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Several antimalarials can cause significant prolongation of the electrocardiograph QT interval, which can be associated with an increased risk of potentially lethal ventricular arrhythmias. High doses of artemether and artemotil have been associated with QT prolongation in dogs, raising the possibility of a class effect with the artemisinin derivatives. Serial electrocardiograms were recorded, and QTc interval was calculated before and after administration of artesunate by intravenous injection in patients with severe falciparum malaria in Bangladesh. Of 21 adult patients with severe malaria enrolled, 8 (38%) died. The mean QTc interval was unaffected by bolus intravenous artesunate (2.4 mg/kg). In two patients, the QTc interval exceeded 0.5 seconds, but in both cases, an alternative explanation was plausible. No effect was observed on the JTc or PR interval, QRS width, blood pressure, or heart rate. Intravenous artesunate does not have significant cardiovascular effects in patients with severe falciparum malaria.

Type

Journal article

Journal

Am J Trop Med Hyg

Publication Date

01/2009

Volume

80

Pages

126 - 132

Keywords

Adult, Antimalarials, Artemisinins, Artesunate, Blood Pressure, Electrocardiography, Ethanolamines, Fluorenes, Glasgow Coma Scale, Heart Rate, Humans, Long QT Syndrome, Lumefantrine, Malaria, Male, Patient Selection