Multifactorial Torsades de Pointes in a Multiple Myeloma Patient

TdP in patients with cancer is almost always multifactorial. The convergence of QT interval-prolonging supportive medications, electrolyte derangements, hemodynamic instability, and critical illness creates the highest arrhythmic risk. A large real-world electronic health record analysis identified lenalidomide as a potentially QTc interval-prolonging agent in clinical populations, with hypertension as a significant effect modifier. Oncologists should not dismiss the contribution of lenalidomide to prolonged QT interval in complex patients.