Drug-Induced Long-QT and Torsades de Pointes in Elderly Polymedicated Patients

García-Fuertes, Daniel; Fernández, E.; Crespín-Crespín, Manuel

doi:10.5935/abc.20150069

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…El monitoreo con ECG basal y repetidos durante el uso de ciertos fármacos que pueden prolongar el QTc o en situaciones de riesgo de SQTP está recomendado con el propósito de evitar arritmias graves pues muchos factores (4,6,12) desencadenantes son prevenibles . Esta recomendación es más fuerte ante pacientes ancianos y (15,17,22,25,30).…”

Section: Discussionunclassified

“…Pero esta frecuencia aumenta cuando se suman factores de riesgo. Las siguientes condiciones aumentan ese riesgo: insuficiencia cardíaca, enfermedad cardíaca estructural, bradicardia, hipopotasemia, hipomagnesemia, mutaciones subclínicas de los canales iónicos, dosis altas de los fármacos, ancianidad, inhibidores del metabolismo, combinación de dos o más (3,6,22,23) medicamentos que prolongan del intervalo QTc . La raza caucásica es más propensa que las (8) demás a sufrir SQTP .…”

Section: Introductionunclassified

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Prolonged QTc interval in patients of Clinical Medicine: multicenter study

Roy¹,

Giménez²,

Cardozo³

et al. 2020

Rev. virtual Soc. Parag. Med. Int

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Antecedentes: el síndrome de QT prolongado (SQTP) adquirido se asocia al uso de ciertos fármacos. La detección oportuna del SQTP permite tomar medidas para prevenir arritmias ventriculares potencialmente letales. Objetivo: determinar la frecuencia de SQTP en pacientes adultos internados en Servicios de Clínica Médica, describir las características demográficas, clínicas, laboratoriales y el uso de fármacos asociados con la prolongación del intervalo QTc. Materiales y métodos: se aplicó diseño observacional, prospectivo, longitudinal, en varones y mujeres, mayores de 16 años de edad, internados en el Servicio de Clínica Médica del Hospital Nacional (Itauguá, Paraguay) y del Hospital Militar Central (Asunción, Paraguay) en 2019. Se midieron variables demográficas, clínicas, laboratoriales y un electrocardiograma (ECG) al ingreso y a la semana de internación. Se consideró STQL todo valor del intervalo QTc ≥0,45 seg en hombres y ≥0,47 seg en mujeres. Resultados: ingresaron al estudio 257 sujetos, 55% varones y 45% mujeres, con edad media 58±20 años. Se detectó SQTP en 55 pacientes (21%). Los fármacos más utilizados en los pacientes con SQTP fueron omeprazol, furosemida, piracilina-tazobactam, tramadol, ondasentrón, amiodarona, salbutamol, ciprofloxacina, antirretrovirales, levofloxacina, metoclopramida y cotrimoxazol. Conclusión: la frecuencia de SQTP fue 21%. La comorbilidad más frecuente fue la hipertensión arterial (62%). Los fármacos más utilizados en los pacientes con SQTP fueron los de uso común en las salas de Clínica Médica.

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Section: Discussionunclassified

Section: Introductionunclassified

Prolonged QTc interval in patients of Clinical Medicine: multicenter study

Roy¹,

Giménez²,

Cardozo³

et al. 2020

Rev. virtual Soc. Parag. Med. Int

View full text Add to dashboard Cite

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“…Dementia and cognitive impairment are common chronic conditions affecting older individuals and, in these patients, falls and suspected syncope are frequent cause of admission to hospital [43][44][45]. Most of these vulnerable patients usually are treated with one or more psychoactive medications and other concomitant drug therapy potentially associated with QTc prolonging effect [30,46]. Our findings suggest that diuretics, rather than antipsychotics, are closely associated with prolonged QTc in these patients.…”

Section: Discussionmentioning

confidence: 76%

Prevalence, predictors and clinical implications of prolonged corrected QT in elderly patients with dementia and suspected syncope

Bo¹,

Ceccofiglio

Mussi

et al. 2019

European Journal of Internal Medicine

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Background: Long QT and use of QT-prolonging drugs are common among older patients receiving polytherapies, but real-world evidence on their impact in clinical practice is controversial. We investigated prevalence, variables associated and clinical implications of prolonged corrected QT (QTc) among patients from the Syncope and Dementia study. Methods: Observational, prospective, multicenter study. Patients≥65 years with dementia and fall suspected for syncope in the previous three months were enrolled. Several clinical variables and the complete list of medications were recorded for each patient. A 12-lead ECG was obtained and corrected QT was calculated by the Bazett's formula. One-year followup for death and recurrent syncope was performed. Results: Prolonged QTc was observed in 25% of the 432 enrolled patients (mean age 83.3), and was significantly associated with male gender (OR 2.09; 95% CI 1.34-3.26) and diuretics use (OR 1.85; 95% CI 1.18-2.90). At one-year 23.3% of patients died and 30.4% reported at least one recurrent event. Variables associated with oneyear mortality were: age, male gender, atrial fibrillation (AF), use of calcium channel blockers and prolonged QTc (OR 1.80; 95% CI 1.01-3.20). Among patients with prolonged QTc a significant interaction for mortality was found with AF. Recurrent events were associated with the use of antiplatelets, cholinesterase. inhibitors and antipsychotics, but not with prolonged QTc. Conclusions: We documented a high prevalence of prolonged QTc, that was associated with male gender and diuretics but not with psychoactive medications. Patients with prolonged QTc had higher one-year mortality, that was four-fold increased in those with concomitant AF. 1. Introduction Long QT syndrome is an electro-physiologic disorder in which the ventricular repolarization is lengthened, with an increased susceptibility to ventricular tachy-arrhythmias, potentially leading to syncope, cardiac arrest and sudden cardiac death [1]. Acquired prolonged QT interval is the most common form of long QT syndrome, and usually results from the complex interplay between several factors

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Riskante Gabe von QT-Intervall-verlängernden Wirkstoffen bei älteren Patienten mit arzneimittelinduzierter Torsade de pointes

et al. 2016

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A systematic review was conducted for all published case reports on drug-induced torsade de pointes (TdP) in elderly (≥80 years) patients to study if the administration of the offending agent was reckless. Overall, 61 reports on drug-induced TdP in patients aged 80-97 years were included in the analysis. Non-modifiable risk factors for drug-induced TdP (e.g. acute coronary syndrome, female gender and congestive heart failure), modifiable risk factors (e.g. hypokalemia, severe hypomagnesemia and digitalis toxicity) and reckless administration of a QT interval-prolonging agent (e.g. despite a known QT interval prolongation or a history of TdP, together with other QT interval prolonging agents in higher than recommended doses) were recorded in each case. Overall, 54 (88.5%) patients had non-modifiable risk factors for drug-induced TdP and 21 (34.4%) patients had modifiable risk factors. The administration of the offending agent was reckless in one half (n = 31; 50.8%) of the patients. The most prevalent reckless administration of a QT interval-prolonging agent was together with other QT interval-prolonging agents (n = 16; 51.6%) or despite QT interval prolongation (n = 8; 25.8%). In conclusion, although risk factors for drug-induced TdP are prevalent in elderly patients with drug-induced TdP, in approximately 50% of patients it appeared following a reckless administration of a QT interval-prolonging agent. In this population physicians should particularly avoid administration of two or more QT interval-prolonging agents simultaneously or administration of a QT interval-prolonging agent despite QT interval prolongation.

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Drug-Induced Long-QT and Torsades de Pointes in Elderly Polymedicated Patients

Cited by 3 publications

References 11 publications

Prolonged QTc interval in patients of Clinical Medicine: multicenter study

Prolonged QTc interval in patients of Clinical Medicine: multicenter study

Prevalence, predictors and clinical implications of prolonged corrected QT in elderly patients with dementia and suspected syncope

Riskante Gabe von QT-Intervall-verlängernden Wirkstoffen bei älteren Patienten mit arzneimittelinduzierter Torsade de pointes

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