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BOX 2 – LQTS E CICLO DEPOLARIZZAZIONE-RIPOLARIZZAZIONE Le canalopatie che determinano sincope e morte im-provvisa hanno come caratteristica fondamentale il pro-lungamento dell’intervallo QT dell’elettrocardiogramma e danno luogo alla long-QT syndrome (LQTS). L’intervallo QT misura la durata del ciclo depolarizzazione-ripolariz- A comprehensive list of conditions and drugs that may prolong the QT interval, and cause torsade de pointes (TdP) and long QT syndrome (LQTS) is presented below. With regards to drugs, the risk of QT prolongation and TdP varies markedly across the list but tends to be rather similar within a drug class. RISK FACTORS FOR QT PROLONGATION AND TORSADES DE POINTES. Many factors may influence QT interval and may in turn predispose to TdP[9 10 11] (see infra). Age over 65 years; Female sex (longer QTc interval than men and twice the risk of drug-induced TdP) Increased myocardial mass (e.g., in arterial hypertension) Congenital QT prolongation Molti farmaci aumentano direttamente l'intervallo QT influenzando l’attività di membrana delle cellule cardiache. Con i farmaci che allungano il QT, il rischio di aritmie è di solito dose-dipendente, e aumenta con l’incremento troppo rapido della dose, o con concentrazioni elevate di farmaco, soprattutto se infuso troppo rapidamente. A QT-concentration relationship was reported with moxifloxacin. Gabapentin exposures were dose-proportional with gabapentin enacarbil doses of 1200 and 6000 mg. The most commonly reported adverse events with gabapentin enacarbil 6000 mg were dizziness and somnolence (60.0% and 54.0%, respectively). The length of the QT interval represents the time required for ventricular depolarization and repolarization. Prolongation of ventricular repolarization can result in fatal ventricular arrhythmias [3]. Faster heart rates can shorten the QT interval [4], so it is often adjusted for rate and reported as the heart rate corrected (QTc) interval. Che cos’è il tratto QT, il QTc e perchè va considerato quando si trattano dei pazienti con farmaci antidepressivi e antipsicotici. QTc, Torsione di Punta e psicofarmaci: nel corso degli ultimi anni, in parte per ragioni oggettive ed in parte per ragioni di strumentalizzazione di questo pericolo, si sta portando molto attenzione alla possibilità che farmaci antidepressivi ed antipsicotici Gabapentin binder sig til α2δ-underenheden af de spændingsafhængige calciumkanaler. Biotilgængeligheden falder med stigende dosis, så doser over 2.400-3.600 mg giver sjældent større virkning. Long qt syndrome is reported as a side effect among people who take Gabapentin (gabapentin), especially for people who are female, 60+ old, also take Aspirin, and have High blood pressure. The phase IV clinical study analyzes which people have Long qt syndrome when taking Gabapentin, including time on the drug, (if applicable) gender, age, co QT interval varies dependent on the length of the cardiac cycle and is usually corrected (QTc) for heart rate, several formulas can be used for this, most commonly Bazett’s formula is used (QTc=QT/√RR; QT interval in seconds, RR cardiac cycle in seconds), other correction formulae such as Frederica, Hodges or Framingham may be used. Long QT syndrome (LQTS) is a cardiac conduction disorder characterized by prolongation and increased dispersion of ventricular repolarization, manifested by lengthening of the QT interval on the surface electrocardiography (ECG). Drugs associated with QT Prolongation, QTc prolongation including Antipsychotics, antiarrhythmics, antidepressants, and antihistamines RISK FACTORS FOR QT PROLONGATION AND TORSADES DE POINTES. Many factors may influence QT interval and may in turn predispose to TdP[9,10,11] (see infra). Age over 65 years. Female sex (longer QTc interval than men and twice the risk of drug-induced TdP) Increased myocardial mass (e.g., in arterial hypertension) Congenital QT prolongation syndrome Electrocardiogram qt corrected interval prolonged is reported as a side effect among people who take Gabapentin (gabapentin), especially for people who are female, 40-49 old, also take Mirtazapine, and have High blood pressure. Gabapentin enacarbil, a prodrug of gabapentin, had no effect on cardiac repolarization in healthy volunteers [29,30]. In rabbits, therapeutic doses of pregabalin significantly prolonged the QT interval [ 31 ]. Pregabalin use has been associated with QTc prolongation in patients taking other QTc–prolonging agents, although the relative contributions of pregabalin to QTc prolongation may be minimal. Pregabalin and gabapentin have been associated with a dose-related increased risk of atrial fibrillation. The effects of gabapentin enacarbil (GBPe), a prodrug of gabapentin (GBP), on cardiac repolarization were investigated in a single-center, double-blind, randomized, placebo-controlled, escalating-dose, crossover trial in 32 healthy volunteers who received single doses of either GBPe 2400 mg, 3600 mg, 4800 mg, 6000 mg, or placebo [34]. Although QT prolongation has been linked to the use of certain drugs, it remains difficult to predict the relative risk associated with their administration. Pharmacists can make recommendations to clinicians to help promote safer prescribing practices when selecting QT-prolonging drugs. n engl j med 350;10 www.nejm.org march 4, 2004 The new england journal of medicine 1016 with the congenital long-QT syndrome. 39 The pro-longation of the QT interval to longer than 500 msec 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.
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