Drug-induced long QT interval: prevalence, risk factors, treatment and prevention

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Abstract

Prolongation the QT interval is one of the most important problems in the scientific and practical medical communities. It is known that QT prolongation is a risk factor and a predictor of the life-threatening ventricular arrhythmias, including polymorphic ventricular tachycardia (torsade de pointes), capable of transformation into ventricular fibrillation with fatal outcome. Among the reasons contributing to the development of acquired prolongation the QT interval, the absolute leader is drug-induced prolongation the QT. Currently, most of the known groups of drugs have representatives that affect the duration of the QT interval: antipsychotics, antidepressants, antiarrhythmics, antibacterial, antifungal and anticancer drugs, diuretics (except potassium-sparing), ect. The development of clinically significant QT prolongation, including fatal outcomes, is promoted by certain risk factors, which include female gender, older age, hereditary conditionality, the presence of a structural heart disease, liver and/or kidney disease, as well as bradycardia, electrolyte abnormalities, drug interactions (use of simultaneously ≥2 QT-lengthening drugs, use of drugs with QT-lengthening action in combination with drugs that slow down their metabolism and/or violate and electrolyte metabolism, and/or impaired liver/kidney function), an overdose of QT-prolonged drugs. The main conditions for the prevention of drug-induced prolongation the QT interval are, on the one hand, the rejection of the use of drugs with this side effect, if it is impossible, the choice of the safest in the minimum effective dose. On the other hand, an important element of prevention is the monitoring and feasible correction of risk factors for prolongation the QT interval, with the third - ECG control. With the development of drug-induced prolongation the QT interval, immediate withdrawal of all suspicious drugs is necessary. The possibility of their return to the therapy should be considered only after the normalization the QT interval.

About the authors

Olga D. Ostroumova

A.I. Yevdokimov Moscow State University of Medicine and Dentistry; Pirogov Russian National Research Medical University

Email: ostroumova.olga@mail.ru
D. Sci. (Med.), Prof. Moscow, Russia

Irina V. Goloborodova

A.I. Yevdokimov Moscow State University of Medicine and Dentistry

Email: giv55555@ramler.ru
Cand. Sci. (Med.), Assoc. Prof. Moscow, Russia

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