Original article
Rare Incidence of Ventricular Tachycardia and Torsades de Pointes in Hospitalized Patients With Prolonged QT Who Later Received Levofloxacin: A Retrospective Study

https://doi.org/10.1016/j.mayocp.2015.02.011Get rights and content

Abstract

Objective

To determine the incidence of ventricular tachycardia and ventricular fibrillation in patients with prolonged corrected QT interval (QTc) who received levofloxacin through retrospective chart review at a tertiary care teaching hospital in the United States.

Patients and Methods

We selected 1004 consecutive hospitalized patients with prolonged QTc (>450 ms) between October 9, 2009 and June 12, 2012 at our institution. Levofloxacin was administered orally and/or intravenously and adjusted to renal function in the inpatient setting. The primary outcome measure was sustained ventricular tachycardia recorded electrocardiographically.

Results

With a median time from the start of levofloxacin use to hospital discharge (or death) of 4 days (range, 1-94 days), only 2 patients (0.2%; 95% CI, 0.0%-0.7%) experienced the primary outcome of sustained ventricular tachycardia after the initiation of levofloxacin use.

Conclusion

In this study, the short-term risk for sustained ventricular tachycardia in patients with a prolonged QTc who subsequently received levofloxacin was very rare. These results suggest that levofloxacin may be a safe option in patients with prolonged QTc; however, studies with longer follow-up are needed.

Section snippets

Patients and Methods

A total of 1004 consecutive hospitalized patients with a prolonged QTc (>450 ms) on the electrocardiogram (ECG) who subsequently received levofloxacin at Mayo Clinic Florida Hospital between October 9, 2009, and June 12, 2012, were included in this retrospective study. Patients were excluded if they were younger than 18 years, had an implanted defibrillator, had a history of sustained ventricular tachycardia, were using antiarrhythmic medications at the time of admission, received levofloxacin

Results

Patient characteristics and comorbid conditions for the 1004 study patients are summarized in Table 1. Patient medications on admission, levofloxacin information, and QTc information are summarized in Table 2. Levofloxacin was administered for a median of 3 days (range, 1-37 days). The QTc at admission was a median of 472 ms (range, 451-708 ms), and the median longest QTc during admission was 478 ms (range, 451-708 ms).

With a median time from the start of levofloxacin use to hospital discharge

Discussion

Levofloxacin is one of the most commonly prescribed antibiotics.6 Although the number of cases of torsades de pointes associated with the use of fluoroquinolones between January 1996 and May 2001 was 5.4 per 10 million prescriptions for levofloxacin,7 concerns about its potential arrhythmogenic effects remain. Manufacturers of levofloxacin have recommended that the medication be avoided in patients with known prolongation of the QT interval, patients with uncorrected hypokalemia, and patients

Conclusion

Levofloxacin administration either orally or intravenously was only rarely associated with short-term risk for ventricular tachycardia in those with prolonged QTc. These results suggest that when fluoroquinolones are deemed the appropriate treatment choice for an infection in a patient with a prolonged QTc, they may be considered a reasonable treatment option. Studies with longer follow-up are needed to assess the long-term risk for ventricular tachycardia in this patient population.

Acknowledgment

We thank Fred Kusumoto, MD, from the Division of Cardiovascular Disease at Mayo Clinic Florida for his review of the manuscript and electrocardiographic tracings.

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