Managing drug-induced QT prolongation in clinical practice

作者：Rani Khatib, Fatima R. N. Sabir, Caroline Omari, Chris Pepper, Muzahir Hassan Tayebjee · 发表于：Postgraduate Medical Journal · 年份：2020 · DOI：10.1136/postgradmedj-2020-138661 · 被引用次数：139 · 研究领域：Cardiac electrophysiology and arrhythmias、ECG Monitoring and Analysis、Ion channel regulation and function

Many drug therapies are associated with prolongation of the QT interval. This may increase the risk of Torsades de Pointes (TdP), a potentially life-threatening cardiac arrhythmia. As the QT interval varies with a change in heart rate, various formulae can adjust for this, producing a 'corrected QT' (QTc) value. Normal QTc intervals are typically <450 ms for men and <460 ms for women. For every 10 ms increase, there is a ~5% increase in the risk of arrhythmic events. When prescribing drugs associated with QT prolongation, three key factors should be considered: patient-related risk factors (eg, female sex, age >65 years, uncorrected electrolyte disturbances); the potential risk and degree of QT prolongation associated with the proposed drug; and co-prescribed medicines that could increase the risk of QT prolongation. To support clinicians, who are likely to prescribe such medicines in their daily practice, we developed a simple algorithm to help guide clinical management in patients who are at risk of QT prolongation/TdP, those exposed to QT-prolonging medication or have QT prolongation.