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Drug induced QT prolongation: the measurement and assessment of the QT interval in clinical practice
Author(s) -
Isbister Geoffrey K.,
Page Colin B.
Publication year - 2013
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.12040
Subject(s) - qt interval , prolongation , medicine , torsades de pointes , nomogram , long qt syndrome , cardiology , drug , pentaerythritol tetranitrate , population , heart rate , clinical practice , intensive care medicine , anesthesia , pharmacology , blood pressure , chemistry , environmental health , organic chemistry , family medicine , explosive material
There has been an increasing focus on drug induced QT prolongation including research on drug development and QT prolongation, following the removal of drugs due to torsades de pointes ( TdP ). Although this has improved our understanding of drug‐induced QT prolongation there has been much less research aimed at helping clinicians assess risk in individual patients with drug induced QT prolongation. This review will focus on assessment of drug‐induced QT prolongation in clinical practice using a simple risk assessment approach. Accurate measurement of the QT interval is best done manually, and not using the measurement of standard ECG machines. Correction for heart rate ( HR ) using correction formulae such as B azett's is often inaccurate. These formulae underestimate and overestimate the duration of cardiac repolarization at low and high heart rates, respectively. Numerous cut‐offs have been suggested as an indicator of an abnormal QT , but are problematic in clinical practice. An alternative approach is the QT nomogram which is a plot of QT vs . HR . The nomogram has an ‘at risk’ line and QT‐HR pairs above this line have been shown in a systematic study to be associated with TdP and the line is more sensitive and specific than B azett's QT c of 440 ms or 500 ms. Plotting the QT‐HR pair for patients on drugs suspected or known to cause QT prolongation allows assessment of the QT interval based on normal population QT variability. This risk assessment then allows the safer commencement of drugs therapeutically or management of drug induced effects in overdose.