Drug-induced QT-interval shortening following antiepileptic treatment with oral rufinamide

Heart Rhythm. 2012 May;9(5):776-81. doi: 10.1016/j.hrthm.2012.01.006. Epub 2012 Jan 11.

Abstract

Background: The arrhythmogenic potential of short QT intervals has recently been highlighted in patients with a short QT syndrome. Drug-induced QT-interval prolongation is a known risk factor for ventricular tachyarrhythmias. However, reports on drug-induced QT-interval shortening are rare and proarrhythmic effects remain unclear.

Objective: Recently, rufinamide, a new antiepileptic drug for the add-on treatment of Lennox-Gastaut syndrome, was approved in the European Union and the United States. Initial trials showed drug-induced QT-interval shortening. The aim of our study was to evaluate the effects of rufinamide on QT intervals in patients with difficult-to-treat epilepsies.

Methods: Nineteen consecutive patients with Lennox-Gastaut syndrome and other epilepsy syndromes were included (n = 12 men; mean age 41 ± 12 years). QRS, QT, and T(peak)-T(end) intervals were analyzed before and during rufinamide treatment.

Results: The mean QT interval shortened significantly following rufinamide administration (QT interval 349 ± 23 ms vs 327 ± 17 ms; corrected QT interval 402 ± 22 ms vs 382 ± 16 ms; P = .002). T(peak)-T(end) intervals were 79 ± 17 ms before and 70 ± 20 ms on treatment (P = .07). The mean reduction of the corrected QT interval was 20 ± 18 ms. During follow-up (3.04 ± 1.09 years), no adverse events including symptomatic cardiac arrhythmias or sudden cardiac deaths were observed.

Conclusion: QTc-interval shortening following oral rufinamide administration in a small patient group was not associated with significant clinical adverse effects. These observations notwithstanding, the ability of rufinamide to significantly shorten the QT interval portends a potential arrhythmogenic risk that may best be guarded against by periodic electrocardiographic recordings.

MeSH terms

  • Administration, Oral
  • Adult
  • Aged
  • Anticonvulsants / adverse effects*
  • Anticonvulsants / therapeutic use
  • Arrhythmias, Cardiac / chemically induced*
  • Death, Sudden, Cardiac / etiology
  • Electrocardiography
  • Epilepsy / drug therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Intellectual Disability / drug therapy*
  • Lennox Gastaut Syndrome
  • Male
  • Middle Aged
  • Spasms, Infantile / drug therapy*
  • Triazoles / adverse effects*
  • Triazoles / therapeutic use
  • Young Adult

Substances

  • Anticonvulsants
  • Triazoles
  • rufinamide

Supplementary concepts

  • Epileptic encephalopathy, Lennox-Gastaut type