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Voriconazole-induced QTc prolongation in a paediatric population

Y Pasternak1,2, N Shechter3,2, R Loebstein4,2

  • 1Department of Pediatrics A, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.

Acta Paediatrica (Oslo, Norway : 1992)
|November 21, 2018
PubMed

Insights

Voriconazole (VRC) treatment significantly prolongs the corrected QT (QTc) interval in children, with over 60% experiencing clinically significant prolongation. Older age, low potassium, and baseline QTc are risk factors for this effect.

Area of Science:

  • Pediatric Cardiology
  • Clinical Pharmacology
  • Antifungal Therapy

Background:

  • Voriconazole (VRC) is a crucial antifungal medication used in pediatric patients.
  • QTc interval prolongation (QTcP) is a known adverse effect of some medications, potentially leading to serious cardiac events.
  • Limited data exists on QTcP specifically in pediatric populations treated with VRC.

Purpose of the Study:

  • To evaluate the incidence of corrected QT (QTc) interval prolongation (QTcP) in pediatric patients receiving voriconazole (VRC).
  • To identify risk factors associated with QTcP in this patient group.

Main Methods:

  • Retrospective analysis of electronic medical records from a tertiary medical center (2011-2016).
  • Inclusion of pediatric patients who underwent electrocardiography before and during VRC therapy.
  • Paired QTc interval comparison, adjusted for concurrent medications, electrolyte disturbances, and comorbidities.

Main Results:

  • Fifty-five pediatric patients (mean age 10.1 years) were analyzed.
  • A significant increase in mean QTc interval was observed during VRC treatment (402.8 to 440.0 msec, p < 0.001).
  • Clinically significant QTcP (≥30 msec) occurred in 61.8% of patients, and ≥60 msec in 30.9%. Older age, lower potassium, and longer baseline QTc were associated with QTcP ≥60 msec.

Conclusions:

  • Voriconazole treatment is associated with a high rate of clinically significant QTc prolongation in children.
  • Monitoring QTc intervals, laboratory values, and correcting electrolyte imbalances are crucial for preventing cardiac arrhythmias in pediatric patients on VRC.
  • Risk factors for significant QTcP include older age, hypokalemia, and prolonged baseline QTc.
Abstract

Keywords:
Adverse effectElectrocardiogramPaediatricQTc prolongationVoriconazole

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