Torsade de pointes during low-dosage sotalol therapy in haemodialysis patients

Huynh-Do, U.; Wahl, C.; Sulzer, M.; Buhler, H.; Keusch, G.

doi:10.1093/oxfordjournals.ndt.a027475

Cited by 12 publications

(6 citation statements)

References 3 publications

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“…In our study, the only 2 variables which had a significant effect on the QTc interval were hypomagnesemia and hypokalemia. The QTc interval lengthening might have the potential of making our patients more vulnerable to TDP as reported by Huynh-Do et al (20). However, we did not observe any TDP attack in HD patients; this may LVFS: left ventricular fractional shortening, LVEF: left ventricular ejection fraction, LVPW: left ventricular posterior wall, A: peak velocity of late mitral flow, E: peak velocity of early mitral flow.…”

Section: Discussionsupporting

confidence: 46%

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Acetate Hemodialysis Does Not Increase the Frequency of Arrhythmia in Hemodialysis Patients

et al. 1998

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Arrhythmia is one of the most important causes of mortality in patients on hemodialysis and may develop due to cardiovascular diseases or fluid-electrolyte or acid-base abnormalities. Previous studies have shown that acetate hemodialysis (AHD) increased the frequency of arrhythmia. To evaluate the frequency and the causes of arrhythmias during AHD, we studied 33 randomly selected patients (25 male and 8 female, mean age of 45+/-18 years) who were under AHD (4 h, 3 times/week, mean duration of HD of 38+/-29 months) with the same Cuprophan membranes. All patients underwent a detailed echocardiographic evaluation during the interdialytic period. Twenty-four hours of Holter monitoring was performed starting from the onset of HD. Twelve lead electrocardiography (ECG) was obtained, and venous and arterial blood samples were drawn for serum electrolytes, pH, and arterial blood gas measurements before and after HD. Serum magnesium and potassium levels dropped after AHD (from 2.3+/-0.5 to 1.9+/-0.3 mEq/L and from 5+/-0.7 to 3.4 +/-0.4 mEq/L respectively, p < 0.001); on the other hand serum pH, bicarbonate, sodium, and calcium levels were normalized. Electrocardiographic evaluation revealed significant lengthening of the QTc interval (from 433+/-42 to 464+/-43 ms, p < 0.001), which was thought to be related to the decrease in serum magnesium and potassium levels. The frequencies of ventricular premature contractions (VPCs) were not different during AHD and the interdialytic period (8+/-9.1 to 6.5+/-11 contractions/h, p > 0.05). This was also true for supraventricular premature contractions (SVPCs) and supraventricular tachycardia (SVT). Nonsustained ventricular tachycardia was observed in 2 patients during HD and in 1 patient in the interdialytic period. No relation was established between the echocardiographic findings and the frequency of arrhythmia. In our ambulatory electrocardiographic study, the frequencies of VPCs and SVPCs observed during the interdialytic period were only positively correlated with age (r=0.54, p=0.013 and r=0.50, p=0.010, respectively). No relation was found between the frequency of arrhythmia and the gender of the patients; duration of HD; etiology of kidney disease; or serum Na, K, Ca, iCa, Mg, bicarbonate, or pH levels (p > 0.05). In conclusion, the application of AHD does not increase the frequency of arrhythmia in HD patients as had been shown in previous studies.

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Section: Discussionsupporting

confidence: 46%

“…The QTc interval lengthening might have the potential of making our patients more vulnerable to TDP as reported by Huynh‐Do et al. ( 20). However, we did not observe any TDP attack in HD patients; this may be due to the fact that none of our patients were using any medication including antiarrhythmia drugs.…”

Section: Discussionmentioning

confidence: 63%

Acetate Hemodialysis Does Not Increase the Frequency of Arrhythmia in Hemodialysis Patients

et al. 1998

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“…Previous reports with the drug in patients on renal dialysis are of interest (17,18). To avoid the development of TdP, there have been attempts to correlate the degree of QT or QTc prolongation and QT dispersion (QTd), which might be of value in predicting the risk of TdP in the context of severe renal failure.…”

Section: Discussionmentioning

confidence: 99%

“…Only a few cases of TdP in patients on dialysis have been reported. Of the seven cases reported, two patients were on peritoneal dialysis, one developed acute renal failure during sotalol treatment, and four were on hemodialysis (17,18). All of the patients were on sotalol for supraventricular arrhythmia or AF.…”

Section: Discussionmentioning

confidence: 99%

“…They advocated the recording of serial ECGs for determining the timing for the discontinuation of sotalol before the development of life-threatening arrhythmias. Renal dialysis has been mentioned as an effective tool in the treatment of sotalol-induced TdP (17). Sotalol is primarily excreted unchanged in the urine, with a plasma clearance correlation of 77% with creatinine clearance (19).…”

Section: Discussionmentioning

confidence: 99%

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Recurrent Torsades de Pointes After Sotalol Therapy for Symptomatic Paroxysmal Atrial Fibrillation in a Patient with End-Stage Renal Disease

Rizza

Valderrábano²,

Singh

1999

J Cardiovasc Pharmacol Ther

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BACKGROUND: In recent years there has been ain increase in the use of class III antiarrhythmic drugs such as sotalol, amiodarone, and the so-called pure class III compound for the control of cardiac arrhythmias. It appears there has been a corresponding increase in the frequency of torsades de pointes (TdP). METHODS AND RESULTS: The case reported here, a patient on daily renal dialysis for end-stage renal disease, has important implications for class III agents, which are excreted largely by the kidneys. A relatively low dose of sotalol administered for the prevention of recurrences of atrial fabrillation, with a fast ventricular response producing angina, led to modest increases in the QT interval and moderate bradycardia. This culminated in the development of TdP, which deteriorated into ventricular fibrillation, from which the patient could be resuscitated with considerable difficulty. Dialysis after the occurrence of TdP led to further and striking prolongation of the QT interval associated with numerous episodes of TdP for several days before control was achieved. The atrial fibrillation and recurrences of TdP were eventually controlled with oral amiodarone. CONCLUSIONS: This case emphasizes that in the absence of significant renal function, use of sotalol may not be safe because drug accumulation may not be controlled adequately with renal dialysis. In view of this, in patients with end-stage renal disease, the use of sotalol for arrhythmia control appears contraindicated and alternative agents, the excretion of which does not occur by the renal route, should be used.

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Sotalol

2006

Meyler's Side Effects of Drugs: The International Encyclopedia of Adverse Drug Reactions and Interactions

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Torsade de pointes during low-dosage sotalol therapy in haemodialysis patients

Cited by 12 publications

References 3 publications

Acetate Hemodialysis Does Not Increase the Frequency of Arrhythmia in Hemodialysis Patients

Acetate Hemodialysis Does Not Increase the Frequency of Arrhythmia in Hemodialysis Patients

Recurrent Torsades de Pointes After Sotalol Therapy for Symptomatic Paroxysmal Atrial Fibrillation in a Patient with End-Stage Renal Disease

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