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European Pharmaceutical Contractor
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Historical Perspective
Electrocardiograms (ECGs) have been recorded in clinical trials for years and the results have been used to include/exclude subjects and to determine whether or not a test compound has any cardiovascular effects. Ordinarily, in non-cardiovascular indications the emphasis on ECG data was limited to safety analysis in early Phase I trials only. Holter monitors (continuous 24 or 48 hour amb
ulatory monitors) or telemetry systems were commonly used to screen healthy volunteers in early phase studies and to monitor any potential cardiovascular side effects following drug administration.
In the 1980s however, indications arose that non-cardiovascular drugs may be having unwanted side effects on the repolarisation of the myocardium. The physical evidence of this was a prolongation of the QT interval that, in some cases, led to a potentially life-threatening arrhythmia called 'torsade de pointes' (see Figures 1 and 2). This problem led to the high profile withdrawal of a number of licensed drugs (for example cisapride, grapefloxacin, terfenadine) and firmly focused the industry's attention on the QT interval.
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