Drug-induced proarrhythmia: Discussion and considerations for clinical practice

J Am Assoc Nurse Pract. 2020 Feb;32(2):128-135. doi: 10.1097/JXX.0000000000000348.

Abstract

The clinical practice of pharmaceutical medicine includes contributions from physicians, pharmacists, nurse practitioners, and physician assistants. Drug safety considerations are of considerable importance. This article discusses drug-induced proarrhythmia, with a specific focus on Torsade de Pointes (Torsade), a polymorphic ventricular tachycardia that typically occurs in self-limiting bursts that can lead to dizziness, palpitations, syncope, and seizures, but on rare occasions can progress to ventricular fibrillation and sudden cardiac death. A dedicated clinical pharmacology study conducted during a drug's clinical development program has assessed its propensity to induce Torsade using prolongation of the QT interval as seen on the surface electrocardiogram (ECG) as a biomarker. Identification of QT-interval prolongation does not necessarily prevent a drug from receiving marketing approval if its overall benefit-risk balance is favorable, but, if approved, a warning is placed in its Prescribing Information. This article explains why drugs can have a proarrhythmic propensity and concludes with a case presentation.

MeSH terms

  • Arrhythmias, Cardiac / etiology*
  • Arrhythmias, Cardiac / physiopathology
  • Drug-Related Side Effects and Adverse Reactions / complications*
  • Drug-Related Side Effects and Adverse Reactions / physiopathology
  • Electrocardiography / methods
  • Humans
  • Long QT Syndrome / etiology
  • Long QT Syndrome / physiopathology
  • Torsades de Pointes / etiology
  • Torsades de Pointes / physiopathology