Correlation of QT Interval Correction Methods During Atrial Fibrillation and Sinus Rhythm

Musat, Dan; Adhaduk, Mehul; Preminger, Mark; Arshad, Aysha; Sichrovsky, Tina; Steinberg, Jonathan S.; Mittal, Suneet

doi:10.1016/j.amjcard.2013.06.027

Cited by 22 publications

(32 citation statements)

References 15 publications

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“…Such approach could substantially improve detection of QT prolongation in AF, although its clinical utility remains to be determined. Consistent with the paper by Musat et al [23], our data suggests that the QTc values obtained from Bazett formula in AF are too long (in addition to the undesirable HR dependence). Its use in AF may result in incorrect clinical decisions such as unnecessary cessation of treatment with dofetilide or sotalol.…”

Section: Discussionsupporting

confidence: 89%

“…Repolarization delay predisposes patients to TdP and the short-long-short sequences that classically trigger TdP may be more common in AF than in SR. Many patients are treated for AF with class III antiarrhythmic drugs; these agents are often initiated while patients are in AF and reliable detection of excessive QT prolongation is necessary to minimize proarrhythmia [18,23]. …”

Section: Discussionmentioning

confidence: 99%

“…It is recognized that QT interval changes following the dramatic beat-to-beat changes in RR interval occurring in AF are substantially less pronounced than predicted by the Bazett formula, and it is known that Bazett formula overcorrects for the RR interval duration in AF [23] (as it does in SR [24,25]). Other QTc correction formulas are less prone to overcorrection, but it is uncertain how to best compare their performance since it is typically impossible to maintain steady HR at 60 bpm in most AF patients to determine the “correct” QTc.…”

Section: Discussionmentioning

confidence: 99%

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Recent heart rate history affects QT interval duration in atrial fibrillation

et al. 2017

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QT interval prolongation is associated with a risk of polymorphic ventricular tachycardia. QT interval shortens with increasing heart rate and correction for this effect is necessary for meaningful QT interval assessment. We aim to improve current methods of correcting the QT interval during atrial fibrillation (AF). Digitized Holter recordings were analyzed from patients with AF. Models of QT interval dependence on RR intervals were tested by sorting the beats into 20 bins based on corrected RR interval and assessing ST-T variability within the bins. Signal-averaging within bins was performed to determine QT/RR dependence. Data from 30 patients (29 men, 69.3±7.3 years) were evaluated. QT behavior in AF is well described by a linear function (slope ~0.19) of steady-state corrected RR interval. Corrected RR is calculated as a combination of an exponential weight function with time-constant of 2 minutes and a smaller “immediate response” component (weight ~ 0.18). This model performs significantly (p<0.0001) better than models based on instantaneous RR interval only including Bazett and Fridericia. It also outperforms models based on shorter time-constants and other previously proposed models. This model may improve detection of repolarization delay in AF. QT response to heart rate changes in AF is similar to previously published QT dynamics during atrial pacing and in sinus rhythm.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Recent heart rate history affects QT interval duration in atrial fibrillation

et al. 2017

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“…For example, the Bazett formula has been reported to over-correct the QT interval at faster heart rates and under-correct at slower rates (12, 15, 18, 27–29). Conversely, the Fridericia formula has been shown to do the opposite -- under-correct at faster and over-correct at slower rates (12,13,15).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Formulas for Calculation of the Corrected QT Interval in Infants and Young Children

Phan

Silka

Lan

et al. 2015

The Journal of Pediatrics

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Objective To compare four heart rate correction formulas for calculation of the rate corrected QT interval (QTc) among infants and young children. Study design R and QT intervals were measured from digital electrocardiograms. QTc were calculated with the Bazett, Fridericia, Hodges, and Framingham formulas. QTc versus RR graphs were plotted, and slopes of the regression lines compared. Slopes of QTc-RR regression lines close to zero indicate consistent QT corrections over the range of heart rates. Results We reviewed electrocardiograms from 702 children, with 233 (33%) <1 year of age and 567 (81%) <2 years. The average heart rate was 122 ±20 bpm (median 121 bpm). The slopes of the QTc-RR regression lines for the four correction formulas were: −0.019 (Bazett); 0.1028 (Fridericia); −0.1241 (Hodges); and 0.2748 (Framingham). With the Bazett formula, a QTc >460 ms was 2 standard deviations above the mean, compared with “prolonged” QTc values of 414, 443, and 353 ms for the Fridericia, Hodges, and Framingham formulas, respectively. Conclusions The Bazett formula calculated the most consistent QTc; 460 msec is the best threshold for prolonged QTc. The study supports continued use of the Bazett formula for infants and children and differs from the use of the Fridericia correction during clinical trials of new medications.

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“…10, 11 Considering that multiple ablations might be required, and that there is potential risk carried with each A QTc Predicts Recurrence After AF Ablation in HCM measured from 3 consecutive cardiac cycles and then a mean value was used for analysis. 25 Two investigators (S.-N.W. and N.L.)…”

mentioning

confidence: 99%

QTc Interval Prolongation Predicts Arrhythmia Recurrence After Catheter Ablation of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy

Wen

Liu

et al. 2015

Circ J

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Background:In hypertrophic cardiomyopathy (HCM) patients complicated with atrial fibrillation (AF), catheter ablation has been recommended as a treatment option. Meanwhile, prolongation of QTc interval has been linked to an increased AF incidence in the general population and to poor outcomes in HCM patients. However, whether QTc prolongation predicts arrhythmia recurrence after AF ablation in the HCM population remains unknown. Methods and Results:Thirty-nine HCM patients undergoing primary AF ablation were enrolled. The ablation strategy included bilateral pulmonary vein isolation (PVI) for paroxysmal AF (n=27) and PVI plus left atrial roof, mitral isthmus and tricuspid isthmus linear ablations for persistent AF (n=12). Pre-procedural QTc was corrected by using the Bazett's formula. At a 14.8-month follow up, 23 patients experienced atrial tachyarrhythmia recurrence. Recurrent patients had longer QTc than non-recurrent patients (461.0±28.8 ms vs. 434.3±18.2 ms, P=0.002). QTc and left atrial diameter (LAD) were independent predictors of recurrence. The cut-off value of QTc 448 ms predicted arrhythmia recurrence with a sensitivity of 73.9% and a specificity of 81.2%. A combination of LAD and QTc (global chisquared=13.209) was better than LAD alone (global chi-squared=6.888) or QTc alone (global chi-squared=8.977) in predicting arrhythmia recurrence after AF ablation in HCM patients. Conclusions:QTc prolongation is an independent predictor of arrhythmia recurrence in HCM patients undergoing AF ablation, and might be useful for identifying those patients likely to have a better outcome following the procedure. (Circ J 2015; 79: 1024 -1030

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Correlation of QT Interval Correction Methods During Atrial Fibrillation and Sinus Rhythm

Cited by 22 publications

References 15 publications

Recent heart rate history affects QT interval duration in atrial fibrillation

Recent heart rate history affects QT interval duration in atrial fibrillation

Comparison of Formulas for Calculation of the Corrected QT Interval in Infants and Young Children

QTc Interval Prolongation Predicts Arrhythmia Recurrence After Catheter Ablation of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy

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