Top Things to Know: Drug-Induced Arrhythmias
Published: September 15, 2020
- Many commonly used medications from a wide array of drug classes may cause or worsen a variety of arrhythmias.
- While many clinicians and investigators realize drugs can induce QT interval prolongation and torsades de pointes (TdP), drugs can also trigger or exacerbate other atrial and ventricular arrhythmias, including bradyarrhythmias, atrial fibrillation/flutter, atrial tachycardia, atrioventricular nodal reentrant tachycardia (AVNRT), monomorphic ventricular tachycardia (VT), and Brugada syndrome.
- This scientific statement is intended to increase awareness of specific drugs and drug classes that may cause arrhythmias, as well as awareness of distinct arrhythmias that drugs may induce.
- Some drug-induced arrhythmias (bradyarrhythmias, atrial tachycardia, AVNRT) can be substantially symptomatic and bothersome to patients.
- Some drug-induced arrhythmias (monomorphic VT, Brugada syndrome, TdP) can have serious consequences, including sudden cardiac death.
- For some drug-induced arrhythmias, particularly TdP, modification of risk factors (such as maintaining electrolytes in a normal range) is important for prevention and risk reduction.
- Enhanced electrocardiographic and other monitoring strategies can be beneficial for early detection and treatment in patients with nonmodifiable risk factors (such as kidney or liver disease) for a drug-induced arrhythmia who require a potentially arrhythmogenic drug.
- Management of drug-induced arrhythmias includes discontinuation of the offending medication and following treatment guidelines for the specific arrhythmia. In overdose situations, targeted detoxification strategies may be needed.
- Awareness of drugs that may cause arrhythmias, as well as knowledge of distinct arrhythmias that may be drug-induced, is essential for clinicians.
- For patients with new arrhythmias or unexplained arrhythmia exacerbation, the possibility that the arrhythmia could be drug-induced should be considered.
Citation
Tisdale JE, Chung MK, Campbell KB, Hammadah M, Joglar JA, Leclerc J, Rajagopalan B; on behalf of the American Heart Association Clinical Pharmacology Committee of the Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing. Drug-induced arrhythmias: a scientific statement from the American Heart Association [published online ahead of print September 15, 2020]. Circulation. doi: 10.1151/CIR.0000000000000905