TY - JOUR
T1 - The possible role of propofol in drug-induced torsades de pointes
T2 - A real-world single-center analysis
AU - Abrich, Victor A.
AU - Ramakrishna, Harish
AU - Mehta, Arjun
AU - Mookadam, Farouk
AU - Srivathsan, Komandoor
N1 - Publisher Copyright:
© 2017 Elsevier B.V.
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Background Torsades de pointes (TdP) is a polymorphic ventricular tachycardia associated with QT prolongation. Propofol is a sedative-anesthetic with proarrhythmic effects on cardiac myocytes. We performed a retrospective study to determine the incidence of TdP following propofol exposure at Mayo Clinic (Rochester, MN) from 08/11/1998–11/20/2015. Methods We queried our database using key search terms to identify patients exposed to propofol who developed TdP perioperatively or during non-surgical sedation. QT intervals were obtained from electrocardiograms (ECGs) performed before propofol exposure and after documented TdP and were corrected using Fridericia and Framingham methods. T wave peak-to-end (Tp-e)/QT ratios were also calculated. Results A total of 628,784 patients received propofol over 17.3 years. Of these patients, 21 developed TdP (12, postoperatively; 3, intraoperatively; 6, during sedation). There were 17 patients who were exposed to at least one factor associated with QT-prolongation, including QT-prolonging medications in 8 patients, heart rate < 60 beats per minute in 8 patients, potassium < 3.5 mmol/L in 4 patients, magnesium < 1.8 mg/dL in 2 patients, and subarachnoid hemorrhage in 2 patients. The number of patients with QTc > 500 ms using Fridericia correction was significantly higher from baseline following exposure to propofol (1 patient vs 6 patients, P = 0.04); however no significant difference was observed with Framingham correction. Conclusion In our study, TdP after propofol administration occurred with an annual incidence of 1.93 per million and was often associated with other risk factors. Nevertheless, propofol should be administered with caution in patients at risk of developing TdP.
AB - Background Torsades de pointes (TdP) is a polymorphic ventricular tachycardia associated with QT prolongation. Propofol is a sedative-anesthetic with proarrhythmic effects on cardiac myocytes. We performed a retrospective study to determine the incidence of TdP following propofol exposure at Mayo Clinic (Rochester, MN) from 08/11/1998–11/20/2015. Methods We queried our database using key search terms to identify patients exposed to propofol who developed TdP perioperatively or during non-surgical sedation. QT intervals were obtained from electrocardiograms (ECGs) performed before propofol exposure and after documented TdP and were corrected using Fridericia and Framingham methods. T wave peak-to-end (Tp-e)/QT ratios were also calculated. Results A total of 628,784 patients received propofol over 17.3 years. Of these patients, 21 developed TdP (12, postoperatively; 3, intraoperatively; 6, during sedation). There were 17 patients who were exposed to at least one factor associated with QT-prolongation, including QT-prolonging medications in 8 patients, heart rate < 60 beats per minute in 8 patients, potassium < 3.5 mmol/L in 4 patients, magnesium < 1.8 mg/dL in 2 patients, and subarachnoid hemorrhage in 2 patients. The number of patients with QTc > 500 ms using Fridericia correction was significantly higher from baseline following exposure to propofol (1 patient vs 6 patients, P = 0.04); however no significant difference was observed with Framingham correction. Conclusion In our study, TdP after propofol administration occurred with an annual incidence of 1.93 per million and was often associated with other risk factors. Nevertheless, propofol should be administered with caution in patients at risk of developing TdP.
KW - Prolonged QT interval
KW - Propofol
KW - Torsades de pointes
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U2 - 10.1016/j.ijcard.2017.01.011
DO - 10.1016/j.ijcard.2017.01.011
M3 - Article
C2 - 28100427
AN - SCOPUS:85009357287
SN - 0167-5273
VL - 232
SP - 243
EP - 246
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -