Electrocardiographic identification of drug effects: QT prolongation, arrhythmias, and clinical monitoring.
C, A., AB, U., MC, G., B, E., G, Y., R, B., & O, K. (2026). Electrocardiographic identification of drug effects: QT prolongation, arrhythmias, and clinical monitoring.. European journal of clinical pharmacology. https://doi.org/10.1007/s00228-026-04141-4
C A, AB U, MC G, B E, G Y, R B, et al. Electrocardiographic identification of drug effects: QT prolongation, arrhythmias, and clinical monitoring.. European journal of clinical pharmacology. 2026; doi: 10.1007/s00228-026-04141-4
C A, AB U, MC G, et al. Electrocardiographic identification of drug effects: QT prolongation, arrhythmias, and clinical monitoring.[J]. European journal of clinical pharmacology. 2026. DOI: 10.1007/s00228-026-04141-4.
@article{c2026,
author = {Akman C and Ucar AB and Girgin MC and Erdem B and Yilmaz G and Beyoglu R and Karcioglu O},
title = {Electrocardiographic identification of drug effects: QT prolongation, arrhythmias, and clinical monitoring.},
journal = {European journal of clinical pharmacology},
year = {2026},
doi = {10.1007/s00228-026-04141-4},
note = {PMID: 42627392},
}
TY - JOUR AU - Akman C AU - Ucar AB AU - Girgin MC AU - Erdem B AU - Yilmaz G AU - Beyoglu R AU - Karcioglu O TI - Electrocardiographic identification of drug effects: QT prolongation, arrhythmias, and clinical monitoring. T2 - European journal of clinical pharmacology PY - 2026 DO - 10.1007/s00228-026-04141-4 AN - PMID:42627392 ER -
BACKGROUND: The electrocardiogram (ECG) remains the foremost non-invasive tool for detecting adverse drug effects on cardiac electrophysiology, encompassing QT interval prolongation, torsades de pointes (TdP), atrioventricular (AV) block, and sodium-channel-mediated QRS widening. As polypharmacy becomes ubiquitous - particularly in ageing populations and oncology - clinicians require a structured understanding of drug-ECG interactions to mitigate sudden cardiac death risk. METHODS: A systematic narrative review was conducted using PubMed, Embase, and the Cochrane Library covering January 2006 to April 2026. Priority was given to meta-analyses, systematic reviews, scientific statements, and guidelines addressing drug-induced ECG changes, QTc measurement methodology, TdP risk stratification, and ECG monitoring protocols. Reference lists of key papers were hand-searched. Seventy references meeting quality and relevance criteria are cited. RESULTS: Numerous drug classes - including antiarrhythmics, antibiotics, antipsychotics, antidepressants, antiemetics, and oncology agents - prolong the corrected QT interval primarily through blockade of the cardiac hERG/IKr potassium channel. Modifiable risk factors include hypokalaemia, hypomagnesaemia, bradycardia, and co-prescription of CYP3A4 inhibitors. Female sex, age ≥ 65 years, congenital long QT syndrome carriers, and cardiac failure patients are at disproportionate TdP risk. The validated Tisdale Risk Score enables pre-treatment stratification in hospitalised patients. Drug-specific ECG monitoring protocols with actionable thresholds are summarised. CONCLUSIONS: Drug-induced ECG changes are common, clinically consequential, and often preventable. Evidence-based monitoring protocols, correction of modifiable risk factors, and prompt recognition of ominous ECG patterns substantially reduce adverse outcomes. Prescriber education across all clinical settings is imperative.