Torsade de pointes: A nested case-control study in an integrated healthcare delivery system
Neha Mantri1, Meng Lu2, Jonathan G Zaroff1
1Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA.
Summary
Low potassium and atrial fibrillation are key predictors of Torsade de Pointes (TdP), a dangerous heart rhythm. Early intervention with magnesium and potassium can improve outcomes for TdP patients.
Area of Science:
- Cardiology
- Electrophysiology
- Clinical Research
Background:
- Torsade de Pointes (TdP) is a life-threatening polymorphic ventricular tachycardia associated with a prolonged QT interval.
- Limited data exist on TdP risk factors, management, and prognosis in real-world settings.
Purpose of the Study:
- Validate TdP cases within a large cohort.
- Identify modifiable risk factors for TdP development.
- Describe current management strategies and patient outcomes for TdP.
Main Methods:
- A case-control study nested within the Genetic Epidemiology Research on Aging (GERA) cohort.
- Follow-up period from January 1, 2005, to December 31, 2018.
- 2:1 matching of cases to controls based on age, sex, and race/ethnicity.
Main Results:
- 56 TdP cases identified (incidence rate: 3.6 per 100,000 person-years).
- Independent predictors included low potassium (<3.6 mEq/L), atrial fibrillation/flutter, prolonged QTc (>480 ms), and coronary artery disease.
- Higher exposure to furosemide and amiodarone in TdP cases.
- Common treatments: IV magnesium (78.6%) and IV potassium (73.2%).
- In-hospital and 1-year mortality rates were 10.7% and 25.0%, respectively.
Conclusions:
- Identified key predictors for TdP, enabling risk stratification.
- Findings support the use of continuous ECG monitoring and electrolyte replacement for at-risk patients.
- Informs the development of quantitative risk indices for TdP prediction.
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