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Electrocardiographic and clinical predictors of torsades de pointes induced by almokalant infusion in patients with chronic atrial fibrillation or flutter: a prospective study

The aim of this study was to identify predictors of torsades de pointes (TdP) in patients with atrial fibrillation (AF) or flutter exposed to the Class III antiarrhythmic drug almokalant. TdP can be caused by drugs that prolong myocardial repolarization. One hundred patients received almokalant infu...

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Main Authors: Houltz, Birgitta (Author) , Darpö, Börje (Author) , Edvardsson, Nils (Author) , Blomström, Per (Author) , Brachmann, Johannes (Author) , Crijns, Harry J.g.m. (Author) , Jensen, Steen M. (Author) , Svernhage, Elisabeth (Author) , Vallin, Hans (Author) , Swedberg, Karl (Author)
Format: Article (Journal)
Language:English
Published: May 1998
In: Pacing and clinical electrophysiology
Year: 1998, Volume: 21, Issue: 5, Pages: 1044-1057
ISSN:1540-8159
DOI:10.1111/j.1540-8159.1998.tb00150.x
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1111/j.1540-8159.1998.tb00150.x
Verlag, lizenzpflichtig, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1540-8159.1998.tb00150.x
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Author Notes:Birgitta Houltz, Börje Darpö, Nils Edvardsson, Per Blomström, Johannes Brachmann, Harry J.g.m. Crijns, Steen M. Jensen, Elisabeth Svernhage, Hans Vallin, Karl Swedberg
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Summary:The aim of this study was to identify predictors of torsades de pointes (TdP) in patients with atrial fibrillation (AF) or flutter exposed to the Class III antiarrhythmic drug almokalant. TdP can be caused by drugs that prolong myocardial repolarization. One hundred patients received almokalant infusion during AF (infusion 1) and 62 of the patients during sinus rhythm (SR) on the following day (infusion 2). Thirty-two patients converted to SR. Six patients developed TdP. During AF, T wave alternans was more common prior to infusion (baseline) in patients developing TdP (50% vs 4%, P < 0.01). After 30 minutes of infusion 1, the TdP patients exhibited a longer QT interval (493 ± 114 vs 443 ± 54 ms [mean ± SD], P < 0.01), a larger precordial QT dispersion (50 ± 74 vs 27 ± 26 ms, P < 0.05), and a lower T wave amplitude (0.12 ± 0.22 vs 0.24 ± 0.16 mV. P < 0.01). After 30 minutes of infusion 2, they exhibited a longer QT interval (672 ± 26 vs 489 ± 74 ms, P < 0.001), a larger QT dispersion in precordial (82 ± 7 vs 54 ± 52 ms, P < 0.01) and extremity leads (163 ± 0 vs 40 ± 34 ms, P < 0.001), and T wave alternans was more common (100% vs 0%, P < 0.001). Risk factors for development of TdP were at baseline: female gender, ventricular extrasystoles, and treatment with diuretics; and, after 30 minutes of infusion: sequential bilateral bundle branch block, ventricular extrasystoles in bigeminy, and a biphasic T wave. Patients developing TdP exhibited early during almokalant infusion a pronounced QT prolongation, increased QT dispersion, and marked morphological T wave changes.
Item Description:Elektronische Reproduktion der Druck-Ausgabe 30. Juni 2006
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Physical Description:Online Resource
ISSN:1540-8159
DOI:10.1111/j.1540-8159.1998.tb00150.x

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