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QT-interval prolongation due to medication found in the preoperative evaluation

  • Seto, Mika (Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Fukuoka University) ;
  • Koga, Sayo (Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Fukuoka University) ;
  • Kita, Ryosuke (Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Fukuoka University) ;
  • Kikuta, Toshihiro (Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Fukuoka University)
  • Received : 2017.11.26
  • Accepted : 2017.12.15
  • Published : 2017.12.31

Abstract

QT prolongation is an electrocardiographic change that can lead to lethal arrhythmia. Acquired QT prolongation is known to be caused by drugs and electrolyte abnormalities. We report three cases in which the prolonged QT interval was improved at the time of operation by briefly discontinuing the drugs suspected to have caused the QT prolongation observed on preoperative electrocardiography. The QTc of cases 1, 2, and 3 improved from 518 to 429 ms, 463 to 441 ms, and 473 to 443 ms on discontinuing the use of a gastrointestinal prokinetic agent, a proton pump inhibitor, and a molecular targeted drug, respectively. These cases were considered to have drug-induced QT prolongation. We reaffirmed that even drugs administered for conditions unrelated to cardiac diseases can have adverse side effect of QT prolongation. In conclusion, our cases indicate that dental surgeons should be aware of the dangerous and even potentially lethal side effects of QT prolongation. For safe oral and maxillofacial surgery, cooperation with medical departments in various fields is important.

Keywords

References

  1. Kezerashvili A, Khattak H, Barsky A, Nazari R, Fisher JD. Azithromycin as a cause of QT-interval prolongation and torsade de pointes in the absence of other known precipitating factors. J Interv Card Electrophysiol 2007;18: 243-6. https://doi.org/10.1007/s10840-007-9124-y
  2. Leitch A, McGinness P, Wallbridge D. Calculate the QT interval in patients taking drugs for dementia. BMJ 2007;335: 557. https://doi.org/10.1136/bmj.39020.710602.47
  3. Tisdale JE. Drug-induced QT interval prolongation and torsades de pointes: role of the pharmacist in risk assessment, prevention and management. Can Pharm J 2016; 149: 139-52. https://doi.org/10.1177/1715163516641136
  4. Moss AJ, Schwartz PJ, Crampton RS, Tzivoni D, Locati EH, MacCluer J, et al. The long QT syndrome. Prospective longitudinal study of 328 families. Circulation 1991; 84: 1136-44. https://doi.org/10.1161/01.CIR.84.3.1136
  5. Morganroth J, Horowitz LN. Incidence of proarrhythmic effects from quinidine in the outpatient treatment of benign or potentially lethal ventricular arrhythmias. Am J Cardiol 1985; 56: 585-7. https://doi.org/10.1016/0002-9149(85)91015-X
  6. Soyka LF, Wirtz C, Spangenberg RB. Clinical safety profile of sotalol in patients with arrhythmias. Am J Cardiol 1990;65: 74-81, 82-3.
  7. Litwin JS, Kleiman RB, Gussak I. Acquired (Drug-Induced) Long QT Syndrome. In: Electrical Diseases of the Heart. Edited by Gussak I, Antzelevitch C, Wilde AAM, Friedman PA, Ackerman MJ, Shen WK. London, Springer. 2008, pp 705-18.
  8. Frampton JE. Prucalopride. Drugs 2009; 69: 2463-76. https://doi.org/10.2165/11204000-000000000-00000
  9. Pratt CM, Singh SN, Al-Khalidi HR, Brum JM, Holroyde MJ, Marcello SR, et al. The efficacy of azimilide in the treatment of atrial fibrillation in the presence of left ventricular dysfunction: results from the Azimilide Postinfarct Survival Evaluation (ALIVE) trial. J Am Coll Cardiol 2004; 43: 1211-6. https://doi.org/10.1016/j.jacc.2003.10.057
  10. ICH Harmonised Tripartite Guideline. The clinical evaluation of QT/QTc interval prolongation and proarrhythmic potential for non-antiarrhythmic drugs. E14. 2005. Available from www.ich.org/fileadmin/Public_Web_Site/ICH_Products/Guidelines/Efficacy/E14/E14_Guideline.pdf.