Ibutilide-Induced Long QT Syndrome and Torsade de Pointes

Gowda, Ramesh M.; Punukollu, Gopikrishna; Khan, Ijaz A.; Patlola, Raghotham; Tejani, Furqan H.; Cosme-Thormann, Braulio F; Vasavada, Balendu C.; Sacchi, Terrence J.

doi:10.1097/00045391-200211000-00013

Cited by 9 publications

(4 citation statements)

References 11 publications

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“…It appears to work better in patients with arrhythmias of relatively recent onset and has greater efficacy in atrial flutter 23,24 . Its principal liability is torsades de pointes, which occurs in 2% to 4% of patients and is more likely in women, the elderly, and patients with left ventricular dysfunction 25–27 . Dofetilide was approved for this indication based on its record of effectiveness in patients hospitalized for oral drug loading.…”

Section: Rhythm Controlmentioning

confidence: 99%

“…Conversion to SR occurs in 30% of patients with persistent AF compared with a placebo conversion rate of about 1% to 3% 28 . As with ibutilide, dofetilide's principal liability is torsades de pointes, which fortunately happens early in dosing while the patient is under observation 25 , 27 , 29…”

Section: Rhythm Controlmentioning

confidence: 99%

“…23,24 Its principal liability is torsades de pointes, which occurs in 2% to 4% of patients and is more likely in women, the elderly, and patients with left ventricular dysfunction. [25][26][27] Dofetilide was approved for this indication based on its record of effectiveness in patients hospitalized for oral drug loading. Conversion to SR occurs in 30% of patients with persistent AF compared with a placebo conversion rate of about 1% to 3%.…”

Section: Rhythm Controlmentioning

confidence: 99%

“…28 As with ibutilide, dofetilide's principal liability is torsades de pointes, which fortunately happens early in dosing while the patient is under observation. 25,27,29 Other drugs have been used for acute conversion of AF without convincing demonstration of effectiveness. Amiodarone has gained popularity for this indication.…”

Section: Rhythm Controlmentioning

confidence: 99%

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Overview of the Management of Atrial Fibrillation:

Kowey

Yan

DiMino

et al. 2003

Cardiovasc electrophysiol

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Management of Atrial Fibrillation. There are three fundamental approaches to the management of atrial fibrillation (AF): rate control, rhythm control, and anticoagulation. Selecting a course of treatment requires a thorough knowledge of these therapeutic alternatives. This article explores treatment options, including the relative benefits of rate control versus rhythm control, which are complicated by the lack of highly effective and safe antiarrhythmic drugs. Anticoagulation is also an important issue in AF management, and warfarin effectively reduces the incidence of thromboembolic events in AF patients. The use of warfarin, however, presents its own complications. We conclude that individualization of therapy is paramount when treating AF.

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Section: Rhythm Controlmentioning

confidence: 99%

Section: Rhythm Controlmentioning

confidence: 99%

Section: Rhythm Controlmentioning

confidence: 99%

Section: Rhythm Controlmentioning

confidence: 99%

See 2 more Smart Citations

Overview of the Management of Atrial Fibrillation:

Kowey

Yan

DiMino

et al. 2003

Cardiovasc electrophysiol

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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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QT interval abnormalities: risk factors and perioperative management in long QT syndromes and Torsades de Pointes

et al. 2013

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Electrophysiological abnormalities of the QT interval of the standard electrocardiogram are not uncommon. Congenital long QT syndrome is due to mutations of several possible genes (genotype) that result in prolongation of the corrected QT interval (phenotype). Abnormalities of the QT interval can be acquired and are often drug-induced. Torsades de Pointes (TP) is an arrhythmia that is a result of aberrant repolarization/QT abnormalities. If not recognized and corrected quickly, QT interval abnormalities may precipitate potentially fatal ventricular dysrhythmias. The main mechanism responsible for the development of QT prolongation is blockade of the rapid component of the delayed rectifier potassium current (I kr), encoded for by the human-ether-a-go-go-related gene (hERG). The objectives of this review were (1) to describe the electrical pathophysiology of QT interval abnormalities, (2) to differentiate congenital from acquired QT interval abnormalities, (3) to describe the currently known risk factors for QT interval abnormalities, (4) to identify current drug-induced causes of acquired QT interval abnormalities, and (5) to recommend immediate and effective management strategies to prevent unanticipated dysrhythmias and deaths from QT abnormalities in the perioperative period.

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Ibutilide-Induced Long QT Syndrome and Torsade de Pointes

Cited by 9 publications

References 11 publications

Overview of the Management of Atrial Fibrillation:

Overview of the Management of Atrial Fibrillation:

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

QT interval abnormalities: risk factors and perioperative management in long QT syndromes and Torsades de Pointes

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