A Rare Case Report of “Torsades De Pointes” Induced by Fluconazole-Levetiracetam Combined Therapy

Drugs used to treat cardiovascular disease as well as those used in the treatment of multiple other conditions can occasionally produce exaggerated prolongation of the QT interval on the surface electrocardiogram and the morphologically distinctive polymorphic ventricular tachycardia that results is known as «torsade de pointe». «Torsade de pointe» (TDP) is a characteristic polymorphic ventricular arrhythmia associated with delayed ventricular repolarization as evidenced on the surface electrocardiogram by QT interval prolongation. It typically occurs in self-limiting bursts, causing dizziness and syncope, but may occasionally progress to ventricular fibrillation and sudden death. This rare case report showed the potential higher risk of the occurrences of «Tdp» when levetiracetam (KEPPRA) was used in combination therapy with fluconazole, which is already a known medication with the risk of causing polymorphic ventricular arrhythmia.

Severe primary hypothyroidism presenting as polymorphic ventricular tachycardia / Hipotiroidismo primario grave que se presenta como taquicardia ventricular polimórfica

Abstract Introduction: Hypothyroidism may have various cardiovascular manifestations due to morphological, functional and electrical alterations in the heart. The usual electrocardiographic findings being sinus bradycardia, low voltage complexes, and slowed intraventricular conduction. Hypothyroidism manifesting as polymorphic ventricular tachycardia has only been reported in a few case reports. Clinical case. A 60-year-old lady presented to us in the emergency department in an unresponsive and unconscious state and electrocardiogram showed a polymorphic ventricular tachycardia. After initial resuscitation with direct current cardioversion and supportive care, she found to have severe hypothyroidism and responded well to thyroid replacement therapy. Conclusion. Polymorphic ventricular tachycardia is a life threatening emergency that can have various etiologies. Polymorphic ventricular tachycardia secondary to primary hypothyroidism is a rare presentation but it is treatable and reversible with thyroid replacement therapy. In patients presenting with QT interval prolongation and ventricular tachycardia, hypothyroidism should be one of the differential diagnosis.

Resumen Introducción: El hipotiroidismo puede presentar diferentes manifestaciones cardiovasculares dadas por alteraciones morfológicas, funcionales y eléctricas en el corazón, siendo los hallazgos electrocardiográficos usuales son la bradicardia sinusal, los complejos de bajo voltaje y la conducción intraventricular lenta. El hipotiroidismo manifestado como taquicardia ventricular polimórfica solo se ha descrito en unos pocos reportes de caso. Caso clínico: Se trata de una mujer de 60 años que acudió que acurdió al servicio de urgencias en un estado inconsciente y sin respuesta a estímulos, y el electrocardiograma reveló taquicardia ventricular polimórfica. Luego de la reanimación inicial con cardioversión con corriente directa y tratamiento sintomático se le encontró un hipotiroidismo grave, el cual se trató con terapia de reemplazo con hormona tiroidea. y se obtuvo una buena respuesta Conclusión. La taquicardia ventricular polimórfica es una emergencia vital que puede tener varias etiologías. La taquicardia ventricular polimórfica secundaria a un hipotiroidismo primario es una presentación poco común, pero es tratable y reversible con la terapia de reemplazo con hormona tiroidea. En los pacientes que presentan una prolongación del intervalo QT y taquicardia ventricular, es pertinente incluir el hipotiroidismo en el diagnóstico diferencial.

The QT Interval: What the Pulmonologist Needs to Know

The QT interval is an electrocardiographical measurement that denotes the time interval between the commencement and completion of the cardiac ventricular contraction process. Alterations in its value indicate abnormal cardiac rhythm and herald the risk of torsades de pointes; a fatal ventricular arrhythmia. Causes leading to a prolonged QT interval encompass a heterogeneous gamut including genetic conditions, electrolyte imbalances, hormonal imbalances, and drugs. A wide range of drugs can lead to a prolonged QT interval and these include certain crucial drugs which are routinely prescribed by a pulmonologist for infectious as well as non-infectious pulmonary indications. This becomes particularly relevant in this decade which has witnessed an excrescence in drug-resistant tuberculosis cases. Certain vital drugs employed in its management prolong QT interval significantly. In these situations, the clinician faces the predicament of cautiously prescribing these drugs to eradicate the disease microbiologically whilst balancing the risk of sudden cardiac death due to torsades de pointes. We summarise the basics of QT interval which every pulmonologist presently needs to know.

Arritmias ventriculares en el síndrome de takotsubo: cuestión de sexo / Sex-related risk of arrhythmia in takotsubo syndrome

Resumen El síndrome de takotsubo, también conocido como miocardiopatía de estrés, representa un difícil reto diagnóstico, pues en muchos casos su presentación es superponible al infarto de miocardio por ruptura de placa; el diagnóstico definitivo se basa en la ausencia de lesiones culpables en la coronariografía. La fisiopatología de la enfermedad no está por completo establecida, y tiene un pronóstico generalmente benigno. Sin embargo, existe un porcentaje no despreciable de pacientes que sufren complicaciones graves, entre las que destacan las arritmias malignas tipo taquicardia ventricular polimórfica por prolongación del intervalo QT. A pesar de que el síndrome de takotsubo afecta principalmente a las mujeres, quienes por otra parte también suelen tener intervalos QT más prolongados en condiciones basales, la muerte súbita de origen arrítmico aparece con mayor frecuencia en los hombres que sufren esta enfermedad. Se presentan dos casos de ensanchamiento extremo del intervalo QT corregido en pacientes con takotsubo que tuvieron desenlaces diferentes. El propósito de este trabajo es destacar y revisar las diferencias electrocardiográficas y pronósticas relacionadas con el sexo de los sujetos que desarrollan esta controvertida enfermedad.

Abstract Takotsubo syndrome, also known as stress cardiomyopathy, is a difficult diagnostic challenge as, in many cases, its presentation can overlap with that of myocardial infarction due to plaque rupture. The definitive diagnosis is based on the lack of culprit lesions on coronariography. The pathophysiology of the disease has not been completely ascertained, and it has a generally benign prognosis. However, a not inconsiderable percentage of patients experience serious complications, notably malignant arrhythmias like polymorphic ventricular tachycardia due to a prolonged QT interval. Despite takotsubo syndrome affecting mainly women who, furthermore, generally have longer basal QT intervals, sudden death due to arrhythmias is more common in men with this disease. Two cases are presented of extremely prolonged corrected QT intervals in patients with takotsubo, with different outcomes. The purpose of this paper is to highlight and review the electrocardiographic and prognostic differences related to the gender of the individuals who develop this controversial disease.

A new ECG sign for sudden death: Transient prolonged QT interval following premature contraction / 中南大学学报(医学版)

Early recognition and treatment for early warning electrocardiogram (ECG) of sudden death are very important to prevent and treat malignant arrhythmia and sudden death. Previous studies have found that R-on-T and T wave alternation, and QT interval prolongation are closely related to malignant arrhythmia or sudden death, which are included in the critical value of ECG.By analyzing the ECG characteristics of 4 patients with sudden death, we found that although the causes of the patients were different, there were transient prolongation of QT interval after premature contraction in 12 lead ECG, followed by malignant arrhythmia or sudden death. Thus, we thought that the transient prolongation of QT interval after premature contraction had a high value for warning malignant arrhythmia or sudden death. This phenomenon should be paid enough attention to reduce the risk of sudden death.

Analysis of the Incidence and Clinical Significance of Long and Short Corrected QT Interval in Electrocardiogram in Healthy Population of Changsha in China

ABSTRACT Objective: To analyse the incidence of long and short corrected QT (QTc) in a healthy sample of the population of Changsha in China. Methods: Standard 12-lead electrocardiograms (ECGs) were performed on 4025 subjects in Changsha of China, whose age ranged from 6 minutes after birth to 83 years, between January 1993 and December 2012. Heart rate and QT interval were measured and recorded. Corrected QT was calculated with Bazett´s formula (QTc = QT/RR0.5). All recruited individuals had taken healthy examination, ruling out general health issue, in The Second Xiangya Hospital of Central South University. Statistical analyses were performed using the SPSS 16.0 software (IBM Corp, Armonk, NY, USA). Results: The incidence of short QTc was 7.13% (287/4025 cases). The peak values of the incidence were in the 30-40 years group (15.71%). The low values were in the 1-3 months group and 3-6 months group (0%, 0.76%), respectively. The incidence of long QTc was 3.16% (127/4025 cases). The values diminished significantly after adulthood. The low values were in the age groups of 18-30 years (0.86%) and 30-40 years (0.71%), respectively. After the age of 50 years, the incidence of long QTc increased with age 50-60 years and 60-70 years and 70-83 years (7.89%, 9.06%, 14.06%), respectively. There was no statistically significant difference between the genders (p > 0.05). Conclusion: The peak incidences of long and short QTc existed in two separate age groups in the healthy sample. The peak incidence of short QTc was in the age group of 18-40 years, and the peak incidence of long QTc was in the age group beyond the 50 years. For these two age groups, it was recommended to pay close attention to the changes in their QTc in order to prevent cardiovascular events.

Variables electrocardiográficas asociadas a la aparición de eventos cardiovasculares adversos en el infarto agudo de miocardio sin elevación del segmento ST / Electrocardiographic variables associated to the occurrence of adverse cardiovascular events in non-ST elevation acute myocardial infarction

Introducción: La frecuencia de infarto agudo de miocardio sin elevación del segmento ST se está incrementando y, con ella, los resultados adversos en pacientes con enfermedad coronaria isquémica aguda. Objetivo: Identificar las variables electrocardiográficas asociadas a la aparición de eventos cardiovasculares adversos en el infarto agudo de miocardio sin elevación del segmento ST. Método: Se realizó un estudio transversal, de tipo correlacional, con 68 pacientes con infarto agudo de miocardio sin elevación del segmento ST atendidos en el Hospital Arnaldo Milián Castro, en la provincia de Villa Clara. Se estudiaron los hallazgos electrocardiográficos y eventos cardiacos adversos durante el ingreso. Se hicieron análisis bivariados para establecer la relación de ambas variables, utilizando el estadígrafo chi cuadrado y el riesgo relativo. Resultados: Los hallazgos electrocardiográficos más frecuentes fueron la inversión de la onda T (#8805; 2mm), depresión del segmento ST y el QT corregido largo mediante la fórmula de Bazzet. El 26,5 por ciento presentaron eventos cardiovasculares adversos. La depresión del segmento ST, el QT largo corregido y la elevación del segmento ST en aVR se asociaron significativamente con eventos adversos intrahospitalarios (p lt; 0,05). Conclusiones: La asociación de la depresión del segmento ST, la elevación del segmento ST en aVR y el QT largo corregido con la ocurrencia de eventos cardiovasculares adversos intrahospitalarios, sugiere que estos hallazgos se pueden tener en cuenta como posibles indicadores de evolución desfavorable en pacientes con infarto agudo de miocardio sin elevación del segmento ST(AU)

Introduction: The frequency of non-ST elevation acute myocardial infarction is on the increase, and so is the number of adverse results in patients with acute ischemic coronary disease. Objective: Identify the electrocardiographic variables associated to the occurrence of adverse cardiovascular events in non-ST elevation acute myocardial infarction. Method: A cross-sectional correlational study was conducted of 68 patients with non-ST elevation acute myocardial infarction cared for at Arnaldo Milián Castro Hospital in the province of Villa Clara. Attention was paid to electrocardiographic findings and adverse cardiac events occurring during the hospital stay. Bivariate analyses were performed to establish the relationship between the two variables, using the chi square statigram and relative risk estimation. Results: The most common electrocardiographic findings were T-wave inversion (#8805; 2 mm), ST depression and long corrected QT by Bazzet's formula. Of the total study subjects 26.5 percent had adverse cardiovascular events. ST depression, long corrected QT and ST elevation in aVR were significantly associated to in-hospital adverse events (p < 0.05). Conclusions: Association of ST depression, ST elevation in aVR and long corrected QT with the occurrence of adverse in-hospital cardiovascular events suggests that these findings may be taken into account as possible indicators of an unfavorable evolution in patients with non-ST elevation acute myocardial infarction(AU)

Is Teneligliptin Safe in Patients with Diabetes Mellitus Mainly with Reference to QT Prolongation.

Diabetes mellitus (DM) is a chronic disease associated with polyurea, polydipsia, and polyphagia. It is associated severe complication if not controlled properly. The probability of developing cardiac arrythmia is more in patients with diabetes compared to general population. Previously, studies which used a maximum dose of 40 mg of Teneligliptin didn’t show any QT prolongation. There are hardly any studies which was done to prove the cardio safety of Teneligliptin. Therefore, we wanted to evaluate the prevalence of QT prolongation with teneligliptin in diabetic patients. MethodsWe analysed all patients who were treated with teneligliptin. We analysed ECG of all patients before and after therapy with teneligliptin. Our main aim was to compare the QT interval in ECG before and at the end of 3 months. We also analysed their HbA1c, fasting plasma glucose (FPG), and postprandial plasma glucose (PPG) before and after therapy. ResultsThe mean age of these patients was 55.5 ± 10.6 years. They were on treatment for diabetes with a mean duration of diabetes of 7.9 ± 5.7 years. All patients responded well to the treatment with a reduction in HbA1c, FBS and PPBS, all of those being statistically significant. When we analysed the QT interval of all patients before and after three months of therapy, there was no significant increase in the mean QTc interval at the end of 3 months. All of them tolerated the drug without any serious adverse effects. ConclusionsTeneligliptin in dose of 20 mg didn’t prolong QTc interval; meanwhile, it was found to be very effective in reducing the HbA1c, fasting plasma glucose, and post prandial plasma glucose at the end of 3 months.

Correlation between QoTc and serum as well as ionised calcium in sick neonates

Background: Hypocalcemia is a frequently observed clinical and laboratory abnormality in neonates with risk factors such as prematurity, infant of diabetic mothers and perinatal asphyxia. Hypocalcemia can be asymptomatic or can cause apnoea, seizures, jitteriness, stridor, cardiac abnormalities. Clinically as calcium levels are maintained within narrow ranges. It is therefore imperative to measure and correct any deficit at the earliest. Unfortunately, total serum calcium level correlates poorly with ionized calcium level. Measurement of ionized calcium is both time consuming and expensive and therefore the need for more rapid, inexpensive and non-invasive method for screening at risk-neonates. Serum calcium levels are known to affect the duration of the QoTc interval. Therefore establishing a good correlation between serum/ionized calcium levels and QoTc will validate ECG as a reliable marker of hypocalcemia. Objective was to find correlation between QoTc interval and serum calcium levels in sick neonates.Methods: Total 730 infants were for serum total calcium and ionized calcium levels. Off these 142 infants with hypocalcemia, 29 infants were excluded based on exclusion criteria. The remaining 113 neonates were subjected to three cycles of ECG measurement before correction of calcium and were taken as cases. QoTc intervals were measured and were correlated with corresponding serum total calcium and ionized calcium levels.Results: In this study, a moderate negative or downhill correlation was found between total serum calcium QoT (r = -0.694 and p = <0.001) and QoTc (r = -0.680 and p = <0.001). The ionized calcium levels were found to have strong negative or downhill correlation with QoT (r = -0.837 and p = <0.001), QoTc (r = -0.819 and p = <0.001). All these correlations were found to be statistically significant with p<0.05.Conclusions: QoTc interval can be used as a surrogate marker for blood total or ionized calcium levels.

Effect of CO2 Insufflation on Corrected QT Interval Prolongation during Laparoscopic Surgeries: A Prospective Observational Study

Introduction: Laparoscopic surgeries in various surgical specialties are most routinely performed with general anesthesia. Thephysiological effects of intra-abdominal CO2 insufflation combined with the variations in patient positioning can have a majorimpact on cardiorespiratory function. Prolongation of corrected QT interval (QTc) has been known to predispose torsades depointes, a potentially fatal ventricular arrhythmia may occur during CO2 insufflation. Our aim is to evaluate the effect of insufflationof CO2 on QT interval and QTc during prolonged laparoscopic surgeries.Methodology: Fifty patients of American Society of Anesthesiologists physical status 1 and 2, of either sex, between the agesof 25 and 65 years posted for laparoscopic surgeries included in the study. After general anesthesia, we measured mean arterialpressure, heart rate, SpO2 and ETCO2 before anesthesia induction, before CO2 insufflation, 30, 60, 120, and 150 min after CO2insufflation, 5 min after CO2 deflation, and at the end of surgery. We observed statistically significant increase of QTc intervalaround 120 min after CO2 insufflation.Conclusion: The cause of this QTc interval prolongation is multifactorial and clinical significance of producing life-threateningcardiac arrhythmias has to be determined.

Case of COVID-19 Pneumonia: Lessons Learnt

@#This is a case of a patient with Coronavirus (COVID-19) Pneumonia, with pneumonitis, complicated by transaminitis. Evidence for non-pharmacological approaches, such as prone positioning, and pharmacological management, such as Hydroxychloroquine and Azithromycin are discussed and evaluated. The sensitivity and specificity of COVID-19 swab tests, the association between COVID-19 infection and specific acute phase laboratory markers and current known evidence versus ongoing controversial debates revolving around the topic of COVID-19 infection have also been briefly explored.

A study of cardiological autonomic neuropathy in Type 2 Diabetes Mellitus with reference to QT interval for its diagnosis

Background: Presence of cardiac autonomic neuropathy (CAN) is responsible for silent myocardial infarction and sudden death in diabetics. Hence recognizing cardiac dysautonomia early, which is asymptomatic will help to delay or arrest its progression.Methods: A cross-sectional study to evaluate the Prevalence of Cardiovascular Autonomic Neuropathy in Type 2 diabetes and correlate it with duration of Diabetes and to investigate the relationship between cardiac autonomic dysfunction and corrected QT interval.Results: In the study population, the prevalence of definite CAN was 8%, 24% and 58% in group A, B and C respectively. The prevalence of definite CAN increases with increase in duration of diabetes. P value <0.001 significant.Conclusions: A significant correlation is present between Cardiovascular autonomic dysfunction and QTc prolongation. QTc interval in the ECG can be used to diagnose Cardiovascular autonomic neuropathy with a reasonable sensitivity and specificity.

Effect Of Various Phases Of Menstrual Cycle On Electrocardiogram In 18-22 Years Healthy Females

During the menstrual cycle phases changes in the levels of female sex hormones mainly estrogens and progesterone, have some possible influence over the clotting and fiinolytic activity of the blood, rhythmicity and conductivity of the electrical impulse of heart. Aim: Main objective of the study is to find out the effects of different phases of menstruation on ECG intervals. Methodology: This was a cross sectional descriptive study conducted in female nursing students aging18 to22 years were considered Sample size was decided to be 140 female nursing students from LN Nursing College, Bhopal. Inclusion criteria were normal healthy female aged 18 to 22 years with regular menstrual cycle (30 days +- 3 days) in previous six cycles. There Electrocardiographic changes were accessed in different phases of menstrual cycle. Results- In our study we found longest RR interval in secreatory phase in comparison to proliferative and menstrual phase. Shortest Bleeding Time was found in menstrual phase. The results related to QT and QTc intervals shows that longest clotting time measures in proliferative phase as comparison to Menstrual and secreatory phase. Shortest QT and QTc intervals were found in secreatory phase

Repolarización ventricular en la terapia oncológica / Ventricular repolarization in cancer therapy

RESUMEN Se discuten los procesos de despolarización y repolarización ventriculares, con su falta de uniformidad y su heterogeneidad, tanto en pacientes con corazón sano como en aquellos enfermos, cuestión de rangos. Se analizan las mediciones que expresan las características de la repolarización ventricular: el intervalo QT y otras mediciones incluso más fidedignas como el intervalo TPICO-TFINAL, su dispersión y otras. Se precisa la existencia del signo y del síndrome de QT largo, así como los tres procesos básicos de la arritmogenia: la heterogeneidad, la alternancia y la dispersión, con las diferencias de los potenciales de acción en las tres zonas del miocardio ventricular. Se precisan los factores de riesgo del QT largo (común con esta terapia), de las arritmias ventriculares (en especial la torsión de puntas, extremadamente rara en estos casos) y se discute la necesidad de valorar datos clínicos, eléctricos, comorbilidades, conflictos agregados y las medidas a tomar en estos pacientes.

ABSTRACT Ventricular depolarization and repolarization processes are discussed, including their differences and heterogeneity both in patients with a healthy/sick heart, a matter of ranges. Measurements expressing the characteristics of ventricular repolarization are analyzed: the QT interval and other even more reliable measurements such as the TPEAK-TEND interval, its dispersion and others. We emphasize on the existence of the long QT syndrome (and sign) and the three basic processes of arrhythmogenesis: heterogeneity, alternation and dispersion, with differences in action potentials in the three zones of the ventricular myocardium. The risk factors of long QT (common in this therapy) and ventricular arrhythmias (especially torsades de pointes, extremely rare in these cases) are highlighted. The need to assess clinical and electrical features, comorbidities, aggregate conflicts, and management of these patients is also discussed.

Study of Corrected QT Dispersion in Acute ST-elevation Myocardial Infarction (Thrombolysed/ Non-Thrombolysed) Patients and its Prognostic Significant During Hospital Stay

Introduction: In the electrocardiogram, the QT interval reflects the duration of depolarization and repolarization of the ventricularmyocardium thus reflects changes in local myocardial milieu. Dispersion of repolarization is thought to reflect regional heterogeneityof the recovery process within the myocardium, which believed to be important in the genesis of ventricular arrhythmias.Purpose of Study: The purpose of the present study was to predict the risk of life-threatening ventricular arrhythmias andother cardiac complications after acute ST-elevation myocardial infarction (STEMI) event with using rate adjusted corrected QT(QTc) dispersion as one of the cheapest modalities and non-invasive investigation, which may reflect as a prognostic marker.Materials and Methods: The present study had been carried out in the Department of Medicine, NSCB. Medical College andassociated Hospital, Jabalpur, Madhya Pradesh, India, from March 2017 to August 2018. This was a case–control prospectiveobservational study. The targeted populations were 60 cases of both sexes with the age group of ≥18–≤70 years, and age- andsex-matched 60 apparently healthy control subjects.Results: Mean QTc dispersion was increased in patients of acute MI compared to control subjects; which were found statisticallyhighly significant. The mean QTc dispersion remained consistently high in a group of patients with cardiac complications incomparison to patients without cardiac complications on day 1 up to discharge. The mean QTc dispersion was found high inpatients who were died compared to who were survived on day 1.Conclusion: It could be concluded that QTc dispersion measurement may provide a potentially simple, cheap, and non-invasivemethod of identification of patients with acute MI (STEMI) at risk of development of ventricular arrhythmias and also relates tothe prognosis in that patients and the future may prove to be an independent predictor of death.

Comparación de cuatro fórmulas para ajustar el intervalo QT a la frecuencia cardiaca en pacientes cardiópatas / Comparison of four formulas to adjust the QT interval to the heart rate in a cardiac patient / Comparação de quatro fórmulas para ajustar o intervalo QT à freqüência cardíaca em pacientes com doença cardíaca

Resumen. Introducción: La prolongación del intervalo QT en el electrocardiograma es un conocido factor de riesgo para desarrollar eventos cardiovasculares. En Latinoamérica existe poca evidencia acerca de la epidemiología de este tipo de alteraciones electrocardiográficas. El objetivo de este estudio fue evaluar la prevalencia del intervalo QT corregido largo según cuatro fórmulas. Metodología: Estudio descriptivo retrospectivo. Se realizó una revisión de 156 registros electrocardiográficos de 12 derivaciones realizados a pacientes mayores a 40 años. Las medidas se realizaron manualmente y posteriormente los valores se ajustaron a la frecuencia cardiaca mediante cuatro fórmulas validadas existentes. Se consideró intervalo QT largo cuando la duración sobrepasaba los 470 ms. Resultados: De los 156 registros analizados, 55.7% de los registros pertenecieron a pacientes de sexo femenino y la edad media fue 70.3 ± 9.7 años. 9.6% de los registros fueron considerados como largos mediante la fórmula de Bazzet, 4.4% mediante la fórmula de Hodges, 3.8% mediante la fórmula de Fridericia y 3.2% mediante la fórmula deFramingham. La fórmula de Fridericia fue hallada como la más consistente para ajustar el intervalo QT a la frecuencia cardiaca. Conclusión: Dependiendo de la fórmula utilizada la prevalencia del intervalo QT largo varió significativamente. La fórmula de Fridericia fue la que demostró mejor consistencia.

Abstract. Introduction: The prolongation of the QT interval in the electrocardiogram is a well-known risk factor for developing cardiovascular events. In Latin America there is no much evidence about the epidemiology of electrocardiographic alterations. The objective of this study was to evaluate the prevalence of long corrected QT interval according to four formulas. Methodology: Retrospective descriptive study. A total of 156 electrocardiographic records of 12 referrals made to patients older than 40 years were review. The measurements were made manually and later the values ​​were adjusted to the heart rate by means of four existing validated formulas. The long QT interval was considered when the duration exceeded 470ms. Results: Of the 156 records analyzed, 55.7% of the records belonged to female patients and the mean age was 70.3 ± 9.7 years. 9.6% of the records were considered long using the Bazzet formula, 4.4% according to the Hodges formula, 3.8% according to the Fridericia formula and 3.2% according to the Framingham formula. The formula of Fridericia was found to be the most consistent to adjust the QT interval to the heart rate. Conclusion: Depending on the formula used, the prevalence of the long QT interval varied significantly. The formula of Fridericia was the one that showed the best consistency.

Resumo. Introdução: O prolongamento do intervalo QT no eletrocardiograma é um fator de risco conhecido para o desenvolvimento de eventos cardiovasculares. Na América Latina, há poucas evidências sobre a epidemiologia desse tipo de alteração eletrocardiográfica. O objetivo deste estudo foi avaliar a prevalência do intervalo QT longo corrigido de acordo com quatro fórmulas. Metodologia: Estudo descritivo retrospectivo. Uma revisão de 156 registros eletrocardiográficos de 12 derivações realizadas em pacientes com mais de 40 anos foi realizada. As medidas foram feitas manualmente e posteriormente os valores foram ajustados à freqüência cardíaca por meio de quatro fórmulas validadas existentes. O intervalo QT longo foi considerado quando a duração ultrapassou 470 ms. Resultados: Dos 156 prontuários analisados, 55,7% dos prontuários pertenciam a pacientes do sexo feminino e a média de idade foi de 70,3 ± 9,7 anos. 9,6% dos registros foram considerados longos usando a fórmula de Bazzet, 4,4% usando a fórmula de Hodges, 3,8% usando a fórmula de Fridericia e 3,2% usando a fórmula de Fraingham. A fórmula de Fridericia foi considerada a mais consistente para ajustar o intervalo QT à frequência cardíaca. Conclusão: Dependendo da fórmula utilizada, a prevalência do intervalo QT longo variou significativamente. A fórmula da Fridericia foi a que apresentou a melhor consistência.

​Effect Of Teneligliptin On Qt Interval In Type Ii Diabetes Mellitus Patients: A Retrospective Evaluation

Background and Aim: According to a strict QT/QTc evaluation study and clinical studies for type 2 diabetes conducted in Japanand other countries, NO AEs related to QT prolongation were detected with 40 mg/day of teneligliptin, which is the maximaldosage used in clinical practice. So far, there are no data regarding the safety of teneligliptin in Indian type 2 diabetic patientswith respect to QTc prolongation. Therefore, the study was conducted to evaluate the safety of teneligliptin in type 2 diabeticpatients with respect to QT prolongation.Methods: A retrospective data were collected from type 2 diabetes mellitus patients with electrocardiogram (ECG) recordswho were treated with teneligliptin along with ongoing treatment. Primary endpoint was to compare the change in the ECGat 3 months from the baseline from the collected data. Mean daily dose (MDD) of antidiabetic drugs, HbA1c, fasting plasmaglucose (FPG), and postprandial plasma glucose (PPG) was also analyzed.Results: A total of 49 patients’ data were collected and analyzed with a mean age of 55.5 years and mean duration ofdiabetes 9.3 years. Hypertension was the most common comorbid disease (63.3%) along with diabetes for a mean durationof 10.0 years. Metformin plus glimepiride were the most prescribed dual drugs (63.3%) along with teneligliptin with an overallMDD of metformin (1065.2 mg) and glimepiride (2.1 mg). From the collected data, there was significant reduction in FPG andPPG at 3 months which were 49.6 mg/dL (P < 0.0001) and 100.5 mg/dL (P < 0.0001) reduction observed from the baseline,respectively. Significant changes were observed in the HbA1c from the baseline to 3 months (0.9%, P < 0.0001). There wasno significant increase in the mean QTc interval from baseline to 3 months. No serious adverse events or hypoglycemiawere reported.Conclusion: Teneligliptin was well tolerated with no significant change in QTc prolongation and significantly effective in reducingthe FPG, PPG, and HbA1c at 3 months from the baseline with no adverse events. There was no increase in the mean QT interval.

Antipsychotics and sudden cardiac death risk factors / 中华行为医学与脑科学杂志

Antipsychotics treatment significantly increases the risk of sudden cardiac death in psy-chiatric patients,especially in elder patients. This paper reviews the major clinical risk factors of sudden car-diac death including myocardial infarction,QT interval prolongation and venous thromboembolism,as well as discusses the possible pharmacological mechanisms. We should focus on assessing somatic factors at the on-set of treatment and during maintenance therapy,and choose the antipsychotics reasonably to reduce the pos-sibility of sudden cardiac death.