The QT dispersion (QT d ) is a non-invasive means of identifying those patients at an increased risk of developing sudden cardiac death (SCD). Although levofloxacin has a minimal effect on the QT c interval, isolated reports of QT prolongation, polymorphic ventricular tachycardia with a normal QT interval and TdP have been reported. The purpose of this study was to examine the effect of intravenous levofloxacin on the QT interval and QT d . Of the 50 patients who were deemed candidates to receive intravenous levofloxacin, 29 met the eligibility criteria and were enrolled in this study. A 12-lead ECG was performed before the initiation of levofloxacin (baseline), and on days 3 and 5. The QT c min , QT c max and the QT d were calculated. Measurements where made by two independent observers blinded to the patientsÕ clinical status. The QT d increased significantly on days 3 and 5 following the initiation of therapy [QT d (baseline) 33.3 ± 20 ms, QT d (day 3) 64.4 ± 31.3 ms (p = 0.023), QT d (day 5) 66.8 ± 20.3 ms, (p = 0.008)]. The increase in the QT d was significantly longer in men than women. Although women had a shorter baseline QT d compared to men, this did not achieve statistical significance. Intravenous levofloxacin was found to significantly increase the QT d , which was more pronounced in men compared to women. Its effect on the QT d may increase the risk of developing a potentially fatal ventricular arrhythmia. Therefore, care must be taken when prescribing this medication to patients with a pre-existing risk of developing SCD.
The authors present an unusual case of torsades de pointes (Tdp) in an elderly woman with a history of aortic stenosis, status post aortic valve replacement. She was admitted for atrial fibrillation with a slow ventricular response. At the time of admission, the patient was asymptomatic and not taking any medications known to be associated with QT prolongation. During hospitalization, she developed episodes of Tdp without any provocable cause. This case highlights the occurrence of Tdp secondary to conduction disturbance caused by aortic valve surgery.
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