org/10.20996/1819-6446-2013-9-3-311-315
Abstract
Interval QT 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.
About the Authors
N. V. Furman
Saratov Research Institute of Cardiology, Saratov
Russian Federation
Russian Federation
S. S. Shmatova
Saratov Research Institute of Cardiology, Saratov
Russian Federation
Russian Federation
References
1. Rautaharju P.M., Surawicz B., Gettes L.S. AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram Part IV: The ST Segment, T and U Waves, and the QT Interval A Scientific Statement From the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Circulation 2009;119:e241–e250
2. Al-Khatib S.M., LaPointe N.M.K., Kramer J.M. What clinicians should know about the QT interval. JAMA2003;289(4): 2120–7.
3. Hannibal G.B. Hasanien A.A., Pickham D. ECG Challenges: Measurement and Rate Correction of the QT Interval. AACN Advanced Critical Care 2013;24(1):90–6.
4. Algra A., Tijssen J.G., Roelandt J.R. et al QTc prolongation measured by standard 12-lead electrocardiography is an independent risk factor for sudden death due to cardiac arrest. Circulation 1991;83:1888–94.
5. Straus S.M., Kors J.A., De Bruin M.L. et al Prolonged QTc interval and risk of sudden cardiac death in a population of older adults. J Am Coll Cardiol 2006;47:362–7.
6. Chugh S.S., Reinier K., Singh T. Determinants of Prolonged QT Interval and Their Contribution to Sudden Death Risk in Coronary Artery Disease The Oregon Sudden Unexpected Death Study. Circulation 2009;119:663–70.
7. van Noord C., Eijgelsheim M., Stricker B.H.Ch. Drug- and non-drug-associated QT interval prolongation. British Journal of Clinical Pharmacology 2010;70 (1):16–23.
8. Liew R. Electrocardiogram-Based Predictors of Sudden Cardiac Death in Patients With Coronary Artery Disease. Clin. Cardiol. 2011;34(8):466–73.
9. Zhang Y., Post W.S., Blasco-Colmenares E. et al Electrocardiographic QT interval and mortality: a metaanalysis. Epidemiology 2011;22(5):660–70.
10. Zhang Y., Post W.S., Dalal D. et al QT-Interval Duration and Mortality Rate. Results From the Third National Health and Nutrition Examination Survey. Arch Intern Med 2011;171(19):1727–33.
11. Williams E.S.В., Thomas K.L.В., Broderick S.В. et al. Race and gender variation in the QT interval and its association with mortality in patients with coronary artery disease: Results from the Duke Data- bank for Cardiovascular Disease (DDCD). Am Heart J 2012;164(3):434–41.
12. Sauer A.J., Newton-Cheh C. Clinical and Genetic Determinants of Torsade de Pointes Risk Circulation 2012;125:1684–94.
13. Yan G.X., Lankipalli R.S., Burke J.F. et al Ventricular repolarization components on the electrocardiogram. Cellular basis and clinical significance. J Am Coll Cardiol 2001;42:401–9.
14. Zareba W., Moss A.J., La Cessie S. Dispersion of ventricular repolarization and arrhythmic cardiac death in coronary artery disease. Am J Cardiol 1994;74:550–3.
15. Doschitsin VL. Clinical analysis of electrocardiograms. Moscow: Medicine; 1982. Russian (Дощицин В.Л. Клинический анализ электрокардиограммы. М: Медицина, 1982).
16. Sagie A., Larson M.G., Goldberg R.J. et al An improved method for adjusting the QT interval for heart rate (the Framingham Heart Study). Am J Cardiol 1992;70:797–801.
17. Fridericia L.S. The duration of systole in an electrocardiogram in normal humans and in patients with heart disease. Ann Noninvasive Electrocardiol 2003;8:343–51.
18. Meier P., Gloekler1 S., de Marchi S.F. An indicator of sudden cardiac death during brief coronary occlusion: electrocardiogram QT time and the role of collaterals. Eur Heart J 2010; 31:1197–204.
19. Nachimuthu S., Assar M. D., Schussler J.M. Drug-induced QT Interval Prolongation Mechanisms and Clinical Management. Ther Adv Drug Safe 2012;5(3):241–53.
20. Makarov L.M., Chuprova S.N., Kiseleva I.I. Comparison of methods for measuring the QT interval and their clinical significance. Cardiology 2004;(5):71–3. Russian (Макаров Л.М., Чупрова С.Н., Киселева И.И. Сравнение способов измерения интервала Q–T и их клиническое значение. Кардиология 2004;(5):71–73)
21. Chan A., Isbister G., Kirkpatrick C., Dufful S. Drug-induced QT prolongation and torsades de pointes: evaluation of a QT nomogram. QJM 2007;100:609–15.
22. Higham P.D., Furniss S.S., Campbell R.W.F. Q–T dispersion and components of the Q–T interval in ischemia and infarction. Br Heart J 1995;73:32–6.
23. Moss A.J. Measurement of the Q–T interval and the risk associated with Q–Tc interval prolongation: a review. Am J Cardiol 1993;72:23B–25B.
24. Makarov L.M. Features of the dynamics and the measurement of the QT interval in Holter monitoring. Cardiology 2002;(1):98–102. Russian (Макаров Л.М. Особенности динамики и измерения интервала Q–T при холтеровском мониторировании. Кардиология 2002;(1):98–102)
25. Merri M., Moss A., Benhorin J. et al. Relation between ventricular repolarisation duration and cardiac cycle length during 24-hour Holter recordings: findings in normal patients and patients with long QT syndrome. Circulation 1992;84:1816–21.
26. Panikkath R., Reinier K., Uy-Evanado A. Prolonged Tpeak-to-Tend Interval on the Resting ECG Is Associated With Increased Risk of Sudden Cardiac Death. Circ Arrhythm Electrophysiol 2011;4:441– 7.
27. Kuszakowski M.S. Cardiac arrhythmias. St. Petersburg: IKF Foliant; 1998. Russian (Кушаковский М.С. Аритмии сердца. СПб.: ИКФ Фолиант; 1998).
28. Shkol'nikova M.A., editor. Long QT interval syndrome. Moscow: Medpractika; 2001. Russian (Школьникова М.А., редактор. Синдром удлиненного интервала Q–T. М.:Медпрактика; 2001).
29. Vatutin N.T., Sklyanov E.V., Gritsenko P.V. Long QT syndrome. Cardiology 2002;(9):83–9. Russian (Ватутин Н.Т., Склянная Е.В., Гриценко П.В. Синдром удлиненного интервала QT. Кардиология 2002;(9):83–9).
30. Antzelevitch C. Cellular basis for the repolarization waves of the ECG. Ann N Y Acad Sci 2006;1080:268–81.
31. Butaev T.D., Treshkur T.V., Ovechkin M.A. et al. Congenital and acquired long QT syndrome. St. Petersburg: INKART; 2002. Russian (Бутаев Т.Д,. Трешкур Т.В. Овечкина М.А. и др. Врожденный и приобретенный синдром удлиненного интервала QT. СПб.: ИНКАРТ; 2002).
32. Behr E.R., Roden D. Drug-induced arrhythmia: pharmacogenomic prescribing? Eur Heart J 2013;34:89–95.
33. Boqueria L.A., Boqueria O.L., Glushko L.A. Mechanisms of cardiac arrhythmias. Annals arrhythmology 2010;(3):69–79. Russian (Бокерия Л. А., Бокерия О. Л., Глушко Л. А. Механизмы нарушений ритма сердца. Анналы аритмологии 2010;(3):69–79).
34. Heist E.K., Ruskin J.N. Drug-Induced Arrhythmia. Circulation 2010;122:1426–35.
35. Goldenberg I., Moss A.J. Long QT Syndrome. J Am Coll Cardiol 2008;51:2291–300.
36. Kulik V.L., Yabluchansky N.I. The QT interval in the cardiac clinic. Bulletin of Kharkov National University. 2009; 879(18):73–96. Russian (Кулик В.Л., Яблучанский Н.И. Интервал QT в кардиологической клинике. Вісн Харк нац ун-ту 2009;879 (18):73–96).
37. Kannankeril P., Roden D. M., Darbar D. Drug-Induced Long QT Syndrome. Pharmacol Rev 2010;62(4):760–81.
38. Doschitsin V.L., Segal E.S., Sedov V.V. ECG QT interval prolongation: classification, clinical significance. Cardiology 1981;(10):22–8. Russian (Дощицин В.Л., Сигал Е.С., Седов В.В. Удлинение интервала Q–T ЭКГ: классификация, клиническое значение. Кардиология 1981;(10):22–8).
39. Yiyi Z., Wendy S.P., Darshan D. et al. Coffee, alcohol, smoking, physical activity and QT interval duration: results from the Third national health and nutritional examination survey. PLoS One 2011;6(2):e17584.
40. Haverkamp W., Breithardt G., Camm A. J. et al The potential for QT prolongation and pro-arrhythmia by non-anti-arrhythmic drugs: Clinical and regulatory implications. Report on a Policy Conference of the European Society of Cardiology. Cardiovascular Research 2000;47:219–33.
41. Yap Y. G., Camm A. J. Drug induced QT prolongation and torsades de pointes. Heart 2003;89:1363– 72.
42. Kowey P.R., Malik M. The QT interval as it relates to the safety of non-cardiac drugs. Eur Heart J Suppl 2007;9 (Supplement G):G3–G8.
43. Gupta A., Lawrence A. T., Krishnan K. et al Current concepts in the mechanisms and management of drug-induced QT prolongation and torsade de pointes. Am Heart J 2007;153:891–9.
44. Roden D. Drug-Induced Prolongation of the QT Interval. N Engl J Med 2004;350:1013–22.
45. Drew B.J., Ackerman M.J., Funk M. et al Prevention of Torsade de Pointes in Hospital Settings: A Scientific Statement From the American Heart Association and the American College of Cardiology Foundation. Circulation 2010;121:1047–60.
46. Zipes D.P., Camm A.J., Borggrefe M. et al ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Car- diology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol 2006;48:e247– e346.
47. Straus M., Sturkenboom M.C., Bleumink G.S. Non-cardiac QTc-prolonging drugs and the risk of sudden cardiac death. Eur Heart J 2005;26:2007–12.
48. Roden D. M. Long QT syndrome: reduced repolarization reserve and the genetic link. Journal of Internal Medicine 2006;259:59–69.
49. Jamshidi Y., Nolte I.M., Dalageorgou C. et al Common Variation in the NOS1AP Gene Is Associated With Drug-Induced QT Prolongation and Ventricular Arrhythmia. J Am Coll Cardiol 2012;60:841– 50.
50. Simons G.R., Eisenstein E.L., Shaw L..J, Mark D.B. Cost effectiveness of inpatient initiation of antiarrhythmic therapy for supraventricular tachycardia’s. Am J Cardiol 1997;80:1551–7.
51. Ritter J. M. Cardiac safety, drug-induced QT prolongation and torsade de pointes (TdP). Br J Clin Pharmacol 2012;3(73):331–4.
52. Lopatin Y.M. Diuretics and the development of hyperkalemia in patients with arterial hypertension: Are the security of the original and generic drugs. Atmosphere. Cardiology 2004; (3):12–5. Russian (Лопатин Ю.М. Диуретики и развитие гиперкалиемии у больных артериальной гипертонией: одинакова ли безопасность оригинальных и генерических препаратов. Атмосфера. Кардиология 2004;(3):12–5).
53. National Guidelines for the determining of risk and prevention of sudden cardiac death (draft). Available at: http://www.scardio.ru/downloads/c4m1i1153/ВССрекомендации.pdf. Date of access
54. 06.2013. Russian (Национальные Рекомендации по определению риска и профилактике внезапной сердечной смерти (проект). Доступен на: http://www.scardio.ru/downloads/c4m1i1153/ВСС рекомендации.pdf. Дата доступа: 22.06.2013).
55. Mizusawa Y., Wilde A. A. M. QT Prolongation and Mortality in Hospital Settings: Identifying Patients at High Risk. Mayo Clin Proc 2013;88(4):309–11.
56. Freeman B.D., Dixon D.J., Coopersmith C.M. et al Pharmacoepidemiology of QT-interval prolonging drug administration in critically ill patients. Pharmacoepidemiol Drug Saf 2008;17(10):971–81.
57. Pickham D., Helfenbein E., Shinn J. A. et al High prevalence of corrected QT interval prolongation in acutely ill patients is associated with mortality: Results of the QT in Practice (QTIP) Study. Critical Care Medicine 2012;2(40):394–9. 316-322.
Review
For citations:
Furman N.V., Shmatova S.S. CLINICAL SIGNIFICANCE OF DRUGINDUCED INTERVALS QT AND QTC PROLONGATION. Rational Pharmacotherapy in Cardiology. 2013;9(3):311-315. (In Russ.) https://doi.org/10.20996/1819-6446-2013-9-3-311-315
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