Elsevier

Heart Rhythm

Volume 1, Issue 5, November 2004, Pages 624-626
Heart Rhythm

Case report
Ciprofloxacin-induced acquired long QT syndrome

https://doi.org/10.1016/j.hrthm.2004.06.020Get rights and content

Quinolone antibiotics have potentially serious proarrhythmic effects. The effects on intracardiac potassium channels result in QT interval prolongation, leading to torsades de pointes. Evidence suggests fluoroquinolones cause QT-mediated proarrhythmia, and weak evidence links ciprofloxacin with QT-mediated arrhythmias. Ciprofloxacin may be given to select patients because the agent is believed to be safer than other drugs in its class. We report two cases of unexplained cardiac arrest temporally related to ciprofloxacin administration. Two female patients (ages 44 and 67 years) developed marked QTc prolongation (QTc 590 and 680 ms) within 24 hours of ciprofloxacin administration, with recurrent syncope and documented torsades de pointes requiring defibrillation. The patients previously were stable with sotalol and amiodarone therapy for supraventricular arrhythmia without obvious QTc prolongation prior to ciprofloxacin therapy. Marked QTc prolongation and subsequent proarrhythmia became a clinical concern only after initiation of ciprofloxacin. In both cases, the QTc normalized after cessation of ciprofloxacin. Ciprofloxacin may cause QTc prolongation and rarely torsades de pointes. This effect is of particular concern in patients with predisposing factors, such as concomitant medications or underlying heart disease reflecting decreased repolarization reserve.

Section snippets

Case 1

A 67-year-old woman with no previous cardiac history was admitted to the hospital for new-onset atrial fibrillation with a rapid ventricular response. She had a recent history of increasing exertional dyspnea and associated malaise and fatigue diagnosed as congestive heart failure. Furosemide and lisinopril therapy were started. On admission, she was given amiodarone 400 mg PO bid, digoxin 0.25 mg/day, and warfarin. An echocardiogram demonstrated global hypokinesis of the left ventricle with an

Commentary

Fluoroquinolones are bactericidal agents that directly inhibit DNA synthesis by inactivating two enzymes. They are being used with increasing frequency because of their wide spectrum of antimicrobial activity against common respiratory, gastrointestinal, and genitourinary pathogens. The cases presented here illustrate ciprofloxacin’s potential to cause proarrhythmia via QTc prolongation. It is interesting that multiple risk factors were present in both cases. However, a clear temporal

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Supported by Grant NA3397 from the Heart and Stroke Foundation of Ontario. A.K. is a Research Scholar of the Heart and Stroke Foundation of Ontario.

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