Drug-induced long QT syndrome in women

Adv Ther. 2013 Sep;30(9):793-802. doi: 10.1007/s12325-013-0056-x. Epub 2013 Oct 2.

Abstract

Congenital long QT syndromes (LQTS) are inherited heart diseases that can present as palpitations, syncope (fainting), seizures, cardiac arrest, and sudden death. Acquired LQTS mostly occurs as a result of exposure to an environmental stressor that is responsible for the excessive prolongation of the QT interval. The most common environmental stressor is adverse drug reactions, which can lead to drug-induced LQTS (di-LQTS). Female gender has been increasingly recognized as an independent risk factor for di-LQTS, which in females is influenced by other factors, including age, menstrual cycle, and hormone replacement therapy. The estrogen-mediated reduced repolarization reserve in women is believed to be responsible for their higher susceptibility to di-LQTS. More studies, especially randomized trials, should be carried out to confirm these findings, and elucidate the clinical impact of gender disparity in modifying the risk of di-LQTS in women, with the ultimate goal of promoting the clinical safety of medication. In this article, we review current knowledge about di-LQTS, specifically in women, and discuss methods for the prevention of di-LQTS in females.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Action Potentials / physiology
  • Age Factors
  • Analgesics, Opioid / adverse effects
  • Anti-Arrhythmia Agents / adverse effects
  • Anti-Infective Agents / adverse effects
  • Antiemetics / adverse effects
  • Antineoplastic Agents / adverse effects
  • Antipsychotic Agents / adverse effects
  • Calcium Channel Blockers / adverse effects
  • Electrocardiography
  • Estradiol / physiology
  • Estrogen Replacement Therapy / adverse effects*
  • Estrogens / physiology
  • Female
  • Gastrointestinal Agents / adverse effects
  • Histamine Antagonists / adverse effects
  • Humans
  • Long QT Syndrome / chemically induced*
  • Menstrual Cycle / physiology
  • Progesterone / physiology*
  • Sex Factors
  • Torsades de Pointes / chemically induced*

Substances

  • Analgesics, Opioid
  • Anti-Arrhythmia Agents
  • Anti-Infective Agents
  • Antiemetics
  • Antineoplastic Agents
  • Antipsychotic Agents
  • Calcium Channel Blockers
  • Estrogens
  • Gastrointestinal Agents
  • Histamine Antagonists
  • Progesterone
  • Estradiol