Electrocardiographic identification of drug effects: QT prolongation, arrhythmias, and clinical monitoring
European Journal of Clinical Pharmacology, cilt.82, sa.9, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Derleme
- Cilt numarası: 82 Sayı: 9
- Basım Tarihi: 2026
- Doi Numarası: 10.1007/s00228-026-04141-4
- Dergi Adı: European Journal of Clinical Pharmacology
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, Chimica, CINAHL, EMBASE, MEDLINE, Academic Search Ultimate (EBSCO), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest), Pharma Collection (ProQuest)
- Anahtar Kelimeler: Cardiotoxicity, Drug-induced arrhythmia, ECG monitoring, Electrocardiogram, hERG, QT prolongation, QTc, Tisdale score, Torsades de pointes
- Çanakkale Onsekiz Mart Üniversitesi Adresli: Evet
Özet
Background: The electrocardiogram (ECG) remains the foremost non-invasive tool for detecting adverse drug effects on cardiac electrophysiology, encompassing QT interval prolongation, torsades de pointes (TdP), atrioventricular (AV) block, and sodium-channel-mediated QRS widening. As polypharmacy becomes ubiquitous — particularly in ageing populations and oncology — clinicians require a structured understanding of drug-ECG interactions to mitigate sudden cardiac death risk. Methods: A systematic narrative review was conducted using PubMed, Embase, and the Cochrane Library covering January 2006 to April 2026. Priority was given to meta-analyses, systematic reviews, scientific statements, and guidelines addressing drug-induced ECG changes, QTc measurement methodology, TdP risk stratification, and ECG monitoring protocols. Reference lists of key papers were hand-searched. Seventy references meeting quality and relevance criteria are cited. Results: Numerous drug classes — including antiarrhythmics, antibiotics, antipsychotics, antidepressants, antiemetics, and oncology agents — prolong the corrected QT interval primarily through blockade of the cardiac hERG/IKr potassium channel. Modifiable risk factors include hypokalaemia, hypomagnesaemia, bradycardia, and co-prescription of CYP3A4 inhibitors. Female sex, age ≥ 65 years, congenital long QT syndrome carriers, and cardiac failure patients are at disproportionate TdP risk. The validated Tisdale Risk Score enables pre-treatment stratification in hospitalised patients. Drug-specific ECG monitoring protocols with actionable thresholds are summarised. Conclusions: Drug-induced ECG changes are common, clinically consequential, and often preventable. Evidence-based monitoring protocols, correction of modifiable risk factors, and prompt recognition of ominous ECG patterns substantially reduce adverse outcomes. Prescriber education across all clinical settings is imperative.