Patel Anshul M, Singh Jagmeet P, Ruskin Jeremy N
Cardiac Arrhythmia Service, Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Am J Cardiol. 2008 Jan 15;101(2):209-11. doi: 10.1016/j.amjcard.2007.07.068.
Patients with methadone-induced long-QT syndrome may experience Torsades de Pointes (TDP) or aborted sudden death requiring the placement of implantable cardioverter-defibrillators (ICDs). Outcomes after ICD implantation in these patients are unknown. Eight patients presenting with methadone-induced long-QT syndrome and episodes of symptomatic TDP were followed after having undergone ICD implantation. The study group included 5 women and 3 men (mean age 48.5 +/- 5 years) receiving methadone doses of 204 +/- 173 mg. All but 1 subject had preserved ventricular function (mean left ventricular ejection fraction 61 +/- 1.1%). All of the patients had prolonged QTc intervals (mean 613 +/- 71 ms) while taking methadone. After ICD implantation, 6 of the 8 patients continued treatment with methadone as a result of intractable dependence. Over a mean follow-up period of 27 months, 1 patient expired from unknown causes. Three of those patients had interrogation-proved ICD shocks for TDP. In conclusion, patients with methadone-induced long-QT syndrome and TDP are at high risk for recurrent arrhythmic events if methadone is continued. This small cohort of patients suggests that ICDs may be lifesaving in those subjects who continue taking methadone after initial episodes of TDP.
美沙酮诱发长QT综合征的患者可能会经历尖端扭转型室速（TDP）或需要植入植入式心脏复律除颤器（ICD）的心脏骤停。这些患者植入ICD后的预后尚不清楚。8例美沙酮诱发长QT综合征并伴有症状性TDP发作的患者在接受ICD植入后接受了随访。研究组包括5名女性和3名男性（平均年龄48.5±5岁），美沙酮剂量为204±173mg。除1名受试者外，所有受试者的心室功能均正常（平均左心室射血分数61±1.1%）。所有患者在服用美沙酮时QTc间期均延长（平均613±71ms）。植入ICD后，8例患者中有6例因难以戒除的依赖性而继续接受美沙酮治疗。在平均27个月的随访期内，1例患者因不明原因死亡。其中3例患者经问询证实因TDP接受了ICD电击。总之，如果继续使用美沙酮，美沙酮诱发长QT综合征和TDP的患者发生心律失常复发事件的风险很高。这一小群患者表明，ICD对那些在初次TDP发作后继续服用美沙酮的患者可能具有挽救生命的作用。
