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Das medikamentös induzierte Long-QT-Syndrom

Bedeutung in der Intensivmedizin

Drug-induced long QT syndrome

Relevancy in intensive care medicine

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Zusammenfassung

QT-Zeit-verlängernde Medikamente verzögern die ventrikuläre Repolarisation und begünstigen daher das Auftreten von Torsade de pointes (TdP). Patienten auf Intensivstation sind bezüglich dieses klinischen Bildes besonders gefährdet, da sie oft gleichzeitig mehrere Risikofaktoren aufweisen. In der Arbeit werden die wichtigsten Risikofaktoren für das medikamentös induzierte Long-QT-Syndrom beschrieben. Es wird aufgezeigt, wie das QT-Intervall durch verschiedene endo- und exogene Faktoren beeinflusst werden kann; die Messung dieses Intervalls und mögliche Fehlerquellen werden beschrieben. Die elektrophysiologischen Eigenschaften der TdP werden skizziert, ebenso wichtige Aspekte der Arrhythmogenese wie z. B. die transmurale Dispersion der Repolarisation. Das Tpeak-Tend-Intervall als Marker für diese Dispersion wird vorgestellt. Es wird diskutiert, warum die Verlängerung des QT-Intervalls nicht allein die proarrhythmische Wirkung von QT-Zeit-verlängernden Medikamenten erklären kann. Des Weiteren werden die wichtigsten QT-Zeit-verlängernden Medikamente erläutert und Maßnahmen zur Prävention des medikamentös induzierten TdP und deren Behandlung dargelegt.

Abstract

QT-prolonging drugs delay ventricular repolarization and, thus, favor the occurrence of Torsade de pointes (TdP). Intensive care patients are particularly endangered to suffer from this clinical picture as they often simultaneously exhibit multiple risk factors. In the following article, the most important risk factors for drug-induced long QT syndrome are described. An overview on how the QT interval can be influenced by various endo- and exogenous factors is provided. In addition, the measurement of this interval and potential sources of errors are described. Electrophysiological characteristics of TdP are delineated as well as important pathophysiological mechanisms of arrhythmogenesis, e.g., transmural dispersion of repolarization; Tpeak–Tend interval as a marker for that dispersion is described. Potential explanations why prolongation of the QT interval is not the main or only factor for the proarrhythmic potential of QT-prolonging drugs are discussed. Furthermore, a summary of QT-prolonging drugs relevant in intensive care units is given and prevention of drug-induced long QT syndrome with consecutive TdP is discussed. Finally, recommendations for treatment of drug-induced TdP are reviewed.

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Authors and Affiliations

  1. Medizinische Klinik II (Kardiologie), Kreiskliniken Esslingen, Klinikum Kirchheim/Teck, Eugenstr. 3, 72320, Kirchheim/Teck, Deutschland

    R. Laszlo & S. Laszlo

  2. II. Medizinische Klinik und Poliklinik (Kardiologie, Angiologie, Internistische Intensivmedizin), Universitätsklinikum Mainz, Mainz, Deutschland

    K. Kettering

  3. Medizinische Klinik III (Kardiologie und Kreislauferkrankungen), Klinikum der Eberhard-Karls-Universität Tübingen, Tübingen, Deutschland

    J. Schreieck

  4. Medizinische Klinik, Internistische Intensivstation, Klinikum der Eberhard-Karls-Universität Tübingen, Tübingen, Deutschland

    R. Riessen

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  1. R. Laszlo
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  2. S. Laszlo
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  3. K. Kettering
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  4. J. Schreieck
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  5. R. Riessen
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Correspondence to R. Laszlo.

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Laszlo, R., Laszlo, S., Kettering, K. et al. Das medikamentös induzierte Long-QT-Syndrom. Med Klin Intensivmed Notfmed 107, 197–205 (2012). https://doi.org/10.1007/s00063-011-0072-z

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  • DOI: https://doi.org/10.1007/s00063-011-0072-z

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