Antihistamines are among the most widely used medications in the world. Ebastine is an antihistaminic which is long-acting, second-generation, and selective H1-receptor inverse agonist. I report a twelve-year-and-six-month-old girl with temporary prolongation of the QTc interval caused by acute ebastine intoxication due to TikTok challenge. Initial electrocardiogram showed sinus arrhythmia (72 beats/min) and prolongation of the QTc interval (QTc 482 milliseconds). Gastric lavage was performed. Intravenous fluid was administered, and activated charcoal (1 g/kg/per dose) was given. Electrocardiogram 9 h after drug ingestion showed sinus rhythm and normal QTc interval (QTc 414milliseconds). During follow-up, no electrocardiogram abnormalities were detected with electrocardiogram monitoring. She was discharged on day 2 without any complications. This case report is the first in the literature to show acute intoxication with ebastine due to challenge video on TikTok, which leads to a temporary prolongation of the QTc interval. Also, with this case report, I assert the fact that it is important to properly supervise the use of social media, such as TikTok and to review the content of TikTok videos.

Artemether (ATM) cardiotoxicity, its short half-life and low oral bioavailability are the major limiting factors for its use to treat malaria. The purposes of this work were to study free-ATM and ATM-loaded poly-ε-caprolactone nanocapules (ATM-NC) cardiotoxicity and oral efficacy on Plasmodium berghei-infected mice. ATM-NC was obtained by interfacial polymer deposition and ATM was associated with polymeric NC oily core. For cardiotoxicity evaluation, male black C57BL6 uninfected or P. berghei-infected mice received, by oral route twice daily/4 days, vehicle (sorbitol/carboxymethylcellulose), blank-NC, free-ATM or ATM-NC at doses 40, 80 or 120 mg kg−1. Electrocardiogram (ECG) lead II signal was obtained before and after treatment. For ATM efficacy evaluation, female P. berghei-infected mice were treated the same way. ATM-NC improved antimalarial in vivo efficacy and reduced mice mortality. Free-ATM induced significantly QT and QTc intervals prolongation. ATM-NC (120 mg kg−1) given to uninfected mice reduced QT and QTc intervals prolongation 34 and 30%, respectively, compared with free-ATM. ATM-NC given to infected mice also reduced QT and QTc intervals prolongation, 28 and 27%, respectively. For the first time, the study showed a nanocarrier reducing cardiotoxicity of ATM given by oral route and it was more effective against P. berghei than free-ATM as monotherapy.

Introduction: Fever is one of the most common reasons for presentation to the emergency department (ED). Interestingly, a number of small studies suggest that fever may function as a modulator of the QT interval in healthy individuals and an arrhythmogenic trigger in patients with occult congenital QT abnormalities. The objective of this study was to explore whether presence of fever adversely affects the QT interval, and whether medications known to prolong this interval affect any association found. Methods: We performed a retrospective, single center study identifying patients (age > 18 years) presenting to the ED with fever (temperature > 38.0 °C) between January 1st, 2012 and December 31st, 2013 via electronic chart review. The subset for analysis were those who had an ECG both at time of fever and while afebrile (within 30 days of initial ECG). Temperature measurement was within 30 minutes of ECG. Actively paced patients were excluded. Univariate and multiple regression analysis were used to determine risk factors for QT derangement in patients with fever. Results: 2018 febrile visits occurred during the reviewed period, 181 of these patients went on to be included in the study. 54.1% of study subjects were female, and the average age was 68.9 years old. The etiology of fever was predominately infectious (69.6%), with community acquired pneumonia being the most frequent cause (24.3%). We found the median corrected QT interval to be significantly shorter in febrile as compared to afebrile patients [QTc = 388.7ms, (371.5-407.5) vs 406.7, (386.7-434.4); p < 0.001]. This difference was observed in both sexes. Males were found to be more likely to experience medication induced QTc prolongation [OR 5.35, 95% CI = 1.46 - 19.68; P < 0.05]. Two instances of Torsades de pointes were identified in our study, both occurring in males on QT prolonging medications. Conclusion: In an ED patient population, fever generally shortens the QT interval independent of sex. Prolongation of the QT interval during fever should thus increase clinical suspicion of congenital or acquired QT disorders. Additionally, males appear to be more susceptible to medication-induced derangements in the QT interval and may require more vigilant monitoring when treated with multiple QT prolonging medications.

Patients treated with haemodialysis are at high risk of sudden cardiac death (SCD) often caused by arrhythmias. Atrial fibrillation (AF) is frequent among haemodialysis patients and is associated with increased mortality. Prolonged QTc is a risk marker of ventricular arrhythmia and is thereby associated with SCD. Studies have suggested that n-3 PUFA may have an antiarrhythmic effect, but the exact mechanism is not clear. The aim of this study was to examine whether AF was associated with n-3 PUFA in plasma phospholipids and whether supplementation with n-3 PUFA would shorten the QTc interval in haemodialysis patients compared to placebo. In a double-blinded randomised, placebo-controlled intervention trial 206 haemodialysis patients with CVD were treated with 1·7 g n-3 PUFA or placebo (olive oil) daily for 3 months. Blood samples and electrocardiogram evaluations were carried out at baseline and after 3 months. The QT interval, PQ interval and heart rate were measured in all patients with sinus rhythm (SR). At baseline 13 % of patients had AF. The content of the n-3 PUFA, DHA, was significantly lower (P < 0·05) in serum of patients with AF compared with patients with SR. Thus, the DHA content was independently negatively associated with AF. Supplementation with n-3 PUFA did not shorten the QT interval significantly compared to the placebo group (P = 0·42), although subgroup analysis within the n-3 PUFA group revealed a shortening effects on QTc (P = 0·01). In conclusion, an inverse association was found between the presence of AF and the plasma DHA in haemodialysis patients. Intervention with n-3 PUFA did not shorten the QTc interval compared to placebo.

Abuse of alcohol during pregnancy is known to cause alcoholic embryopathy and congenital cardiac disease. We sought to establish if there were any cardiac abnormalities to be found in patients known to have alcoholic embryopathy, but with structurally normal hearts. We reviewed the electrocardiograms and echocardiographic data of 347 such patients without congenital cardiac disease. A shortened QT interval was found in half of the cases. The left ventricular diameter was small in one quarter of all patients, independent from age, gender, and the degree of alcoholic embryopathy. We conclude that intrauterine exposure to alcohol as a primary toxin can lead to minor cardiac abnormalities, even in the absence of structural congenital cardiac disease.

The prevention of unexpected cardiac events in the young remains elusive. Among them, some are lethal. Early identification of life-threatening arrhythmogenic disorders which often manifest in infancy, childhood or even later, may allow initiation of effective preventive therapies. A large prospective study has indicated that some infants with prolongation of the QT interval in the first week of life died suddenly, and would have previously been labelled as victims of the sudden infant death syndrome. Furthermore, in infants with this diagnosis, post-mortem molecular screening has revealed the presence of the long QT syndrome. As an evolution of this background, some European countries have begun to consider the possibility of introducing in their National Health Services the performance of an electrocardiogram during the first month of life in all newborns, as part of a programme for cardiovascular screening. Most adult cardiologists, however, have no or minimal experience with electrocardiograms recorded in infants. Accordingly, the European Society of Cardiology has instituted a Task Force with the objective of creating guidelines for the interpretation of the neonatal electrocardiogram, focusing on the most clinically relevant abnormalities and on the ensuing options for management and referral. The main objective of the present document is to provide adult cardiologists with a practical approach to neonatal electrocardiography, and paediatricians and neonatologists with a tool that should facilitate medical interaction on cardiologic issues. There are important differences between neonatal and adult electrocardiograms. When a cardiologist examines the electrocardiogram of an apparently normal and healthy infant, the focus has to be on distinguishing between patterns that should cause no alarm, and those that require action or additional investigations. To provide clues for this distinction has been the main objective of the members of this Task Force. Whenever possible or appropriate, we have also suggested steps in management.

Background and objective: Thiopental prolongs the QT interval more than propofol, and the two induction agents were compared in patients with subarachnoid haemorrhage predisposed to electrocardiographic abnormalities and cardiac dysrhythmias.

Methods: Twenty-nine patients were studied randomly. Anaesthesia was induced with either thiopental or propofol and fentanyl; vecuronium was used as a neuromuscular blocking agent. The electrocardiogram and arterial blood pressure were monitored from before the induction of anaesthesia to 2 min after endotracheal intubation.

Results: The median QT interval was at baseline 423 ms in the thiopental group and at 432 ms in the propofol group, and it increased in the thiopental group to 446 ms and decreased in the propofol group to 425 ms (P < 0.01 between groups). After induction and endotracheal intubation, the number of patients with increased QT dispersion was greater in the propofol group (P < 0.05). The incidence of cardiac dysrhythmias was similar in the study groups.

Conclusions: Thiopental and propofol are equally suitable for the induction of anaesthesia in patients with subarachnoid haemorrhage.

Local anaesthesia combined with conscious sedation is becoming a popular technique for implantation of cardioverter-defibrillator devices. Propofol was given to provide loss of consciousness during defibrillation shock administration, for induced ventricular fibrillation testing. Propofol was found to decrease QT interval and QT dispersion in two patients with idiopathic prolonged QT interval and QT dispersion. The findings of the procedure are reported.

Prolongation of the QT interval may produce potentially hazardous arrhythmias. The effects of midazolam or propofol, followed by suxamethonium on the QT interval have been investigated. Thirty patients, ASA I or II, without cardiovascular disease, electrolyte abnormalities or receiving any medication were studied. All patients were premedicated with midazolam 0.08 mg kg−1 i.m., 30–60 min prior to surgery. Anaesthesia was induced with either midazolam 0.4 mg kg−1 i.v., (15 patients) or propofol 1 mg kg−1 i.v. bolus, followed by a continuous infusion (15 patients). ECG, heart rate and arterial pressure were measured before induction of anaesthesia and at 1 and 3 min after the bolus of midazolam or propofol. Further recordings were obtained at 1 and 3 min after a bolus of suxamethonium 1.5 mg kg−1 i.v. and also immediately after tracheal intubation and 1 min later. Neither midazolam nor propofol had any significant effect on QTc interval. Prolongation of QTc was observed in both groups after suxamethonium and this was further prolonged following intubation. Heart rate and arterial pressure were also increased significantly in both groups following intubation.