Association of QT-Prolonging Medications With Risk of Autopsy-Defined Causes of Sudden Death

Abstract

Sudden cardiac death (SCD) is one of the most feared manifestations of cardiovascular disease and is responsible for as many as 5% to 15% of total deaths in the United States.^1,2 Heart rate–corrected QT interval prolongation has long been established as an important risk factor for SCD, conveying a 2- to 3-fold increased risk in certain populations.^3,4 As such, use of QT interval–prolonging medication (QTPM) has represented a traditional target for prevention of SCD.⁵ Cautious use of QTPMs has been bolstered by a number of studies linking use of key drug classes such as antipsychotics and antibiotics to SCD.^6,7 The collective evidence linking QTPMs and SCD has had lasting clinical and regulatory practice implications, including removal of several QTPMs from the market and the widely adopted practice of routine electrocardiographic monitoring on initiation or increase of a known QTPM regimen.^8,9