Serial ECG monitoring revealed mild-to-moderate QT interval prolongation in 41% and severe prolongation in 16% of hospitalized patients with tuberculosis receiving fluoroquinolones.
Cohort (n=32)
Does serial ECG monitoring four times daily improve the detection of QT interval prolongation compared to intermittent monitoring in hospitalized tuberculosis patients receiving fluoroquinolones?
Serial ECG monitoring reveals a high prevalence of QT prolongation in older TB patients on fluoroquinolones, suggesting that sparse intermittent monitoring may be inadequate due to circadian variability.
BACKGROUND: Fluoroquinolones, crucial components of treatment regimens for drug-resistant tuberculosis (TB), are associated with QT interval prolongation and risks of fatal cardiac arrhythmias. However, few studies have explored dynamic changes in the QT interval in patients receiving QT-prolonging agents. METHODS: This prospective cohort study recruited hospitalized patients with TB who received fluoroquinolones. The study investigated the variability of the QT interval by using serial electrocardiograms (ECGs) recorded four times daily. This study analyzed the accuracy of intermittent and single-lead ECG monitoring in detecting QT interval prolongation. RESULTS: This study included 32 patients. The mean age was 68.6 ± 13.2 years. The results revealed mild-to-moderate and severe QT interval prolongation in 13 (41%) and 5 (16%) patients, respectively. The incremental yields in sensitivity of one to four daily ECG recordings were 61.0%, 26.1%, 5.6%, and 7.3% in detecting mild-to-moderate QT interval prolongation, and 66.7%, 20.0%, 6.7%, and 6.7% in detecting severe QT interval prolongation. The sensitivity levels of lead II and V5 ECGs in detecting mild-to-moderate and severe QT interval prolongation exceeded 80%, and their specificity levels exceeded 95%. CONCLUSION: This study revealed a high prevalence of QT interval prolongation in older patients with TB who receive fluoroquinolones, particularly those with multiple cardiovascular risk factors. Sparsely intermittent ECG monitoring, the prevailing strategy in active drug safety monitoring programs, is inadequate owing to multifactorial and circadian QT interval variability. Additional studies performing serial ECG monitoring are warranted to enhance the understanding of dynamic QT interval changes in patients receiving QT-prolonging anti-TB agents.
Ju et al. (Wed,) conducted a cohort in Tuberculosis (n=32). Fluoroquinolones was evaluated on QT interval prolongation. Serial ECG monitoring revealed mild-to-moderate QT interval prolongation in 41% and severe prolongation in 16% of hospitalized patients with tuberculosis receiving fluoroquinolones.