Ciprofloxacin induced acquired long QT syndrome in a patient under class III antiarrhythmic therapy.
We report one case of cardiac arrest related to ciprofloxacin administration. One female patient (aged 70 years old) developed a marked QTc prolongation (QTc = 0.62 s) within 24 hours of ciprofloxacin administration, with documented torsades de pointes and recurrent syncope that required defibrillation. The patient was under amiodarone and sotalol therapy for atrial fibrillation, with no obvious QT prolongation prior to ciprofloxacin therapy. QT prolongation and subsequent torsades de pointes appeared only after initiation of ciprofloxacin and normalized after drug discontinuation. Even though ciprofloxacin is thought to be safer than other agents in its class, it may cause QT prolongation and torsades de pointes, particularly in high risk patients with predisposing factors. Prolongation of the QT interval related to the effect of fluoroquinolones on rapid potassium channels (IKr) may result on potentially serious proarrhythmic effect, leading to torsades de pointes.
Keivanidou
Anastasia
A
Department of Cardiology, 2nd IKA "Panagia" Hospital, Thessaloniki, Greece. keivanidou@yahoo.com
Arnaoutoglou
Christos
C
Krommydas
Argyrios
A
Papanikolaou
Georgios
G
Tsiptses
Konstantinos
K
Chrisopoulos
Charalampos
C
Kirpizidis
Christos
C
D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D002939:Ciprofloxacin / Q000009:adverse effects*; D004554:Electric Countershock; D004562:Electrocardiography; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced; D006801:Humans; D008133:Long QT Syndrome / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D013015:Sotalol / Q000627:therapeutic use; D013575:Syncope / Q000139:chemically induced; D016171:Torsades de Pointes / Q000139:chemically induced; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D000890:Anti-Infective Agents; D002939:Ciprofloxacin; D013015:Sotalol; D000638:Amiodarone