Torsade de pointes in patients on chronic amiodarone treatment: contributing factors and drug interactions.
BACKGROUND
Torsade de pointes is rarely associated with chronic amiodarone treatment, despite the effect of amiodarone on QT interval prolongation.


OBJECTIVE
To identify risk factors and associated conditions that may cause TdP in patients on chronic amiodarone treatment.


METHODS
We reviewed the data of six consecutive patients on chronic amiodarone treatment who were admitted to the intensive cardiac care unit due to syncope and TdP.


RESULTS
The patients' median age was 73.5 years, and five were women. Concomitantly, loratadine was given to two patients and trazodone to one patient. Associated and attributing conditions to the development of TdP were hypokalemia in three patients, drug-induced bradycardia in one and reduced left ventricular function in four.


CONCLUSIONS
TdP associated with chronic amiodarone treatment may occur when amiodarone is co-administered with drugs that may potentially prolong QT interval. Additional risk factors for amiodarone-associated TdP include female gender, hypokalemia, reduced left ventricular function and bradycardia.
Antonelli
Dante
D
Department of Cardiology, HaEmek Medical Center, Afula, Israel. Antonelli_dante@hotmail.com
Atar
Shaul
S
Freedberg
Nahum A
NA
Rosenfeld
Tiberio
T
D000368:Aged; D000638:Amiodarone / Q000009:adverse effects* / Q000494:pharmacology; D004347:Drug Interactions; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016171:Torsades de Pointes / Q000139:chemically induced*
D000638:Amiodarone