QT interval prolongation and the rate of malignant ventricular dysrhythmia and cardiac arrest in adult poisoned patients - 29/07/21
Abstract |
Introduction |
Prolongation of QTc interval, a common electrocardiographic (ECG) abnormality encountered in the toxicology patient, is reportedly associated with an increased risk of malignant ventricular dysrhythmias (MVD), such as ventricular tachycardia (VT, with and without a pulse), ventricular fibrillation (VF), and/or cardiac arrest. Quantifiable cardiac arrest risk in relation to specific QTc interval length is not known in this population.
Methods |
We conducted a retrospective, observational study to assess the rate of cardiac arrest and its association with degree of QTc prolongation in a cohort of patients requiring toxicology consultation.
Results |
550 patients were included in our analysis (average age 36 years and 49% male). Average QTc was 453 milliseconds (ms). Overall incidence of cardiac arrest in the study cohort was 1.1% with 6 reported cases; when considering patients with QTc > 500 ms, incidence was 1.7%. Two patients with cardiac arrest experienced ventricular dysrhythmia with decompensation prior to cardiac arrest; four patients developed sudden cardiac arrest.
Conclusions |
The risk of malignant ventricular dysrhythmia, including cardiac arrest, is low in this poisoned patient population with an overall rate of 1.1%. Two-thirds of cardiac arrest cases occurred in patients with normal QTc intervals. When considering patients with prolonged QTc intervals, the rate of cardiac arrest remains very low at 0.8%. Considering QTc greater than 500 ms, the rate of cardiac arrest is 1.7%. Further prospective studies are required to quantify the risk of malignant ventricular dysrhythmias, including cardiac arrest, and its relation to the degree of QTc interval in poisoned patients.
Le texte complet de cet article est disponible en PDF.Keywords : QTc interval, Drug induced QTc prolongation, Ventricular dysrhythmia, Malignant ventricular dysrhythmia, Cardiac arrest, Ingestion, Overdose, Poisoning
Plan
Vol 46
P. 156-159 - août 2021 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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