Evaluation of Prolonged QT Interval: Structural Heart Disease Mimicking Long QT Syndrome

Weissler‐Snir, Adaya; Gollob, Michael H.; Chauhan, Vijay S.; Sc, Chiang; Spears, Danna

doi:10.1111/pace.13040

Cited by 8 publications

(6 citation statements)

References 55 publications

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“…Table 3 provides a selective list of commonly used noncancer treatment drugs that prolong QTc and some safer alternatives, and an exhaustive list can be obtained from http://crediblemeds.org and is updated frequently. 188 Other causes of baseline QTc prolongation include structural heart disease 189 and genetic inherited arrhythmias, including Brugada syndrome, congenital long QT syndrome, and catecholaminergic polymorphic ventricular tachycardia. These patients should be evaluated by a cardiologist or cardiac electrophysiologist before cancer therapy with potential QT-prolonging drugs.…”

Section: Identifying Causes and Risk For Qt Prolongationmentioning

confidence: 99%

Incidence, Diagnosis, and Management of QT Prolongation Induced by Cancer Therapies: A Systematic Review

Porta‐Sánchez

Gilbert

Spears

et al. 2017

JAHA

154

142

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BackgroundThe cardiovascular complications of cancer therapeutics are the focus of the burgeoning field of cardio‐oncology. A common challenge in this field is the impact of cancer drugs on cardiac repolarization (ie, QT prolongation) and the potential risk for the life‐threatening arrhythmia torsades de pointes. Although QT prolongation is not a perfect marker of arrhythmia risk, this has become a primary safety metric among oncologists. Cardiologists caring for patients receiving cancer treatment should become familiar with the drugs associated with QT prolongation, its incidence, and appropriate management strategies to provide meaningful consultation in this complex clinical scenario.Methods and ResultsIn this article, we performed a systematic review (using Preferred Reporting Items of Systematic Reviews and Meta‐Analyses (PRISMA) guidelines) of commonly used cancer drugs to determine the incidence of QT prolongation and clinically relevant arrhythmias. We calculated summary estimates of the incidence of all and clinically relevant QT prolongation as well as arrhythmias and sudden cardiac death. We then describe strategies to prevent, identify, and manage QT prolongation in patients receiving cancer therapy. We identified a total of 173 relevant publications. The weighted incidence of any corrected QT (QTc) prolongation in our systematic review in patients treated with conventional therapies (eg, anthracyclines) ranged from 0% to 22%, although QTc >500 ms, arrhythmias, or sudden cardiac death was extremely rare. The risk of QTc prolongation with targeted therapies (eg, small molecular tyrosine kinase inhibitors) ranged between 0% and 22.7% with severe prolongation (QTc >500 ms) reported in 0% to 5.2% of the patients. Arrhythmias and sudden cardiac death were rare.ConclusionsOur systematic review demonstrates that there is variability in the incidence of QTc prolongation of various cancer drugs; however, the clinical consequence, as defined by arrhythmias or sudden cardiac death, remains rare.

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Section: Identifying Causes and Risk For Qt Prolongationmentioning

confidence: 99%

Incidence, Diagnosis, and Management of QT Prolongation Induced by Cancer Therapies: A Systematic Review

Porta‐Sánchez

Gilbert

Spears

et al. 2017

JAHA

154

142

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“…It is well known that QT intervals can be affected by several other factors, 14,43 such as electrolyte imbalances, other QT prolonging drugs, female sex, bradycardia, cardiovascular disease, 44,45 and genetic polymorphisms of ion channels. 46 Because MMT patients are a heterogeneous population, we controlled for other factors affecting the QT interval.…”

Section: Discussionmentioning

confidence: 99%

Effect on QTc interval by switching from methadone to equipotent R‐methadone dose in methadone maintenance treatment patients

Havig,

Berg‐Pedersen,

Krabseth

et al. 2024

Basic Clin Pharma Tox

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Methadone (R,S‐methadone) can prolong the QT interval. R‐methadone inhibits cardiac potassium channel function less than S‐methadone. We tested if switching from methadone to R‐methadone would reduce corrected QT (QTc) intervals in methadone maintenance treatment (MMT) patients. Nine patients, with automatically read QTc intervals ≥450 ms, were required to detect a 20 ms (clinically relevant) reduction in QTc intervals with 15 ms standard deviation (SD) and 90% power. Nine stabilized MMT patients, using median (range) 70 (40–120) mg methadone, were included. Data (ECG recordings, serum samples, and withdrawal symptoms) were collected both before drug intake (Cmin) and at 3 h after drug intake (Cmax), and were collected on the day before the switch from methadone to equipotent R‐methadone dose and at 14 and 28 days after the switch. A cardiologist calculated QTc intervals retrospectively. Serum electrolytes and methadone concentrations were measured. Mean QTc intervals at Cmin were 472 ms and 422 ms on methadone (automatically and manually read) and 414 ms on R‐methadone (manually read). Mean (SD) change in QTc intervals was −8 (10) ms (p = 0.047) at Cmin but non‐significant at Cmax. R‐methadone showed a concentration‐dependent relationship with QTc intervals. Switching to R‐methadone reduced QTc intervals, but far less than the 20 ms considered clinically relevant.

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“…An observed effect of maternal age on the neonatal ECG could be direct or mediated through different prevalences of underlying CHDs in the newborns in the different maternal age groups. Secondary ECG changes, e.g., an abnormal QRS axis, and left and/or right ventricular hypertrophy are established markers of underlying structural heart disease [11, 12] and we therefore excluded all newborns with abnormal echocardiograms. Precordial amplitudes and the QRS axis evolve during the first month of life [13, 14], but our findings persisted when subdividing the newborns after age at inclusion.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Maternal Age on the Neonatal Electrocardiogram

et al. 2022

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Background: Previous studies have suggested an increased prevalence of congenital heart disease among children born to women aged ≥35 years. In recent decades, the mother’s age at childbirth has increased dramatically in industrialized countries. It has not been investigated if increasing maternal age affects the neonatal cardiac electrical system. Methods: The Copenhagen Baby Heart Study is a prospective general population study that performed cardiac evaluation in newborns. Electrocardiograms were analyzed with a computerized algorithm. Results: We included 16,518 newborns with normal echocardiograms (median age 11 days; range 0–30 days; 52% boys). Median maternal age at delivery was 31 years; 790 newborns were born to mothers aged between 16 and 24 years, 11,403 between 25 and 34 years, 4,279 between 35 and 44 years, and 46 newborns had mothers aged between 45 and 54 years. The QRS axis and maximum R-wave amplitude in V1 (R-V1) differed across the four maternal age groups (both p < 0.01), with absolute differences of 3.5% (114 vs. 110°) and 12% (1,152 vs. 1,015 µV), respectively, between newborns with the youngest and oldest mothers. Associations between maternal age and the QRS axis and R-V1 remained significant after multifactorial adjustment. Heart rate, PR interval, QRS duration, uncorrected QT interval, QTcBazett, and maximum amplitudes of S-V1, R-V6, and S-V6 were not associated with maternal age (all p > 0.05). Conclusion: We observed a significant association between maternal age and the neonatal QRS axis and R-V1. However, the absolute differences were relatively small and maternal age is unlikely to have a clinically significant effect on the neonatal cardiac electrical system.

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Evaluation of Prolonged QT Interval: Structural Heart Disease Mimicking Long QT Syndrome

Abstract: Structural pathology was detected in a quarter of gene-negative patients evaluated for possible LQTS. Hence, cardiac imaging and Holter monitoring should be strongly encouraged to rule out structural heart disease in this population.

Cited by 8 publications

References 55 publications

Incidence, Diagnosis, and Management of QT Prolongation Induced by Cancer Therapies: A Systematic Review

Incidence, Diagnosis, and Management of QT Prolongation Induced by Cancer Therapies: A Systematic Review

Effect on QTc interval by switching from methadone to equipotent R‐methadone dose in methadone maintenance treatment patients

The Impact of Maternal Age on the Neonatal Electrocardiogram

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