Arrhythmogenesis and Prolonged Repolarization From Synthetic Opioids: Finally Sorted?

Abstract

The synthetic opioid methadone has long been recognized to cause not only QT prolongation on ECG but also a predilection for torsade de pointes.1,2 Despite the limited distribution of the drug in comparison to other opioids, methadone use has been inordinately implicated in sudden death from ventricular arrhythmia.3 However, the full mechanistic scope of why this drug is arrhythmogenic has been unresolved.