The Comprehensive Systematic Review of Association of QT prolonging medications torsades de pointes in hospitalized patients

Introduction: Drug-induced QT interval prolongation and its progression to torsades de pointes (TdP), a potentially fatal polymorphic ventricular tachycardia, represent a significant clinical challenge in hospitalized patients. Numerous medications across various therapeutic classes possess this off-target adverse effect, creating a complex landscape for risk management, especially in vulnerable inpatient populations often burdened by comorbidities, polypharmacy, and acute illness. A comprehensive synthesis of the evidence regarding the incidence, risk factors, and mitigation strategies is crucial for optimizing patient safety. Methods: This systematic review was conducted by screening studies from multiple databases based on pre-defined criteria. The population of interest was hospitalized patients of any age receiving medications known to prolong the QT interval. The primary outcome was the occurrence of TdP, with clear diagnostic criteria required. Included study designs were observational studies, randomized controlled trials, systematic reviews, meta-analyses, or case series with ≥10 patients. Data extraction covered study population, specific QT-prolonging drugs, TdP outcomes, risk factors, QT monitoring methodologies, and key statistical findings (Tleyjeh et al., 2020; Vandael et al., 2017). Results: Analysis of 80 included studies revealed marked heterogeneity in TdP incidence across drug classes. Class III antiarrhythmics (e.g., dofetilide, ibutilide) demonstrated the highest risk (1-17%), directly related to their potassium channel-blocking mechanism (Mazur et al., 2001; Bianconi et al., 2000). Antimalarials (hydroxychloroquine/chloroquine), widely used during the COVID-19 pandemic, showed a TdP incidence of 0.06-0.72%, which increased when combined with azithromycin (Aleem et al., 2021; Diaz-Arocutipa et al., 2021). Other agents like fluoroquinolones, antipsychotics, and methadone were associated with lower absolute TdP risk (