The role of QT-prolonging medications in a forensic autopsy study from Western Denmark

• Published in: Forensic science international Vol. 325; p. 110889
• Main Authors: Ahmed, H., Larsen, M.K., Hansen, M.R., Andersen, C.U.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 01.08.2021; Elsevier Limited
• Subjects: Addicts; Antidepressants; Antiemetics; Antimycotics; Antipsychotics; Arrhythmia; Atherosclerosis; Autopsies; Autopsy; Cardiac arrhythmia; Chromatography; Congenital diseases; Death; Ethics; Forensic science; Forensic sciences; Heart; Lethal levels; Mass spectrometry; Medical research; Mortality; Prolongation; Risk; Scientific imaging; Substance abuse treatment; Suicides & suicide attempts; Torsades de pointes; Denmark; Antiemetics; Cardiac arrhythmia; Antipsychotics; Antimycotics; Antidepressants; Torsades de pointes
• DOI: 10.1016/j.forsciint.2021.110889
• ISSN: 0379-0738

•Treatment with QT-prolonging medications may induce fatal cardiac arrhythmia.•22.5% of 741 autopsy cases had a high risk of medication-induced QT-prolongation.•Cardiac arrhythmia related to QT-prolonging medications could be suspected in 0.9%.•A genetic pro-arrhythmic background in these 0.9% cannot be excluded. Medication-induced prolongation of the QT-interval (miQTP) can lead to cardiac arrhythmia. Our aim was to investigate the prevalence of forensic autopsy cases where fatal cardiac arrhythmia related to treatment with QT-prolonging medications (QT-PMs) could be suspected. We performed a cross-sectional study of 741 forensic autopsies undertaken at our institution in non-drug addicts aged 15 years or above from 2017 to 2019. We defined a high risk of miQTP by one detected QT-PM in a concentration above therapeutic level, or two or more detected QT-PMs in post mortem blood. We reviewed the autopsy reports from cases with a high miQTP-risk to identify cases with no other apparent cause of death. We discarded suicides and cases with lethal levels of QT-PMs. We identified 167 cases (22.5%) with high risk of miQTP, and discarded 36 suicides (4.9%) and 7 (0.9%) with lethal levels of QT-PMs. Apart from a high risk of miQTP, no other apparent explanation of the cause of death was present in seven (0.9%). In 18 cases (2.4%) with high miQTP-risk, the cause of death was primarily attributed to cardiac changes other than acute cardiovascular events. In conclusion, 22.5% had a high risk of miQTP, and fatal cardiac arrhythmia related to treatment with QT-PMs could be suspected in 0.9%. However, a genetic pro-arrhythmic background could not be excluded in our study. Furthermore, it is possible that QT-PMs could have played a role in some of the 2.4% of cases where the cause of death was mainly attributed to cardiac changes and the risk of miQTP was high.