Torsade de Pointes, Prolonged QT Intervals, and Patients With Cancer

Abstract

Many kinase inhibitors, chemotherapeutic agents, antiemetics, antibiotics, and antifungal agents can prolong QT intervals, placing the patient as risk for the life-threatening ventricular arrhythmia Torsade de pointes (Tdp). In addition, common electrolyte imbalances experienced by many patients with cancer compound the risk. Because numerous medications used in oncology and common electrolyte imbalances in patients with cancer increase the risk for Tdp, oncology nurses must be informed about this life-threatening arrhythmia.

Repolarization effects of multiple-cycle chemotherapy and predictors of QTc prolongation: a prospective female cohort study on >2000 ECGs

“…Moreover, none of the chemotherapy protocols evaluated in this study seemed to be associated with a higher QTc prolongation, a finding reinforced both by the direct comparison of average QTc recorded on chemotherapy ECGs among the 6 subgroups of protocols and by the absence of an association between each protocol (or compound) and a QTc prolongation >470/480 ms. These findings confirm previous reports showing a significant QTc prolongation by most of the chemotherapy agents used in current clinical practice [19,20], highlighting the need for a shift of our perspective from struggling to develop compounds free of arrhythmic risk to the development of strategies for risk management. Considering that drug-induced ventricular arrhythmias are extremely rare in subjects with a normal QTc, any strategy aimed at identifying subjects at high risk of developing a prolonged QTc can potentially target our preventive efforts.…”