Genetic basis of drug-induced arrhythmias

Abstract

Drug-induced torsade de pointes arrhythmia (TdP) is frequently seen in patients. This proarrhythmia is not restricted to anti-arrhythmics but includes a variety of drugs. A genetic predisposition is an attractive explanation for this clinical problem. In this review, we: 1) explain the arrhythmogenic mechanisms of TdP, 2) provide data for a genetic cause based upon mutations in the long QT or in cytochrome genes responsible for drug metabolism, and 3) present pathology-based electrical remodeling as an alternative explanation. It can be concluded that the current evidence for a genetic basis for drug-induced TdP is weak.