QT Interval Prolongation and Antiretroviral Treatment: Another Point of Interest

Chinello, Pierangelo; Petrosillo, Nicola

doi:10.1086/516614

Cited by 10 publications

(5 citation statements)

References 16 publications

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“…There is controversy about the impact of Efavirenz on QT length regardless of its subsequent clinical manifestations. 9,[16][17][18][19] Nevertheless, most studies such as the one by Charbit et al, found that prolonged QT is associated with conventional factors as well as chronicity of HIV infection rather than with ART drugs. 20 We found that Efavirenz regimen increased the length of corrected QT interval overall and in males while females were not affected.…”

Section: Discussionmentioning

confidence: 99%

Association between exposure to Efavirenz and substrates of dysrhythmia in HIV‐infected young adults

Hosseini

Mollazadeh

Dehghan-Manshadi

et al. 2021

Clinical Cardiology

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Background: Dysrhythmia and sudden cardiac arrest occur more likely in HIV patients than healthy subjects. Thus, we need to examine dysrhythmias adverse effects of medications including Efavirenz as early as possible especially in young subjects.Hypothesis: Efavirenz might have contributed to increased risk of developing common types of dysrhythmia in young HIV infected patients.Methods: We performed a retrospective cohort study among 62 patients on Efavirenz and 38 controls. All participants were under 40 years old without cardiovascular disease. Total significant dysrhythmia in 24-hour ECG monitoring was the primary endpoint determined as the composite of high premature ventricular contraction (PVC) (>500 beats per 24 hours), high premature atrial contraction (PAC) (>500 bp24h), sinus pause, atrioventricular blocks, ventricular tachycardia, prolonged QTc, and low heart rate variability (HRV). Modified composite dysrhythmia consisted of low HRV (SD of normal-to-normal [SDNN]), high PVC and prolonged QT.Results: Mean heart rate, Efavirenz regimen, male gender, and CD4 count predicted total dysrhythmia. Odds ratios were 1.108, 2.90, 4.36, and 0.96, respectively. The incidence of total dysrhythmia, high PVC, high PAC, low HRV(SDNN), and prolonged QTc were 54.8%, 41.85%, 9.71%, 45.2%, and 12.9% in patients on Efavirenz against 42.11%, 31.64%, 0%, 34.2%, and 7.91% in controls, respectively (p-values: .031, .001, <.0001, .063, and .043 respectively). Modified composite dysrhythmia was also more frequent in Efavirenz group than that of control group (69.42% vs. 52.60%, respectively p = .032).

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Section: Discussionmentioning

confidence: 99%

Association between exposure to Efavirenz and substrates of dysrhythmia in HIV‐infected young adults

Hosseini

Mollazadeh

Dehghan-Manshadi

et al. 2021

Clinical Cardiology

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“…drugs, electrolyte disturbances, diabetes, liver and renal disease, etc). Indeed, both HIV infection and antiretroviral drugs can prolong the QTc interval [24] Continuous monitoring has demonstrated that variation of the QTc interval is common during acute illness and that its prolongation is associated with mortality [25] . Recently institution wide systems have been introduced to detect it [26] .…”

Section: Discussionmentioning

confidence: 99%

Prognostic performance of ECG abnormalities compared to vital signs in acutely ill patients in a resource-poor hospital in Uganda

Namujwiga

Nakitende

Kellett

et al. 2019

African Journal of Emergency Medicine

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Background There are few reports of electrocardiogram (ECG) findings and their prognostic value in acutely ill patients admitted to low resource hospitals in sub-Saharan Africa. Methods We undertook an observational study of acutely ill medical patients admitted to a low-resource hospital in Uganda. Vital signs were used to calculate the National Early Warning Score (NEWS), and all ECGs were assessed using Tan et al.’s scoring system as described in Clin Cardiol 2009;32:82–86. Results There were 1361 ECGs performed, covering 68% of all acutely ill medical patients admitted to the hospital during the study. The most common ECG abnormality was a prolonged QTc interval (42% of all patients) and left ventricular hypertrophy (13.5%). Compared to the 519 patients (38%) with no Tan score abnormality, the 842 (62%) patients with one or more abnormalities were more likely to die in hospital (OR = 2.82; CI 95% = 1.50–5.36) and within 30 days of discharge (OR = 2.46; CI 95% = 1.50–4.08). There was no relationship between age and mortality; however, after adjustment by logistic regression, any NEWS ≥1 on admission, a Tan score of ≥1, and male sex all remained clinically significant predictors of both in-hospital and 30-day mortality. Discussion The majority of acutely ill medical patients admitted in a low-resource hospital in sub-Saharan Africa had ECG abnormalities, of which prolonged QTc and left ventricular hypertrophy were most common. Those with any Tan score abnormality were twice as likely to die as those without an abnormality.

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“…QTc prolongation leads to a risk of ventricular arrhythmias, especially torsades de pointes, after the administration of macrolides, fluoroquinolones, halofantrine (antimalarial), pentamidine, azole antifungals [49,50], as well as with the combination of ceftriaxone and lansoprazole [51] or with antiretroviral drugs [52]. QTc altered after trimethroprim-sulfamethoxazole may be rare [53].…”

Section: Medicationmentioning

confidence: 99%

Management of arrhythmia in sepsis and septic shock

Borggrefe¹,

Matoušek²,

Malý³

et al. 2017

Anaesthesiol Intensive Ther

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The occurrence of supraventricular arrhythmias is associated with an unfavourable prognosis in septic shock. Available trials are difficult to apply in sepsis and septic shock patients due to included cohorts, control groups and because "one size does not fit all". The priorities in the critically ill are maintenance of the sinus rhythm and diastolic ventricular filling. The rate control modality should be reserved for chronic AF and in situations when the sinus rhythm is difficult to maintain due to extreme stress conditions resulting from a high dosage of vasoactive agents. Electric cardioversion is indicated in unstable patients with an absence of contraindications and is more feasible in combination with an antiarrhythmic agent. Besides amiodarone being preferred for its lower cardiodepressant side effect compared to other agents, drugs with a different degree of betablocking activity are very useful in supraventricular arrhythmias and septic shock, providing echocardiography is routinely used to support their indications within the current summary of product characteristics. A typical patient benefiting from propafenone is without significant structural heart disease, i.e. typically with normal to moderately reduced left ventricular systolic function. Future research should be channelled towards echocardiography-guided prospective controlled trials on antiarrhythmic therapy which may clarify the issue of rhythm versus rate control, the effects of various antiarrhythmic drugs, and a place for electric cardioversion in critically ill patients in septic shock.

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QT Interval Prolongation and Antiretroviral Treatment: Another Point of Interest

Cited by 10 publications

References 16 publications

Association between exposure to Efavirenz and substrates of dysrhythmia in HIV‐infected young adults

Association between exposure to Efavirenz and substrates of dysrhythmia in HIV‐infected young adults

Prognostic performance of ECG abnormalities compared to vital signs in acutely ill patients in a resource-poor hospital in Uganda

Management of arrhythmia in sepsis and septic shock

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