Evidence map›Paper›PMID 26589717›Full record

ArticleJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2016

Drug-induced torsades de pointes in an underserved urban population. Methadone: is there therapeutic equipoise?

Jorge Romero, Samuel H Baldinger, David Goodman-Meza, Krysthel Engstrom, Carolina R Valencia, Anjani Golive, Francisco Medrano, Sabarivinoth Rangasamy, Mohammed Makkiya, John D Fisher and 6 more

Abstract read
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In one paragraph

Article in Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
2.8field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 22 citations in OpenAlex.

  1. Trial
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  4. Article
  5. Article
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  7. Opioids and Cardiac Arrhythmia: A Literature Review.Medical principles and practice : international journal of the Kuwait University, Health Science Centre · 2018
    Review
  8. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors at 4 institutions in 1 country.

Jorge RomeroMontefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Silver Zone, 10467, Bronx, NY, USA.
Samuel H BaldingerBrigham and Women's Hospital/Harvard Medical School, Boston, MA, USA.
David Goodman-MezaMontefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Silver Zone, 10467, Bronx, NY, USA.
Krysthel EngstromMontefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Silver Zone, 10467, Bronx, NY, USA.
Carolina R ValenciaMontefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Silver Zone, 10467, Bronx, NY, USA.
Anjani GoliveMontefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Silver Zone, 10467, Bronx, NY, USA.
Francisco MedranoMontefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Silver Zone, 10467, Bronx, NY, USA.
Sabarivinoth RangasamyMontefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Silver Zone, 10467, Bronx, NY, USA.
Mohammed MakkiyaMontefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Silver Zone, 10467, Bronx, NY, USA.
John D FisherMontefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Silver Zone, 10467, Bronx, NY, USA.
Jay GrossMontefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Silver Zone, 10467, Bronx, NY, USA.
Andrew KrumermanMontefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Silver Zone, 10467, Bronx, NY, USA.
Soo KimMontefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Silver Zone, 10467, Bronx, NY, USA.
Mario J GarciaMontefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Silver Zone, 10467, Bronx, NY, USA.
Luigi Di BiaseMontefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Silver Zone, 10467, Bronx, NY, USA.
Kevin J FerrickMontefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Silver Zone, 10467, Bronx, NY, USA. kferrick@montefiore.org.
Albert Einstein College of Medicine · USMontefiore Medical Center · USBrigham and Women's Hospital · USHarvard University · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAlthough it has been well established that methadone use can result in prolonged QTc/torsades de pointes (TdP) and has been labeled as one of the main drugs that cause TdP, it is still prescribed indiscriminately, and several cases of methadone-associated TdP have been seen in our community.

methodsOur objective was to determine the associated factors for prolonged QTc and the development of torsades de pointes (TdP) in our underserved patient population. We found 12,550 ECGs with prolonged QTc between 2002 and 2013. Medical records were reviewed in order to identify precipitating factors for prolonged QTc and to detect incidence of TdP.

resultsWe identified 2735 patients with prolonged QTc who met the inclusion criteria. Of these, 89 (3%) experienced TdP. There was a greater prevalence of HIV infection in the TdP group (11.2 vs. 3.7%, p < 0.001). Furosemide, hydrochlorothiazide, selective serotonin reuptake inhibitors (SSRIs), amiodarone, ciprofloxacin, methadone, haloperidol, and azithromycin were the drugs most often associated with prolonged QTc (31, 8.2, 7.6, 7.1, 3.9, 3.4 and 3.3%, respectively). However, the agents most commonly associated with TdP were furosemide (39.3%), methadone (27%), SSRIs (19.1%), amiodarone (18%), and dofetilide (9%). The medications with statistical significance in the multivariate analysis for TdP development in descending order were as follows: ranolazine (odds ratios [OR] = 53.61, 95% confidence interval [CI] 5.4-524, p < 0.001), dofetilide (OR = 25, CI 6.47-103.16, p < 0.001), voriconazole (OR = 21.40, CI 3.24-124.25, p < 0.001), verapamil (OR = 10.98, CI 2.62-44.96, p < 0.001), sotalol (OR = 12.72, 1.95-82.81, p = 0.008), methadone (OR = 9.89, CI 4.05-24.15, p < 0.001), and SSRI (OR = 2.26, CI 1.10-5.96, p < 0.001). This multivariate analysis revealed that amiodarone and HIV infection were not implicated in TdP.

conclusionMethadone was by far the leading medication implicated in the development of TdP and an independent predictor in both univariate and multivariate analyses despite the fact that it was not the most common QT-prolonging medication in our population.

Indexed as

Medically Underserved AreaAge DistributionCausalityComorbidityDrug-Related Side Effects and Adverse ReactionsFemaleHumansIncidenceLong QT SyndromeMaleMethadoneMiddle AgedNew York CityRisk FactorsSex DistributionTorsades de PointesMethadoneMethadoneProlonged QTTorsades de pointes

Identifiers

PMID26589717
OpenAlexW2173900385

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.