Electrocardiographic Findings in Children Treated with Leuprolide Acetate for Precocious Puberty: Does it Cause Prolonged QT?

Introduction: Central precocious puberty is treated with long-acting GnRH analogues. Some adult patients undergoing GnRHa treatment experienced prolonged QT syndrome, which is associated with an increased risk of serious cardiac events such as myocardial infarction, stroke, arrhythmias, and sudden cardiac death. Method: Seventy-four patients, aged between 5 and 11 years and diagnosed with central precocious puberty but with no other concomitant disease or medication use, underwent electrocardiogram assessment. They had been receiving 3.75 mg leuprolide acetate (Lucrin® Depot) injections every 28 days for at least three months. Results: The electrocardiograms of all patients showed a QTc interval within normal limits, consistent with the data of healthy Turkish children of the same age and gender. No other pathological physical examination or ECG findings were observed. Furthermore, there was no significant difference in QTc interval in relation to age, anthropometric data, or the duration or cumulative dose of the treatment. Conclusion: The study found no correlation between QTc interval values and age, treatment duration, total cumulative dose, and anthropometric data. The findings suggest that cardiovascular adverse events associated with GnRHa may be related to age and other underlying physiopathological conditions rather than the drug.

Pediatric and Familial Genetic Arrhythmia Syndromes-Evaluation of Prolonged QTc-Differential Diagnosis and what You Need to Know.

The case series reviews differential diagnosis of a genetic arrhythmia syndrome when evaluating a patient with prolonged QTc. Making the correct diagnosis requires: detailed patient history, family history, and careful review of the electrocardiogram (ECG). Signs and symptoms and ECG characteristics can often help clinicians make the diagnosis before genetic testing results return. These skills can help clinicians make an accurate and timely diagnosis and prevent life-threatening events.

QTNet: Predicting Drug-Induced QT Prolongation With Artificial Intelligence-Enabled Electrocardiograms.

BACKGROUND: Prediction of drug-induced long QT syndrome (diLQTS) is of critical importance given its association with torsades de pointes. There is no reliable method for the outpatient prediction of diLQTS. OBJECTIVES: This study sought to evaluate the use of a convolutional neural network (CNN) applied to electrocardiograms (ECGs) to predict diLQTS in an outpatient population. METHODS: We identified all adult outpatients newly prescribed a QT-prolonging medication between January 1, 2003, and March 31, 2022, who had a 12-lead sinus ECG in the preceding 6 months. Using risk factor data and the ECG signal as inputs, the CNN QTNet was implemented in TensorFlow to predict diLQTS. RESULTS: Models were evaluated in a held-out test dataset of 44,386 patients (57% female) with a median age of 62 years. Compared with 3 other models relying on risk factors or ECG signal or baseline QTc alone, QTNet achieved the best (P < 0.001) performance with a mean area under the curve of 0.802 (95% CI: 0.786-0.818). In a survival analysis, QTNet also had the highest inverse probability of censorship-weighted area under the receiver-operating characteristic curve at day 2 (0.875; 95% CI: 0.848-0.904) and up to 6 months. In a subgroup analysis, QTNet performed best among males and patients ≤50 years or with baseline QTc <450 ms. In an external validation cohort of solely suburban outpatient practices, QTNet similarly maintained the highest predictive performance. CONCLUSIONS: An ECG-based CNN can accurately predict diLQTS in the outpatient setting while maintaining its predictive performance over time. In the outpatient setting, our model could identify higher-risk individuals who would benefit from closer monitoring.

Complete Heart Block Induced Torsades de Pointes.

High-degree atrioventricular node block is a known cause of bradycardia. Heart rate and QT interval have an inverse relation. Therefore, bradycardia can lead to prolonged QT interval, which can predispose patients to Torsades de Pointes, a life-threatening arrhythmia. Correcting the underlying etiology can often reverse the arrhythmia and prevent recurrence. For this reason, recognizing the etiology of this arrhythmia plays an essential role in management.

Decision Support System Detecting Patients at Risk of Prolonged QT and Associated Mortality.

Prolonged QT interval is an independent risk factor for all-cause mortality. However, evaluation of mortality associated to the implementation of a clinical decision support system to increase awareness and provide management recommendations has been challenging. Here we present our attempt to develop a model using only electronic data and different control groups.

Cardiomyopathy in cirrhosis: From pathophysiology to clinical care.

Cirrhotic cardiomyopathy (CCM) is defined as systolic or diastolic dysfunction in the absence of prior heart disease or another identifiable cause in patients with cirrhosis, in whom it is an important determinant of outcome. Its underlying pathogenic/pathophysiological mechanisms are rooted in two distinct pathways: 1) factors associated with portal hypertension, hyperdynamic circulation, gut bacterial/endotoxin translocation and the resultant inflammatory phenotype; 2) hepatocellular insufficiency with altered synthesis or metabolism of substances such as proteins, lipids, carbohydrates, bile acids and hormones. Different criteria have been proposed to diagnose CCM; the first in 2005 by the World Congress of Gastroenterology, and more recently in 2019 by the Cirrhotic Cardiomyopathy Consortium. These criteria mainly utilised echocardiographic evaluation, with the latter refining the evaluation of diastolic function and integrating global longitudinal strain into the evaluation of systolic function, an important addition since the haemodynamic changes that occur in advanced cirrhosis may lead to overestimation of systolic function by left ventricular ejection fraction. Advances in cardiac imaging, such as cardiac magnetic resonance imaging and the incorporation of an exercise challenge, may help further refine the diagnosis of CCM. Over recent years, CCM has been shown to contribute to increased mortality and morbidity after major interventions, such as liver transplantation and transjugular intrahepatic portosystemic shunt insertion, and to play a pathophysiologic role in the genesis of hepatorenal syndrome. In this review, we discuss the pathogenesis/pathophysiology of CCM, its clinical implications, and the role of cardiac imaging modalities including MRI. We also compare diagnostic criteria and review the potential diagnostic role of electrocardiographic QT prolongation. At present, no definitive medical therapy exists, but some promising potential treatment strategies for CCM are reviewed.

Ramen noodle neuropathy: an atypical case of partial paralysis from malnutrition.

INTRODUCTION: Due to a COVID-related job loss resulting in financial and food insecurity, a 28-year-old woman initiated a diet consisting solely of one cup of ramen noodles daily for twenty-two months, leading to 27 kg of weight loss. Ramen noodles are low in calories and lack key nutrients, including potassium, chloride, and vitamin B12. CASE DESCRIPTION: The patient presented to the emergency department with acute, worsening weakness and paresthesias in her left wrist and hand. Exam revealed no other abnormalities aside from a cachectic appearance. Labs revealed marked hypokalemia, hypochloremia, lactic acidosis, a mixed metabolic alkalosis with respiratory acidosis, and low levels of zinc and copper. An EKG revealed a prolonged QT interval. After a neurology and psychiatry consult, the patient was admitted for failure to thrive with malnutrition, peripheral neuropathy, hypokalemia, and an acid-base disorder. An MRI of the brain was unremarkable. Studies of other nutritional deficiencies, autoimmune conditions, and sexually transmitted infections were unremarkable. The patient received food and vitamin supplementation, was monitored for re-feeding syndrome, and had a significant recovery. DISCUSSION: After stroke, spinal injury, multiple sclerosis, and the most common focal mononeuropathies were ruled out, the clinical focus turned to nutritional deficiencies, the most significant of which was hypokalemia. Prior research has shown that severe hypokalemia can lead to weakness. It has also shown that chronically insufficient dietary intake is a common cause of hypokalemia. This case, with its partial paralysis of a unilateral upper extremity, may add to the known clinical manifestations of hypokalemia. We review the role of hypokalemia and hypochloremia in acid-base dynamics. Etiologies and clinical manifestations of cobalamin, thiamine, pyridoxine, and copper deficiencies, along with lead toxicity, are also discussed. Diagnostic clarity of mononeuropathies in the context of malnutrition and hypokalemia can be aided by urine potassium levels prior to repletion, neuroimaging that includes the cervical spine, and follow-up electromyography.

Corrected QT Interval (QTc) Diagnostic App for the Oncological Routine: Development Study.

BACKGROUND: Numerous antineoplastic drugs such as chemotherapeutics have cardiotoxic side effects and can lead to long QT syndrome (LQTS). When diagnosed and treated in time, the potentially fatal outcomes of LQTS can be prevented. Therefore, regular electrocardiogram (ECG) assessments are critical to ensure patient safety. However, these assessments are associated with patient discomfort and require timely support of the attending oncologist by a cardiologist. OBJECTIVE: This study aimed to examine whether this approach can be made more efficient and comfortable by a smartphone app (QTc Tracker), supporting single-lead ECG records on site and transferring to a tele-cardiologist for an immediate diagnosis. METHODS: To evaluate the QTc Tracker, it was implemented in 54 cancer centers in Germany. In total, 266 corrected QT interval (QTc) diagnoses of 122 patients were recorded. Moreover, a questionnaire on routine ECG workflow, turnaround time, and satisfaction (1=best, 6=worst) was answered by the centers before and after the implementation of the QTc Tracker. RESULTS: Compared to the routine ECG workflow, the QTc Tracker enabled a substantial turnaround time reduction of 98% (mean 2.67, 95% CI 1.72-2.67 h) and even further time efficiency in combination with a cardiologic on-call service (mean 12.10, 95% CI 5.67-18.67 min). Additionally, nurses and patients reported higher satisfaction when using the QTc Tracker. In particular, patients' satisfaction sharply improved from 2.59 (95% CI 2.41-2.88) for the routine ECG workflow to 1.25 (95% CI 0.99-1.51) for the QTc Tracker workflow. CONCLUSIONS: These results reveal a significant improvement regarding reduced turnaround time and increased user satisfaction. Best patient care might be guaranteed as the exposure of patients with an uncontrolled risk of QTc prolongations can be avoided by using the fast and easy QTc Tracker. In particular, as regular side-effect monitoring, the QTc Tracker app promises more convenience for patients and their physicians. Finally, future studies are needed to empirically test the usability and validity of such mobile ECG assessment methods. TRIAL REGISTRATION: ClinicalTrials.gov NCT04055493; https://classic.clinicaltrials.gov/ct2/show/NCT04055493.

Efecto de los fármacos en la prolongación del QT y la aparición de muerte súbita en la COVID-19 / Effect of Drugs on QT Prolongation and Sudden Death in COVID-19

Introducción: Las evidencias científicas han demostrado que durante el período pandémico por la COVID-19 ha existido un incremento de la incidencia de muerte súbita cardiovascular, proporcional al incremento de los casos y a la letalidad por la enfermedad. Objetivos: Compilar información sobre los fármacos empleados en el tratamiento de la COVID-19 y sus posibles efectos en la prolongación del intervalo QT y la aparición de muerte súbita. Métodos: Se realizó una búsqueda de información a partir de las bases de datos PubMed, Medline y SciELO, en los idiomas español e inglés en el período de enero de 2020 a enero de 2023. Resultados: Los hallazgos más recientes sugieren que los factores relacionados con el tratamiento médico del paciente para sus enfermedades cardiovasculares previas, el empleo concomitante de drogas para otras comorbilidades, el ensayo de nuevas drogas que se investigan en la actualidad para el tratamiento de la enfermedad y el uso inadecuado de fármacos en complicaciones graves por la COVID-19, pueden ocasionar prolongación del intervalo QT y arritmias ventriculares tipo torsades de pointes, lo que puede conllevar a la aparición de muerte súbita. Conclusiones: Ha sido demostrado el efecto deletéreo de los fármacos en el tratamiento de la COVID-19 y sus posibles asociaciones a la terapéutica del paciente, en la prolongación del tiempo de repolarización ventricular cardíaca, cuya traducción eléctrica es un intervalo QT prolongado y su contribución a la génesis de arritmias malignas potencialmente fatales capaces de desencadenar un paro cardíaco y evolucionar a la muerte súbita(AU)

Scientific evidence has shown an increase in the incidence of sudden cardiovascular death during the COVID-19 pandemic period. This has been proportional to the increase in cases and mortality from the disease. Direct and indirect injury to the myocardium and vascular system allow to partially explain the statistics. Among the factors related to the medical treatment of the patient for previous cardiovascular diseases, it is the concomitant use of drugs for other comorbidities. The trial of new drugs for the treatment of this condition and the inappropriate use of drugs in serious complications from COVID-19 are currently being investigated. These can cause QT prolongation and torsades de pointes ventricular arrhythmias, which can lead to sudden death. Monitoring the QT interval is recommended, before and during treatment, in patients who come to the emergency room with a clinical condition suggestive of COVID-19. Additionally, modifiable factors favoring its prolongation should be evaluated. Decision-making in the application of therapeutic protocols in patients with COVID-19 with prolonged QTc at baseline, or with increased QTc after starting treatment, must go through the analysis of the risk/benefit ratio defined by a multi- and interdisciplinary team(AU)

Taquicardia ventricular polimórfica tipo torsadess de pointes secundaria a estimulación por marcapasos / Polymorphic ventricular taquicardia "torsades de pointes" associated to abnormal pacemaker stimulation

La taquicardia ventricular polimórfica se origina en los ventrículos, cuyos complejos QRS son de morfología, amplitud y dirección variable, con frecuencias que oscilan entre 200 y 250 lpm, pudiendo ser autolimitadas o degenerar en una fibrilación ventricular. La TdP es un tipo de taquicardia ventricular polimórfica caracterizada por complejos con un eje eléctrico que gira alrededor de la línea isoeléctrica y que está asociada a QT largo. Se presenta el caso de una paciente portadora de marcapaso que presenta episodios de taquicardia ventricular polimórfica, con una morfología típica de TdP, sin documentación de QT prolongado previo ni actual, generada por la estimulación ventricular sobre onda T, de forma accidental por desplazamiento del electrodo auricular a Ventrículo Derecho (VD).

Polymorphic ventricular tachycardia is a tachycardia originating in the ventricles, where the QRS complexes have variable morphology, amplitude, and direction, with frequencies ranging between 200 and 250 bpm; it may be self-limited or degenerate into ventricular fibrillation. Torsades de Pointes (TdP) is a type of polymorphic ventricular tachycardia characterized by complexes with an electrical axis that rotates around the isoelectric line and that is associated with long QT interval. We present the case of a patient with a pacemaker who presents episodes of polymorphic ventricular tachycardia, with a typical morphology of TdP, without documentation of previous or current prolonged QT, generated by ventricular stimulation on the T wave, accidentally due to displacement of the atrial electrode to the Right Ventricle (RV).

Atrial fibrillation and QT prolongation after a single dose of hydroxychloroquine / Fibrilación auricular y prolongación del QT después de una dosis única de hidroxicloroquina

Non-antiarrhythmic drugs may induce QT-prolongation and increase the risk of arrhythmias. Recent studies have determined that there is a risk of atrial fibrillation (AF) due to QT prolongation. We report a case of FA associated to QT prolongation secondary to a single dose of hydroxychloroquine (HCQ) in an 83-years-old polymedicated patient admitted to our hospital due to SARS-CoV-2 infection. Quetiapine was prescribed as regular medicine after admission and a 5-days oral HCQ regimen was started for COVID-19. Thirty minutes after HCQ loading dose, FA was reported on electrocardiogram (EKG). COVID-19 treatment is leading to use off-label drugs that may generate adverse effects. It should be considered that drugs that induce QT prolongation may be triggers for atrial arrhythmias. There is not any report of sudden onset of increased QT interval with associated arrythmia after a single dose of HCQ, even in a short course treatment. (AU)

Los fármacos no antiarrítmicos pueden inducir la prolongación del intervalo QT y aumentar el riesgo de arritmias. Estudios recientes han determinado que existe riesgo de desarrollar fibrilación auricular (FA) asociada a la prolongación del intervalo QT. Presentamos un caso de FA asociado a prolongación del QT secundario a una dosis única de hidroxicloroquina (HCQ) en una paciente polimedicada de 83 años ingresada en nuestro hospital por infección por SARS-CoV-2. A la paciente se le prescribió quetiapina como parte de su medicamento habitual al ingreso y se inició tratamiento frente a COVID-19 basado en HCQ oral. Treinta minutos tras la dosis de carga de HCQ, se informó FA en el electrocardiograma (ECG). El tratamiento de COVID-19 está llevando al uso de medicamentos no aprobados que pueden generar efectos adversos. Además, debe considerarse que los fármacos que inducen la prolongación del QT pueden desencadenar arritmias auriculares. No se han reportado casos de aparición repentina de aumento del intervalo QT con arritmia asociada después de una dosis única de HCQ. (AU)

QTc is Prolonged in Patients with SSc and Associates with Skin Score.

Background: Systemic sclerosis is an autoimmune disease characterised by endothelial dysfunction and fibrosis of the skin and internal organs. Cardiac involvement during systemic sclerosis can be primary or secondary to pulmonary arterial hypertension and renal pathology. Among the disorders in systemic sclerosis, prolongation of QTc time is also associated with more anti-RNA polymerase III antibodies, longer duration, and severity of disease. Methods: This case-control study was performed on 35 patients with systemic scleroderma who filled in the American Society of Rheumatism (ACR / EULAR criteria) and 35 healthy subjects prior to entering the study. Then, the QTc distance was extracted from the electrocardiogram and calculated using the formula. The measured QTc distance in the electrocardiogram, QTc> 440ms in men and QTc> 460ms in women, was defined as QTc long. The patients and the control group then underwent echocardiography, and changes in QTc interval and their relations with echocardiographic findings were evaluated. Results: The results of this study indicated a significant relationship between QTc distance in patients with scleroderma compared with healthy controls. There was also a significant relationship between QTc and Skin Score of patients. However, there was no significant correlation between QTc distance and age, duration of disease, Anti-Centromere, Anti-Scl70, and pulmonary artery pressure. Conclusion: This study concludes that patients with scleroderma are at high risk for cardiac conduction impairment. The only factor that significantly correlated with QTc was the Skin Score of the patients.

Bradycardia-Induced Torsades de Pointes in Atrioventricular Block.

Bradycardia is known to prolong QT interval. Persistent bradycardia and high-grade atrioventricular (AV) block may lead to persistently prolonged QTc interval with a risk for life-threatening ventricular arrhythmias, which needs addressing the underlying cause. We present the case of a patient with persistent sinus bradycardia with a high-grade AV block leading to persistently prolonged QTc without any reversible etiology that resulted in torsades de pointes. The underlying treatment involved shortening the QTc by increasing the heart rate to prevent any further episodes of polymorphic ventricular tachycardia.

Changes in QT Interval in Maintenance Hemodialysis Patients: Pre-Dialysis, One Hour after Initiation of Dialysis, and Post-Dialysis.

INTRODUCTION: This study aimed to evaluate the effects of dialysis on change of QT interval in pre-dialysis, 1 h after dialysis initiation, and post-dialysis period in patients on maintenance dialysis (MHD). METHODS: An observational prospective study was conducted, including 61 patients, on thrice-weekly MHD ≥3 months, and without acute diseases, at the Nephrology-Dialysis Department of a tertiary hospital in Vietnam. The exclusive criteria were atrial fibrillation, atrial flutter, branch block, prolonged QT recorded in medical history, and taking antiarrhythmic drugs lengthening QT interval before entering the study. Twelve-lead electrocardiographs and blood chemistries were done simultaneously before, 1 h after initiation, and after the dialysis session. RESULTS: The proportion of patients with prolonged QT interval increased significantly from 44.3% in pre-dialysis to 77% 1 h after dialysis initiation and 86.9% in post-dialysis session. Immediately after dialysis, the QT and QTc intervals on all 12 leads were significantly longer. Post-dialysis levels of potassium, chloride, magnesium, and urea decreased significantly from 3.97 (0.7), 98.6 (4.7), 1.04 (0.2), and 21.4 (6.1) to 2.78 (0.4), 96.6 (2.5), 0.87 (0.2), and 6.33 (2.8) mmol/L, respectively, whereas the calcium increased significantly from 2.19 (0.2) to 2.57 (0.2) mmol/L. There were significant differences in the potassium level at the dialysis initiation and its speed of reduction between the group without and with prolonged QT interval. CONCLUSIONS: There was an increased risk of prolonged QT interval in MHD patients regardless of the absence of the previous abnormal QT interval. Notably, this risk increased rapidly 1 h after the initiation of dialysis.

Unusual Cardiac Manifestations of a Pheochromocytoma in a Girl.

We report the case of an 11-year-old girl who complained about severe asthenia, orthostatic dizziness and abdominal pain for 4 weeks. The primary investigation concluded on febrile urinary tract infection treated by antibiotics. Symptom persistence prompted cardiological and endocrinological investigations. A fluctuation in blood pressure, long QT interval, dilation of the aortic root and left ventricular hypertrophy were documented. Elevated levels of urinary catecholamines together with the presence of a right-sided adrenal mass shown via abdominal ultrasound and magnetic resonance imaging were highly suggestive of a pheochromocytoma. This was confirmed by through iodine-123-metaiodobenzylguathdine ([123I]-mIBG) scintigraphy. Genetic analysis allowed for the exclusion of pathogenic mutations in genes implicated in hereditary paragangliomas and pheochromocytomas but showed a rare somatic mutation in exon 3 of the von Hippel-Lindau gene. The patient was treated with a ß-blocker and calcium channel antagonist and underwent laparoscopic right-sided adrenalectomy. Cardiac manifestations resolved soon after surgery indicating that they were secondary to the pheochromocytoma. After 5 years of follow-up, the patient remains asymptomatic without any sign of tumor recurrence. The presence of aortic root dilation, a prolonged QT-interval and left ventricular hypertrophy may be early cardiac manifestations of a pheochromocytoma in a child and should prompt this diagnosis to be evoked.

Hypocalcemia as a cause of reversible heart failure: A case report and review of the literature.

Introduction: In both pediatric and adult populations, hypocalcemia-induced heart failure is an extremely rare presentation. The aim of the current study is to report a case of reversible heart failure caused by severe hypocalcemia resulting from hypoparathyroidism, which was resolved by correcting the serum calcium level. Case report: A 29-year-old female presented with orthopnea, dyspnea on mild exertion, and bilateral lower limb swelling. She had a positive Trousseau's sign. Vital signs were stable except for tachycardia. On chest auscultation, there were bilateral basal fine inspiratory crackles. She was immediately treated as a case of pulmonary edema with intravenous furosemide and oxygen therapy. Subsequent treatment for correcting the hypocalcemia was then initiated. Discussion: Hypocalcemia has been proven to influence cardiac function, resulting in lower cardiac contractility as determined by decreased left ventricular work index, stroke index, and cardiac index. In rare circumstances, the clinical, biochemical (elevation of cardiac enzymes), electrocardiographic, and echocardiographic data may lead to an incorrect diagnosis of an acute ischemic attack. Conclusion: Hypocalcemia as a possible factor leading to heart failure should be considered in the differential diagnosis of all individuals with congestive heart failure.

Appropriate prescribing of azithromycin for community-acquired pneumonia.

Azithromycin is prescribed for atypical antimicrobial cover in severe community-acquired pneumonia. Inappropriate azithromycin administration incurs unnecessary financial costs, exacerbates antimicrobial resistance and risks QTc interval prolongation leading to cardiac arrhythmias. The present study demonstrated that a majority of patients were prescribed azithromycin without having electrocardiograms to assess the QTc interval and without meeting criteria for severe community-acquired pneumonia based on CURB-65 score.

Riesgo de prolongación del intervalo QT asociado al tratamiento / The risk of treatment-induced QT interval prolongation

Objetivo: La prolongación del intervalo QT puede aumentar la estanciahospitalaria y la tasa de mortalidad de los pacientes. Esta investigacióndetermina la incidencia de prolongación del intervalo QT debido al usode medicamentos y evalúa el método más apropiado para realizar elmonitoreo electrocardiográfico.Método: Se realizó un estudio observacional retrospectivo en pacienteshospitalizados en el Hospital Clínica Bíblica durante el año 2018. Serevisaron los expedientes de los pacientes con hospitalización superiora 48 horas cuya historia clínica incluyera al menos tratamiento con unmedicamento que prolongara el intervalo QT y que las medidas manualesdel intervalo QT fueran corregidas con la fórmula Fridericia y Rautaharju,y las medidas automáticas con la fórmula Bazett. La valoración del riesgose realizó con la escala RISQ-PATH.Resultados: De los 141 pacientes analizados, 23 tenían una arritmia previaen su historia clínica y 14 de ellos sufrieron complicaciones durante la hospitalización.Un total de 113 (80%) pacientes tenían un valor alto RISQ‑PATHy sólo a 64 se les realizó un electrocardiograma al ingreso. En promedio,los pacientes recibieron tres medicamentos que aumentaban el intervalo QT.La mayoría de los QT obtenidos automáticamente fueron más cortos queaquellos obtenidos en forma manual. De todas las correcciones, los valoresdel intervalo QT más largos se obtuvieron con la fórmula de Bazett, y los máscortos con la fórmula Rautaharju. No ocurrieron eventos como taquicardiaventricular compleja o torsade de pointes durante el estudio.Conclusiones: Es necesario implementar estrategias que permitan una mejor monitorización del intervalo QT con el fin de prevenir las complicacionesderivadas en los pacientes ospitalizados

Objective: QT interval prolongation can increase patients’ hospitalstay and mortality rate. This study aims to determine the incidence ofdrug-induced QT interval prolongation and establish which QT intervalmeasurement method is the most appropriate for electrocardiographicmonitoring.Method: A retrospective observational study was conducted of patientsadmitted to the Clínica Bíblica Hospital during 2018. The electronic medicalrecords of patients hospitalized for longer than 48 hours and whosedrug regimen included at least one drug potentially able to prolong the QTinterval were reviewed. Manually-measured QT intervals were correctedusing Fridericia’s and Rautaharju’s formulae, while automatically-measuredQT intervals were corrected with Bazett’s formula. Risk was assessed usingthe RISQ-PATH scale.Results: Of the 141 patients analyzed, 23 had arrhythmia as per theirclinical history and 14 suffered a complication during their stay in hospital.A total of 113 (80%) had a high RISQ-PATH score and only 64 were subjectedto an electrocardiogram on admission. Patients received a meanof three potentially QT interval prolonging drugs. Most of the QT ntervalsmeasured automatically were shorter than those obtained manually. Of allcorrections, the longest QTc interval values were obtained with Bazett’sformula, and the shortest with Rautaharju’s formula. None of the patientsdeveloped TdP or complex ventricular tachycardia.Conclusions: Every effort should be made to implement strategies conducive to more effective monitoring of the QT interval to prevent QT intervalprolongation related complications in hospitalized patients

Treatment of status epilepticus and prolonged QT after massive intentional bupropion overdose with lidocaine.

Bupropion is an atypical antidepressant often used in the treatment of depression, tobacco cessation, seasonal affective disorder, and off label for ADHD. Its primary mechanism of action is by blocking dopamine and norepinephrine reuptake and it is structurally similar to amphetamines. Toxic effects include, most notably and classically, seizures as well as tachycardia, agitation, nausea and vomiting, QT prolongation, QRS widening, hypertension/hypotension. It has a narrow therapeutic window with maximal daily dosing being 450 mg daily. We are reporting the case of a 14-year-old female who ingested 15 g of extended-release bupropion resulting in agitation, status epilepticus, prolonged QT devolving into pulseless Ventricular Tachycardia and briefly V Fib, requiring a total of 5 cardioversions and 1 defibrillation. The QT interval eventually narrowed after supportive care and lidocaine drip. The patient was able to be extubated just two days later with full cognitive function and echocardiogram without cardiac dysfunction. Seizure and cardiotoxicity (including prolonged QT) have been previously described with massive bupropion overdoses. To our knowledge, deterioration to Ventricular Tachycardia and Ventricular Fibrillation with successful treatment and shortening of QT interval with lidocaine bolus and drip has not been reported. Cardiotoxicity related to bupropion has previously been primarily supportive and avoidance of QT prolonging antiarrhythmics such as amiodarone, and at times requiring VA ECMO. Lidocaine has previously been used in tox cases to shorten QT intervals. The hope is for this information to be helpful to other EM and Critical Care providers when placed in similarly difficult circumstances.