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Arrhythmogenic foods - A growing medical problem.

  • 2020-07
  • Trends in cardiovascular medicine 30(5)
    • Raymond L Woosley

Study Design

Type
Review
Arrhythmogenic ingredients in our diet such as mushrooms, licorice, toxic honey, liquid protein drinks, etc. have long been recognized as rare but important considerations in the differential diagnosis of arrhythmias. Anecdotal reports of torsades de pointes (TdP), arrhythmias and/or sudden death and small studies in normal subjects have suggested that simple ingredients such as grapefruit juice or ingredients in energy drinks marketed as dietary supplements could have direct arrhythmogenic actions, especially in patients with congenital long QT syndrome (cLQTS). Two recent studies that employed the industry-standard "thorough QT" trial design leave no doubt that grapefruit juice and some energy drinks can prolong the QTc interval and to exceed 500 msec. in some patients with cLQTS, a threshold known to signal imminent danger. These reports raise numerous clinically important questions such as which other patients may be at risk of arrhythmias. For example, patients with multiple clinical risk factors for TdP (hypokalemia, bradycardia, female sex, etc.) may be at risk from these and possibly other dietary ingredients ingested by millions of people each day. It is essential that further research evaluate the safety of these and similar food products and that vulnerable patients, especially those with cLQTS, be warned of this serious and emerging threat.

Research Insights

  • Grapefruit→Increased QTc Interval

    Two recent studies that employed the industry-standard 'thorough QT' trial design leave no doubt that grapefruit juice and some energy drinks can prolong the QTc interval and to exceed 500 msec. in some patients with cLQTS, a threshold known to signal imminent danger.

    Effect
    Harmful
    Effect size
    Moderate

Adverse Events Reported

  • Grapefruit→qtc interval prolongation

    Two recent studies that employed the industry-standard 'thorough QT' trial design leave no doubt that grapefruit juice and some energy drinks can prolong the QTc interval and to exceed 500 msec. in some patients with cLQTS, a threshold known to signal imminent danger.

    Finding
    Increased risk
    Severity
    Serious adverse event
    Magnitude
    to exceed 500 msec. in some patients with cLQTS
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