Fluoroquinolone use and serious arrhythmias: A nationwide case-crossover study

Resuscitation. 2019 Jun;139:262-268. doi: 10.1016/j.resuscitation.2019.04.030. Epub 2019 Apr 25.

Abstract

Aim: Fluoroquinolones have been associated with life-threatening ventricular arrhythmias and even sudden cardiac death. We aimed to assess the temporal relationship of fluoroquinolone use and serious arrhythmias via a case-crossover analysis of a large cohort of serious arrhythmias patients.

Methods: In a national administrative database, we compare the distributions of fluoroquinolone exposure for the same patient across a 30-day period before the serious arrhythmia event and 5 randomly selected 30-day periods before the serious arrhythmia event. Odds ratios (ORs) and 95% Confidence Intervals (CIs) were estimated using conditional logistic regression analysis.

Results: From a total of 2 million participants, 7657 patients with serious arrhythmias were identified. Use of fluoroquinolones within the 30-day period before the event was significantly associated with increased risk for serious arrhythmia (OR:3.03, 95% CI:2.48, 3.71). The risk association was attenuated, but remained significant after adjustment for time-varying confounders (OR:1.48, 95% CI:1.18, 1.86). A consistent increase in risk of serious arrhythmia was observed for all time windows investigated (7 days, 14 days, 30 days, 60 days and 90 days).

Conclusions: Exposure to fluoroquinolones was substantially associated with serious arrhythmic events, independent of the temporal proximity of fluoroquinolone prescription.

Keywords: Case-crossover study; Fluoroquinolone; Serious arrhythmias.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / adverse effects*
  • Arrhythmias, Cardiac / chemically induced*
  • Cross-Over Studies
  • Female
  • Fluoroquinolones / adverse effects*
  • Humans
  • Male
  • Middle Aged
  • Severity of Illness Index
  • Taiwan
  • Time Factors

Substances

  • Anti-Bacterial Agents
  • Fluoroquinolones