A major concern associated with the use of antiarrhythmic drugs (AAD) is the occurrence of ventricular proarrhythmia, especially torsade de pointes (TdP). The AADs associated with TdP most commonly include quinidine, procainamide, disopyramide, sotalol, and the newer class III agents, such as ibutilide and dofetilide. It is not simply the administration and nature of an AAD but also several additional factors such as heart rate, ventricular hypertrophy, congestive heart failure, gender, age, concomitant drugs, and impaired drug clearance that influence TdP development. Dosing of these agents should be adjusted to take such factors into account to minimize the incidence of proarrhythmia.
1. Hohnloser SH, Singh BN. Proarrhythmia with class III antiarrhythmic drugs: Definition, electrophysiologic mechanisms, incidence, predisposing factors, and clinical implications. J Cardiovasc Electrophysiol6(10 pt II):920-936, 1995
2.
2. Roden DM. Mechanisms and management of proarrhythmia. Am J Cardiol82:491-571, 1998
3.
3. Prystowky EN. Inpatient versus outpatient initiation of antiarrhythmic drug therapy for patients with supraventricular tachycardia. Clin Cardiol17(suppl II):II-7-II-10, 1994
4.
4. Makkar RR, Fromm BS, Steinman RT, Meissner MD, Lehmann MH. Female gender as a risk factor for torsades de pointes associated with cardiovascular drugs. JAMA270:2590-2597, 1992
5.
5. Marcus FT. Risks of initiating therapy with sotalol for treatment of atrial fibrillation (editorial). J Am Coll Cardiol32:177-180, 1998
6.
6. Lehmann MH, Hardy S, Archibald D, MacNeil DJ. JTc prolongation with d,l-sotalol in women versus men. Am J Cardiol83:354-359, 1999
7.
7. Basta MN, Leitch JW, Fletcher PJ. Sotalol proarrhythmia: A report of five cases and an audit of the use of sotalol in a teaching hospital. Aust NZ J Med26:167-170, 1996
8.
8. Prystowsky EN, Benson DW, Jr, Fuster V, et al. Management of patients with atrial fibrillation. A statement for healthcare professionals from the Subcommittee on Electrocardiography and Electrophysiology, American Heart Association. Circulation93:1262-1277, 1996
9.
9. Gray VS. Syncopal episodes associated with cisapride and concurrent drugs. Ann Pharmacother32:648-651, 1998
10.
10. Michlets EL, Smith LK, Van Tassel ED. Torsade de pointes resulting from the addition of droperidol to an existing cytochrome P450 drug interaction. Ann Pharmacother32:761-765, 1998
11.
11. Hanyok JJ. Clinical pharmacokinetics of sotalol. Am J Cardiol72:19A-26A, 1993
12.
12. Dancey D, Wulffhart Z, McEwan P. Sotalol-induced torsades de pointes in patients with renal failure. Can J Cardiol13:55-58, 1997
13.
13. Day CP, MCComb JM, Campbell RWF. QT dispersion: An indication of arrhythmia risk in patients with long QT intervals. Br Heart J63:342-344, 1990
14.
14. Prescribing information: Betapace (sotalol HCI). In Physicians' Desk Reference, ed. 54.Montvale, NJ: Medical Economics Company, 2000, pp 741-745
15.
15. Rimmer LK. Bedside monitoring of the QT interval. Am J Crit Care7:183-189, 1998
16.
16. Kassotis J, Costeas C, Bedi AK, Tolat A, Reiffel J. Effects of aging and gender on QT dispersion in an overtly healthy population. PACE23:1121-1126, 2000
17.
17. Banker J, Dizon J, Reiffel J. Effects of the ventricular activation sequence on the JT interval. Am J Cardiol79:816-819, 1997
18.
18. Hnatkova K, Malik M. Optimum formulae for heart rate correction of the QT interval. Pacing Clin Electrophysiol22:1683-1687, 1999
19.
19. Sagie A, Larson MG, Goldberg RJ, Bengston JR, Levy D. An improved method for adjusting the QT interval for heart rate (the Framingham Heart Study). Am J Cardiol70:797-801, 1992
20.
20. Karjalainen J, Viitasalo M, Manttari M, Manninen V. Relation between QT intervals and heart rates from 40 to 120 beats/min in rest electrocardiograms of men and a simple method to adjust QT interval values. J Am Coll Cardiol23:1547-1553, 1994
21.
21. Franz MR. Time for yet another QT correction algorithm? Bazett and beyond (editorial). J Am Coll Cardiol23:1554-1556, 1994
23. Crijns HJGM, Van Den Berg MP, Van Gelder IC, van Velduisen DJ. Management of atrial fibrillation in setting of heart failure. Eur Heart J18(suppl C):C45-C49, 1987
24.
24. Maisel WH, Kuntz KM, Reimold SC, et al. Risk of initiating antiarrhythmic drug therapy for atrial fibrillation in patients admitted to a university hospital. Ann Intem Med127:281-284, 1997
25.
25. Bellomo R, Ronco C. The kidney in heart failure. Kidney Int (suppl 66):S-58-S-61, 1998
26.
26. Sica D, Gehr T, Much D, Slugg P. The pharmacokinetics (PK) and pharmacodynamics (PD) of D-sotalol (DS) in subjects with renal failure (RF) [abstract PI-107]. Clin Pharmacol Ther59:156-156, 1996
27.
27. Torp-Pedersen C, Moller M, Bloch-Thomsen PE, et al, for the Danish Investigations of Arrhythmia and Mortality on Dofetilide Study Group. Dofetilide in patients with congestive heart failure and left ventricular dysfunction. N Engl J Med341:857-865, 1999
28.
28. Tjandramaga TB, Thomas J, Verbesselt R, Verberckmoes R, DeSchepper PJ. The effect of end-stage renal failure and haemodialysis on the elimination kinetics of sotalol. Br J Clin Pharm3:259-265, 1976
29.
29. Singlas E, Fillastre J-P. Pharmacokinetics of newer drugs in patients with renal impairment (part II). Clin Pharmacokinet20:389-410, 1991
30.
30. Echt DS, Liebson PR, Mitchell LB, et al, and the CAST Investigators. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial. N Engl J Med324: 781-788, 1991
31.
31. Coplen SE, Antman EM, Berlin JA, Hewitt P, Chalmers TC. Efficacy and safety of quinidine therapy for maintenance of sinus rhythm after cardioversion. A meta-analysis of randomized control trials. Circulation82:1106-1116, 1990
32.
32. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron16:31-41, 1976
33.
33. Levey AS, Bosch JP, Lewis JB, et al, for the Modification of Diet in Renal Disease Study Group: A more accurate method of estimate glomerular filtration rate from serum creatinine: A new prediction equation. Ann Intern Med130:461-470, 1999
34.
34. TikosynTM (dofetilide) [US package insert]. New York, NY: Pfizer, August 11, 1999
