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Life-threatening cardiac arrhythmias due to drug-induced QT prolongation

A retrospective study over 6 years from a medical intensive care unit

Lebensbedrohliche kardiale Arrhythmien aufgrund Medikamenten-induzierter QT-Verlängerung

Eine retrospektive Studie über 6 Jahre einer internistischen Intensivstation

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Abstract

Background

Long QT syndrome (LQTS) can lead to ventricular arrhythmia, especially torsade de pointes (TdP) tachycardia and/or ventricular tachycardia (VT). The aim of this study is to characterize patients with life-threatening cardiac arrhythmias associated with drug-induced LQTS and to identify risk factors of distinct presenting arrhythmias.

Material and methods

In this retrospective study, we present 33 consecutive cases of life-threatening cardiac arrhythmias associated with drug-induced long QT, which were direct admitted as emergency to a medical intensive care unit (MICU) during an observational time of 6 years.

Results

Of 33 identified cases, 55 % presented with TdP with the need of resuscitation and 45 % showed nonsustained VT, respectively. In the total cohort the mean corrected QT interval (QTc) was 532 ± 29 ms, with 530 ± 31 ms (n = 14) in men and 533 ± 28 ms (n = 19) in women (p = 0.80), respectively. Cardiac drugs with QTc interval prolonging effect were reported in 24 % of cases, and the other 76 % involved noncardiac medications. Although hypokalemia is the most common risk factor for drug-induced malignant arrhythmias, a QTc interval of at least 500 ms seems to be the major determinant of the risk of drug-induced proarrhythmias. Interestingly, patients with TdP exhibit more bradycardia as such with VT.

Conclusions

This is the first study of patients with drug-induced life-threatening cardiac arrhythmias who were admitted as a case of emergency to a MICU. Physicians should be aware of drug-induced LQTS and be able to identify patients at risk and avoid specific drugs in such patients.

Zusammenfassung

Hintergrund

Das verlängerte QT-Syndrom (LQTS) kann mit ventrikulären Arrhythmien, insbesondere Torsade de pointes (TdP) und/oder ventrikuläre Tachykardien (VT), einhergehen. Das Ziel dieser Studie war es die patientenspezifischen Charakteristika und Risikofaktoren von lebensbedrohlichen kardialen Arrhythmien bedingt durch ein Medikamenten-induziertes LQTS zu identifizieren.

Material und Methoden

Anhand dieser retrospektiven Studie über 6 Jahre präsentieren wir 33 Fälle von lebensbedrohlichen kardialen Arrhythmien beruhend auf ein Medikamenten-induziertes LQTS, welche als Notfall über die internistische Intensivstation aufgenommen wurden.

Ergebnisse

Von den 33 Fällen mit einem Medikamenten-induziertem LQTS präsentierten sich 55 % mit einer TdP-Tachykardie und 45 % mit einer nicht-anhaltenden VT. Die korrigierte QT-Zeit (QTc) betrug im Mittel 532 ± 29 ms (Männer: 530 ± 31 ms, n = 14; Frauen: 533 ± 28 ms, n = 19; p = 0,80). Kardiaka führten in 24 % und nicht-kardiale Medikamente in 76 % der Fälle zu einer QTc-Zeit Verlängerung. Obwohl die Hypokaliämie den häufigsten Risikofaktor für Medikamenten-induzierte maligne Arrhythmien darstellt, so ist eine QTc-Zeit von über 500 ms für derartige Arrhythmien prädisponierend. Bradykardien konnten insbesondere im Zusammenhang mit Medikamenten-induzierten TdP-Tachykardien beobachtet werden.

Schlussfolgerung

Diese Studie präsentiert erstmalig eine Risikoanalyse von Patienten mit Medikamenten-induziertem LQTS, welche notfallmäßig aufgrund von malignen Arrhythmien auf eine internistische Intensivstation aufgenommen wurden. Die Bedeutung eines Medikamenten-induzierten LQTS sollte allen Ärzten vertraut sein, um spezifische QT-verlängernde Medikamente im Zusammenhang mit patientenspezifischen Risiken zu vermieden.

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Authors and Affiliations

  1. Department III of Internal Medicine, University of Cologne, Kerpener-Str. 62, 50937, Cologne, Germany

    G. Michels MD & R. Pfister MD

  2. Department I of Internal Medicine, University of Cologne, Cologne, Germany

    M. Kochanek MD

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  1. G. Michels MD
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Correspondence to G. Michels MD.

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Conflict of interest

G. Michels, M. Kochanek, and R. Pfister declare that they have no conflict of interest.

The study was approved by the institutional ethic committee. No informed consent was necessary as the retrospective data were obtained within the standard diagnostic flow chart in all patients on ICU.

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Michels, G., Kochanek, M. & Pfister, R. Life-threatening cardiac arrhythmias due to drug-induced QT prolongation. Med Klin Intensivmed Notfmed 111, 302–309 (2016). https://doi.org/10.1007/s00063-015-0071-6

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  • DOI: https://doi.org/10.1007/s00063-015-0071-6

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