Epinephrine QT stress testing in the evaluation of congenital long QT syndrome: Diagnostic accuracy of the paradoxical response

Vyas, Himeshkumar; Hejlik, Joseph; Ackerman, Michael J.

doi:10.1016/j.hrthm.2005.02.316

Cited by 48 publications

(67 citation statements)

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“…There are several protocols for administration and interpretation of epinephrine infusion. The authors favor an absolute QT prolongation of ≥30 ms at 0.10 μg/kg/min epinephrine as the criterion for a positive test (Vyas et al, 2006;Krahn et al, 2012). It should be noted that concurrent beta-blockade lowers the diagnostic accuracy of epinephrine infusion.…”

Section: Pharmacologic Provocationmentioning

confidence: 97%

Life threatening causes of syncope: Channelopathies and cardiomyopathies

Herman

Bennett

Chakrabarti

et al. 2014

Autonomic Neuroscience

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Section: Pharmacologic Provocationmentioning

confidence: 97%

Life threatening causes of syncope: Channelopathies and cardiomyopathies

Herman

Bennett

Chakrabarti

et al. 2014

Autonomic Neuroscience

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“…In this patient, we prescribed metoprolol before obtaining the results of the genetic examination. This was because (a) beta-blocker is believed to be a first line medical treatment in most of the LQTS patients [18][19][20], and (b) results of the epinephrine infusion test and treadmill exercise test suggested either type-1 or type-2 LQTS [21][22][23]. Although magnitude of the QTc interval prolongation by the two tests were mild, type-3 LQTS seemed less likely because the QTc interval was not shortened by sympathetic stimulation.…”

Section: Discussionmentioning

confidence: 99%

Secondly ECG recordings in the emergency room revealed Garenoxacin-induced abnormal QT interval prolongation in a patient with multiple syncopal attacks

Tagawa¹,

Ochiai²,

Nakamura³

et al. 2015

Heart Vessels

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A 73-year-old woman first visited our emergency room with multiple syncopal attacks. Before admission, she had received an antibiotic (Garenoxacin) for 3 days from a local clinic. First electrocardiogram (ECG) showed no ST-segment deviation but mild QT interval prolongation with a positive U wave. Second ECG recording 3 h later showed slightly slower heart rate and revealed marked QTU interval prolongation suggesting the cause of her syncopal attacks. After cessation of Garenoxacin, the QTU interval prolongation shortened. However, both epinephrine infusion and treadmill exercise test reproduced similar QTU interval prolongation and T wave deformities. Later, genetic analysis demonstrated that this patient had a mutation in KCNH2 gene, and she was diagnosed as a type-2 long-QT syndrome which was accentuated by use of garenoxacin. At the emergency out-patient clinic, repetitive ECG recordings can be useful and should be considered in order to identify the cause of syncopal attacks in patients who were prescribed antibiotics and had mild QT interval abnormalities.

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“…7 However, there is no test available for risk stratification in patient with LQTS. In our patient, the epinephrine test was performed because it was thought to be helpful to further clarify her diagnosis (type of LQTS) and risk for arrhythmias without the knowledge of the results of genetic testing.…”

Section: Discussionmentioning

confidence: 99%