title: Predicting the Unpredictable: Drug-Induced QT Prolongation and Torsades de Pointes.
abstract: Drug-induced long QT syndrome (diLQTS) and congenital LQTS (cLQTS) share many features, and both syndromes can result in life-threatening torsades de pointes (TdP). Our understanding of their mechanistic and genetic similarities has led to their improved clinical management. However, our inability to prevent diLQTS has resulted in removal of many medicines from the market and from development. Genetic and clinical risk factors for diLQTS and TdP are well known and raise the possibility of TdP prevention. Clinical decision support systems (CDSS) can scan the patient's electronic health records for clinical risk factors predictive of diLQTS and warn when a drug that can cause TdP is prescribed. CDSS have reduced prescriptions of QT-prolonging drugs, but these relatively small changes lack the power to reduce TdP. The growing genetic evidence linking diLQTS to cLQTS suggests that prevention of TdP in the future may require inclusion of both genetic and clinical predictors into CDSS.
authors.affiliation: Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, Milan, Italy. Electronic address: peter.schwartz@unipv.it.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Schwartz
authors.affiliation: Department of Biomedical Informatics, University of Arizona College of Medicine, Phoenix, Arizona; AZCERT, Inc., Oro Valley, Arizona.
authors.forename: Raymond L
authors.initials: RL
authors.lastname: Woosley
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems; D020000:Decision Support Systems, Clinical; D064420:Drug-Related Side Effects and Adverse Reactions; D004562:Electrocardiography; D023281:Genomics; D006801:Humans; D020407:Internet; D008133:Long QT Syndrome / Q000139:chemically induced*; D012307:Risk Factors; D016171:Torsades de Pointes / Q000139:chemically induced*
keywords: QT interval; clinical decision support; pharmacogenomics; sudden death; torsades de pointes