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Deprecated: Implicit conversion from float 213.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Card+Electrophysiol+Clin 2016 ; 8 (2): 481-93 Nephropedia Template TP
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Proarrhythmic and Torsadogenic Effects of Potassium Channel Blockers in Patients #MMPMID27261836
McCauley M; Vallabhajosyula S; Darbar D
Card Electrophysiol Clin 2016[Jun]; 8 (2): 481-93 PMID27261836show ga
The most common arrhythmia requiring drug therapy is atrial fibrillation, which affects 2?5 million Americans and continues to be a major cause of morbidity and increased mortality. Despite recent advances in catheter-based and surgical therapies, antiarrhythmic drugs continue to be the mainstay of therapy for most patients with symptomatic AF. However, many antiarrhythmics block the rapid component of the cardiac delayed rectifier potassium current (IKr) as a major mechanism of action, and marked QT prolongation and pause-dependent polymorphic ventricular tachycardia (torsades de pointes) are major class toxicities. Although this arrhythmia is usually seen in patients with one of the congenital long QT syndromes, torsades de pointes has also been observed with certain antibiotics, antipsychotics, antihistamines and chemotherapeutic agents and is a leading cause of post-market drug withdrawal and relabeling. Clinical risk factors associated with drug-induced long QT syndrome include female gender, bradycardia, electrolyte disturbances, recent conversion from atrial fibrillation to sinus rhythm, variations in drug distribution and sub-clinical long QT syndrome. A unifying concept of reduced repolarization reserve has been proposed to explain the variable risk of torsades de pointes. In this monograph, we provide a historical perspective on drug-induced long QT syndrome, briefly discuss the underlying mechanisms, and detail recent advances in torsadogenic risk factors and the complex interplay between individual patient-related clinical risk characteristics and the development of torsades de pointes with potassium-channel blocking drugs.