Background: To determine when patients presenting with an overdose of QT-interval prolonging drugs can be discharged safely can be challenging, especially when the moment of intoxication and/or the substance(s) ingested are unknown. Objective: In a proof of principle study, we aimed to study if continuous QTc interval analysis can be used to establish optimal observation duration of patients with an intoxication with QTc prolonging medication. Methods: For patients presenting with an intoxication with QT-interval prolonging drugs in the emergency department (ED), ECG signals sampled at 500Hz were pre-processed, and the average heart rate corrected QT-interval (QTc) per 5 minutes was calculated and plotted against time. A third order polynomial was fitted to visualize when the QTc would be highest (the electrophysiological Tmax). This point in time was compared to the estimated Tmax based on pharmacokinetic properties of the ingested substance. Results: In a retrospective biobank-based study, a total of 22 ED visits (of 15 patients) were analyzed. An electrophysiological Tmax could be calculated for 17/22 visits. The remaining five patients presented either long after the electrophysiological Tmax (n=4) or were admitted to the ward before reaching the Tmax (n=1). The average (SD) difference between the estimated Tmax based on drug properties and the calculated electrophysiological Tmax was 18 (133) minutes (range -158-296 minutes). Despite the wide range, there was a significant correlation between recorded electrophysiological Tmax and estimated Tmax (r=0.67, p=0.012). Conclusion: Continuous electrophysiological monitoring can be used as an adjunct to determine the toxicokinetic Tmax for patients presenting with an intoxication, especially when the time of ingestion or the substance ingested are unknown.
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