This Article  • Full text  • PDF  • Correction  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (109)  • Contact me when this article is cited  Related Content  • Related letters  • Related articles  • Similar articles in JAMA  Social Bookmarking   What's this?

Sana M. Al-Khatib, MD, MHS; Nancy M. Allen LaPointe, PharmD; Judith M. Kramer, MD, MS; Robert M. Califf, MD

JAMA. 2003;289:2120-2127.

Context  Of the several factors implicated in causing QT interval prolongation and torsades de pointes, errors in the use of medications that may prolong this interval deserve special attention.

Objective  To systematically summarize the available clinical data on the QT interval and to offer improved recommendations for the use of QT-prolonging medications.

Data Sources  We searched MEDLINE from 1966 through 2002 for all English-language articles related to the QT interval. Additional data sources included bibliographies of articles identified on MEDLINE, a survey of experts, and data presented at a meeting of experts on long QT syndrome.

Study Selection  We selected for review registries and case series examining clinical outcomes of patients with prolonged QT interval and the effect of different methods of measurement of the QT interval on patient outcomes. Ten studies were identified, of which 6 were included in the analysis.

Data Extraction  Data quality was determined by publication in the peer-reviewed literature.

Data Synthesis  Optimal measurement of the QT interval is problematic because of lack of standardization and lack of data regarding the best way to adjust for heart rate. Reliable information on the proper use of QT-prolonging medications is scarce. Although a QT interval of at least 500 milliseconds generally has been shown to correlate with a higher risk of torsades de pointes, there is no established threshold below which prolongation of the QT interval is considered free of proarrhythmic risk. The risk of torsades de pointes should be assessed in patients who are about to begin taking a QT-prolonging medication. Although inadequate clinical studies preclude prediction of absolute risk for individual patients, particularly high-risk situations can be defined based on clinical variables. We propose recommendations on proper monitoring of the QT interval in patients receiving QT-prolonging medications.

Conclusion  Although the use of QT-prolonging medications can predispose to torsades de pointes, there is a relative paucity of information that can help clinicians and patients make optimal informed decisions about how best to minimize the risk of this serious complication.

Author Affiliations: Duke Center for Education and Research on Therapeutics, Duke Clinical Research Institute, Durham, NC.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED LETTERS

Medications That Prolong the QT Interval
Mori J. Krantz, Bridget A. Martell, Julia H. Arnsten, and Marc N. Gourevitch
JAMA. 2003;290(8):1025.
EXTRACT | FULL TEXT  

Medications That Prolong the QT Interval
John A. Gillespie and Cathryn M. Clary
JAMA. 2003;290(8):1025.
EXTRACT | FULL TEXT  

Medications That Prolong the QT Interval
Carol Cappuccio
JAMA. 2003;290(8):1026.
EXTRACT | FULL TEXT  

RELATED ARTICLES

Long QT Syndrome
Arthur J. Moss
JAMA. 2003;289(16):2041-2044.
EXTRACT | FULL TEXT  

Electrocardiograms
Sharon Parmet, Cassio Lynm, and Richard M. Glass
JAMA. 2003;289(16):2166.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Interpreting data about prolongation of the Q-Tc interval induced by amiodarone and haloperidol
Cherry et al.
Am J Health Syst Pharm 2009;66:1254-1255.
FULL TEXT  

Starvation Diets as a Cause of Acquired Long QT Syndrome
Petrov
ANN INTERN MED 2009;150:501-501.
FULL TEXT  

QTc Interval Screening in Methadone Treatment
Krantz et al.
ANN INTERN MED 2009;150:387-395.
ABSTRACT | FULL TEXT  

Effects of concomitant amiodarone and haloperidol on Q-Tc interval prolongation
Bush et al.
Am J Health Syst Pharm 2008;65:2232-2236.
ABSTRACT | FULL TEXT  

High free thyroxine levels are associated with QTc prolongation in males
van Noord et al.
J Endocrinol 2008;198:253-260.
ABSTRACT | FULL TEXT  

Effects of Aliskiren, a Direct Renin Inhibitor, on Cardiac Repolarization and Conduction in Healthy Subjects
Ayalasomayajula et al.
J Clin Pharmacol 2008;48:799-811.
ABSTRACT | FULL TEXT  

Seven Evidence-Based Practice Habits: Putting Some Sacred Cows Out to Pasture
Rauen et al.
Crit Care Nurse 2008;28:98-123.
FULL TEXT  

Torsades de pointes in a patient receiving fluconazole for cerebral cryptococcosis
McMahon and Grayson
Am J Health Syst Pharm 2008;65:619-623.
ABSTRACT | FULL TEXT  

Pharmacist Monitoring of QTc Interval-Prolonging Medications in Critically Ill Medical Patients: A Pilot Study
Ng et al.
The Annals of Pharmacotherapy 2008;42:475-482.
ABSTRACT | FULL TEXT  

Managing an Acute Pain Crisis in a Patient With Advanced Cancer: "This Is as Much of a Crisis as a Code"
Moryl et al.
JAMA 2008;299:1457-1467.
ABSTRACT | FULL TEXT  

Ciprofloxacin-induced Q-T interval prolongation
Knorr et al.
Am J Health Syst Pharm 2008;65:547-551.
ABSTRACT | FULL TEXT  

Persistent Atrial Fibrillation Is Associated With Reduced Risk of Torsades de Pointes in Patients With Drug-Induced Long QT Syndrome
Darbar et al.
J Am Coll Cardiol 2008;51:836-842.
ABSTRACT | FULL TEXT  

Alfuzosin Delays Cardiac Repolarization by a Novel Mechanism
Lacerda et al.
J. Pharmacol. Exp. Ther. 2008;324:427-433.
ABSTRACT | FULL TEXT  

Cardiovascular Safety and Toxicity Profile of New Molecularly Targeted Anticancer Agents
Saad et al.
Am Soc Clin Oncol Ed Book 2008;2008:428-434.
ABSTRACT | FULL TEXT  

Prevalence and significance of an isolated long QT interval in elite athletes
Basavarajaiah et al.
Eur Heart J 2007;28:2944-2949.
ABSTRACT | FULL TEXT  

Molecularly Targeted Oncology Therapeutics and Prolongation of the QT Interval
Strevel et al.
JCO 2007;25:3362-3371.
ABSTRACT | FULL TEXT  

Evidence-based review of the black-box warning for droperidol
Jackson et al.
Am J Health Syst Pharm 2007;64:1174-1186.
ABSTRACT | FULL TEXT  

Moxifloxacin and Torsade de Pointes
Dale et al.
The Annals of Pharmacotherapy 2007;41:336-340.
ABSTRACT | FULL TEXT  

Curbing The Cardiovascular Disease Epidemic: Aligning Industry, Government, Payers, And Academics
Califf et al.
Health Aff (Millwood) 2007;26:62-74.
ABSTRACT | FULL TEXT  

Development of torsade de pointes caused by exacerbation of QT prolongation during clipping of cerebral artery aneurysm in a patient with subarachnoid haemorrhage
Takenaka et al.
Br J Anaesth 2006;97:533-535.
ABSTRACT | FULL TEXT  

Acute respiratory distress syndrome with transiently impaired left ventricular function and Torsades de Pointes arrhythmia unmasking congenital long QT syndrome in a 25-yr-old woman
Hinterseer et al.
Br J Anaesth 2006;97:150-153.
ABSTRACT | FULL TEXT  

Long QTc Interval and Torsade de Pointes Caused by Fluconazole
Pham et al.
The Annals of Pharmacotherapy 2006;40:1456-1461.
ABSTRACT | FULL TEXT  

Drug-Induced Long QT Syndrome in Injection Drug Users Receiving Methadone: High Frequency in Hospitalized Patients and Risk Factors.
Ehret et al.
Arch Intern Med 2006;166:1280-1287.
ABSTRACT | FULL TEXT  

Sudden cardiac death and antipsychotics. Part 2: Monitoring and prevention
Abdelmawla and Mitchell
Adv. Psychiatr. Treat. 2006;12:100-109.
ABSTRACT | FULL TEXT  

Prolonged QTc Interval and Risk of Sudden Cardiac Death in a Population of Older Adults
Straus et al.
J Am Coll Cardiol 2006;47:362-367.
ABSTRACT | FULL TEXT  

QT and QTc Interval With Standard and Supratherapeutic Doses of Darifenacin, a Muscarinic M3 Selective Receptor Antagonist for the Treatment of Overactive Bladder
Serra et al.
J Clin Pharmacol 2005;45:1038-1047.
ABSTRACT | FULL TEXT  

Long QT syndrome presenting as epileptic seizures in an adult
Hunt and Tang
Emerg. Med. J. 2005;22:600-601.
ABSTRACT | FULL TEXT  

Psychiatry and Cardiovascular Disease
Schulman et al.
Focus 2005;3:208-224.
ABSTRACT | FULL TEXT  

Conventional and Atypical Antipsychotics and the Risk of Hospitalization for Ventricular Arrhythmias or Cardiac Arrest
Liperoti et al.
Arch Intern Med 2005;165:696-701.
ABSTRACT | FULL TEXT  

Practice Standards for Electrocardiographic Monitoring in Hospital Settings: An American Heart Association Scientific Statement From the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: Endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical-Care Nurses
Drew et al.
Circulation 2004;110:2721-2746.
ABSTRACT | FULL TEXT  

Drugs and the QT Interval -- Caveat Doctor
Liu and Juurlink
NEJM 2004;351:1053-1056.
FULL TEXT  

Consideration of QT/QTc Interval Data in a Phase I Study in Patients with Advanced Cancer
Varterasian et al.
Clin. Cancer Res. 2004;10:5967-5969.
FULL TEXT  

Drug-Induced Prolongation of the QT Interval
Korantzopoulos et al.
NEJM 2004;350:2618-2621.
FULL TEXT  

Prolonged QTc Interval and Risks of Total and Cardiovascular Mortality and Sudden Death in the General Population: A Review and Qualitative Overview of the Prospective Cohort Studies
Montanez et al.
Arch Intern Med 2004;164:943-948.
ABSTRACT | FULL TEXT  

Sudden Cardiac Death Among Women in the United States * Response
Schwartz et al.
Circulation 2003;108 :e153-e153.
FULL TEXT  

Medications That Prolong the QT Interval
Krantz et al.
JAMA 2003;290:1025-1025.
FULL TEXT  

Medications That Prolong the QT Interval
Cappuccio
JAMA 2003;290:1026-1026.
FULL TEXT  

Medications That Prolong the QT Interval
Gillespie and Clary
JAMA 2003;290:1025-1025.
FULL TEXT