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Drug-induced QT interval prolongation: mechanisms and clinical management

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TLDR
This review focuses on the mechanism of drug-induced QT prolongation, risk factors for TdP, culprit drugs, prevention and monitoring of prolonged drug- induced QT prolongedation and treatment strategies.
Abstract
The prolonged QT interval is both widely seen and associated with the potentially deadly rhythm, Torsades de Pointes (TdP). While it can occur spontaneously in the congenital form, there is a wide array of drugs that have been implicated in the prolongation of the QT interval. Some of these drugs have either been restricted or withdrawn from the market due to the increased incidence of fatal polymorphic ventricular tachycardia. The list of drugs that cause QT prolongation continues to grow, and an updated list of specific drugs that prolong the QT interval can be found at www.qtdrugs.org. This review focuses on the mechanism of drug-induced QT prolongation, risk factors for TdP, culprit drugs, prevention and monitoring of prolonged drug-induced QT prolongation and treatment strategies.

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Risk factors for QTc-prolongation: systematic review of the evidence

TL;DR: This systematic review gives a clear overview of the available evidence for a broad range of risk factors for QTc-prolongation.
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Life Threatening Severe QTc Prolongation in Patient with Systemic Lupus Erythematosus due to Hydroxychloroquine

TL;DR: A case of a syncopal episode resulting from significant QT interval prolongation in a patient on hydroxychloroquine for the treatment of systemic lupus erythematosus and end stage renal disease is presented.
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Development of Safe Drugs: The hERG Challenge.

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Chloroquine and hydroxychloroquine in coronavirus disease 2019 (COVID-19). Facts, fiction and the hype: a critical appraisal.

TL;DR: Hydroxychloroquine is used as a desperate attempt for prophylaxis and treatment of COVID-19, the coronavirus infection that has wide-ranging drug interactions and potential cardiotoxicity.
References
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Journal ArticleDOI

Drug-induced prolongation of the QT interval.

TL;DR: The single most common cause of the withdrawal or restriction of the use of marketed drugs has been QT-interval prolongation associated with polymorphic ventricular tachycardia, or torsade de pointes, a condition that can be fatal.
Journal ArticleDOI

hERG potassium channels and cardiac arrhythmia

TL;DR: Insights gained from the crystal structures of other potassium channels have helped understanding of the block of hERG channels and the mechanisms of gating.
Journal ArticleDOI

Spectrum of Mutations in Long-QT Syndrome Genes KVLQT1, HERG, SCN5A, KCNE1, and KCNE2

TL;DR: KVLQT1 and HERG accounted for 87% of identified mutations, and SCN5A, KCNE1, and KCNE2 accounted for the other 13%, and Missense mutations were most common, followed by frameshift mutations, in-frame deletions, and nonsense and splice-site mutations.
Journal ArticleDOI

Dofetilide in patients with congestive heart failure and left ventricular dysfunction. Danish Investigations of Arrhythmia and Mortality on Dofetilide Study Group.

TL;DR: In patients with congestive heart failure and reduced left ventricular function, dofetilide was effective in converting atrial fibrillation, preventing its recurrence, and reducing the risk of hospitalization for worsening heart failure.
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