Cardiac risk monitoring

The manuals converge on ibogaine carrying meaningful cardiac risk, with QTc prolongation, arrhythmias, and torsades de pointes treated as central safety concerns. Across the extracts, cardiac screening before treatment and ongoing ECG monitoring during treatment are consistent themes, alongside attention to heart rate, blood pressure, and other signs of instability. They also agree that marked QTc prolongation warrants escalation. The GITA guideline refers to hospital care for dangerous QTc prolongation or unstable rhythm, while the 2024 study protocol specifies serial 12 lead ECGs, concern thresholds for QTc, continued monitoring when QTc remains prolonged after 24 hours, and magnesium stabilisation when QTc exceeds 500 ms. The manuals differ mainly in how explicit and operational they are. The 2003 manual emphasises broad pre treatment cardiac exclusion, including prior myocardial infarction and possible hidden cardiovascular disease, whereas the 2024 paper gives more specific exclusion criteria such as syncope, long QT syndrome, ventricular fibrillation, and elevated baseline QTc. The 2024 source is also more protocolised about ECG frequency and QTc cut offs, while the older guidance is broader, focusing on screening and recognition of risk.