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Review
. 2003 Nov;89(11):1363-72.
doi: 10.1136/heart.89.11.1363.

Drug induced QT prolongation and torsades de pointes

Yee Guan Yap  1 , A John Camm
Affiliations
Review

Drug induced QT prolongation and torsades de pointes

Yee Guan Yap et al. Heart. 2003 Nov.
No abstract available

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Figures

Figure 1
Figure 1
(A) Self limiting torsades de pointes (TdP). (B) TdP leading to ventricular fibrillation.
Figure 2
Figure 2
Arrhythmogenesis of torsades de pointes. VF, ventricular fibrillation.
Figure 3
Figure 3
Rhythm strip in a patient with drug induced TdP. Note the typical short-long-short initiating ventricular cycle, pause dependent QT prolongation, and abnormal TU wave leading to the classical “twisting of a point” of the cardiac axis during TdP.
Figure 4
Figure 4
Effect of various fluoroquinolones on prolonging action potential duration. Modified and reproduced from Hagiwara and colleagues with permission.
Figure 5
Figure 5
(A) The ECG of a middle aged woman who was otherwise healthy but suffered a ventricular fibrillation cardiac arrest while receiving 20 mg daily of thioridazine. This ECG was recorded immediately after the cardiac arrest. Note the prolonged T wave offset resulting in a prolonged QTc interval of 619 ms. (B) The ECG of the same patient three days after the withdrawal of thioridazine (QTc = 399 ms).
See this image and copyright information in PMC

References

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    1. Wysowski DK, Bacsanyi J. Cisapride and fatal arrhythmia. N Engl J Med 1996;335:290–1. - PubMed
    1. Dapro B. Spectrum of drugs prolonging QT interval and the incidence of torsades de pointes. Eur Heart J 2001;3(suppl K):K70–80. ▸ A good review providing an insight into the incidence of drug induced TdP.
    1. Antzelevitch C, Sicouri S. Clinical relevance of cardiac arrhythmias generated by afterdepolarisation: role of M cells in the generation of U wave, triggered activity, and torsades de pointes. J Am Coll Cardiol 1994;23:259–77. ▸ An important study that demonstrated the cellular mechanism of drug induced QT prolongation and TdP. - PubMed
    1. Roden DM. Torsades de pointes. Clin Cardiol 1993;16:683–6. - PubMed

MeSH terms