Document Detail


Perioperative torsade de pointes: a systematic review of published case reports.
MedLine Citation:
PMID:  23744954     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Torsade de pointes is a rare but potentially fatal arrhythmia. More than 40 cases of perioperative torsade de pointes have been reported in the literature; however, the current evidence regarding this complication is very limited. To improve our understanding, we performed a systematic review and meta-analysis of all published case reports of perioperative torsade de pointes.
METHODS: MEDLINE was systematically searched for cases of perioperative torsade de pointes. We included patients of all age groups and cases that occurred from the immediate preoperative period to the third postoperative day. Patient and case characteristics as well as QT interval data were extracted.
RESULTS: Forty-six cases of perioperative torsade de pointes were identified; 29 occurred in women (67%), and 2 episodes were fatal (case fatality rate: 4%). Craniotomies and cardiac surgery accounted for 40% of all cases. Preceding events identified by the authors were hypokalemia (12/46, 26%; 99% confidence interval [CI], 9%-43%) and bradycardia (7/46, 15%; 99% CI, 2%-28%). Drugs were implicated in approximately one third of the events (14/46, 30%; 99% CI, 13%-48%). The mean corrected QT (QTc) at baseline was 457 ± 67 milliseconds (minimum 320 milliseconds; maximum 647 milliseconds; data available in 27/46 patients). At the time of the event, the mean QTc increased to 575 ± 77 milliseconds (minimum 413 milliseconds; maximum 766 milliseconds; data available in 33/46 patients). On average, QTc increased by +118 milliseconds (99% CI, 70-166 milliseconds; P < 0.001) between baseline and after the torsade de pointes event. All patients, except for 2, had a substantial prolongation of their QTc interval at the time of the event.
CONCLUSIONS: This systematic review identified several common risk factors for perioperative torsade de pointes. Given the nearly uniform presence of a substantial QTc interval prolongation at the time of a torsade de pointes episode, increased vigilance for perioperative QTc interval prolongation may be warranted.
Authors:
Joshua Johnston; Swatilika Pal; Peter Nagele
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review     Date:  2013-06-06
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  117     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2013 Sep 
Date Detail:
Created Date:  2013-08-22     Completed Date:  2013-10-28     Revised Date:  2014-09-02    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  559-64     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Child
Data Interpretation, Statistical
Electrocardiography
Female
Humans
Intraoperative Complications / therapy*
Long QT Syndrome / physiopathology,  therapy
Male
Middle Aged
Perioperative Care*
Postoperative Complications / epidemiology,  therapy
Predictive Value of Tests
Torsades de Pointes / chemically induced,  drug therapy,  therapy*
Young Adult
Grant Support
ID/Acronym/Agency:
K23 GM087534/GM/NIGMS NIH HHS; K23 GM087534/GM/NIGMS NIH HHS; UL1 TR000448/TR/NCATS NIH HHS; UL1RR024992/RR/NCRR NIH HHS
Comments/Corrections
Comment In:
Anesth Analg. 2014 Aug;119(2):497   [PMID:  25046791 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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