A novel marker to monitor potential cardiac arrhythmic effects of isotretinoin therapy: Frontal QRS-T angle.

Background: . . . . Isotretinoin is widely used to treat acne vulgaris. Although primarily targeting the skin, it exerts systemic effects, including rare cardiac manifestations such as arrhythmia. Electrocardiography (ECG) is the standard tool for rhythm monitoring. The frontal QRS-T angle, a novel ECG-based parameter, reflects ventricular depolarisation-repolarisation heterogeneity and has been recognised as a predictor of arrhythmic events. This study aimed to evaluate electrophysiological and biochemical changes associated with isotretinoin, focusing on the frontal QRS-T angle, basic ECG parameters, hemograms, and lipid profiles.

Methods: Forty patients receiving oral isotretinoin (0.5-1 mg/kg/day) for acne vulgaris were prospectively followed. The frontal QRS-T angle, ECG parameters, hemograms, lipid values, heart rate, and blood pressure were recorded at baseline, 3 months, and 6 months.

Results: At 6 months, statistically significant increases were observed in the frontal QRS-T angle and QRS duration, though both remained within accepted reference ranges. P wave duration, PR interval, QTc interval, heart rate, and blood pressure showed no significant changes. Lipid alterations were notable: HDL decreased, while total cholesterol, LDL, and triglycerides increased significantly. Hematological analysis showed stable leukocyte counts, with platelets rising transiently at 3 months and declining at 6 months.

Discussion: .Isotretinoin therapy was associated with measurable changes in cardiac electrophysiology and lipid metabolism. The frontal QRS-T angle may provide an early ECG marker of arrhythmic risk, supporting its inclusion in dermatologic pharmacovigilance. Concurrent lipid alterations may enhance arrhythmic vulnerability, underscoring the importance of cardiac and metabolic monitoring during isotretinoin treatment.