Provider Response to QTc Prolongation on Standard 12‐Lead EKG: Do We Notice or Do We Care?

Good, Meghan M.; Riad, Fady S.; Good, Chester B.; Shalaby, Alaa

doi:10.1111/pace.12951

Cited by 7 publications

(2 citation statements)

References 21 publications

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“…Reports have also been published evaluating the effectiveness of the suggested good clinical practice 9 – 11 . Regrettably, it has been reported that while the introduction of guidelines and monitoring schemes increases the awareness of the proarrhythmic potentials, therapeutic implications of prolonged QTc interval, such as therapy changes and/or more intensive monitoring, are not necessarily systematically implemented 12 , 13 .…”

Section: Introductionmentioning

confidence: 99%

Influence of heart rate correction formulas on QTc interval stability

Andršová

Hnatkova²,

Šišáková

et al. 2021

Sci Rep

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Monitoring of QTc interval is mandated in different clinical conditions. Nevertheless, intra-subject variability of QTc intervals reduces the clinical utility of QTc monitoring strategies. Since this variability is partly related to QT heart rate correction, 10 different heart rate corrections (Bazett, Fridericia, Dmitrienko, Framingham, Schlamowitz, Hodges, Ashman, Rautaharju, Sarma, and Rabkin) were applied to 452,440 ECG measurements made in 539 healthy volunteers (259 females, mean age 33.3 ± 8.4 years). For each correction formula, the short term (5-min time-points) and long-term (day-time hours) variability of rate corrected QT values (QTc) was investigated together with the comparisons of the QTc values with individually corrected QTcI values obtained by subject-specific modelling of the QT/RR relationship and hysteresis. The results showed that (a) both in terms of short-term and long-term QTc variability, Bazett correction led to QTc values that were more variable than the results of other corrections (p < 0.00001 for all), (b) the QTc variability by Fridericia and Framingham corrections were not systematically different from each other but were lower than the results of other corrections (p-value between 0.033 and < 0.00001), and (c) on average, Bazett QTc values departed from QTcI intervals more than the QTc values of other corrections. The study concludes that (a) previous suggestions that Bazett correction should no longer be used in clinical practice are fully justified, (b) replacing Bazett correction with Fridericia and/or Framingham corrections would improve clinical QTc monitoring, (c) heart rate stability is needed for valid QTc assessment, and (d) development of further QTc corrections for day-to-day use is not warranted.

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Section: Introductionmentioning

confidence: 99%

Influence of heart rate correction formulas on QTc interval stability

Andršová

Hnatkova²,

Šišáková

et al. 2021

Sci Rep

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show abstract

“…These lead to the conclusion that the monitoring schemes result in an increase in the knowledge and awareness of the drug‐induced QTc prolongation with consequent proarrhythmic risk among the clinical community. At the same time, however, the available literature also suggests that in terms of clinical implications, for example, therapy changes in susceptible patients, the ECG monitoring schemes are frequently not particularly successful (Good, Riad, Good, & Shalaby, ).…”

Section: Introductionmentioning

confidence: 99%

Sources of QTc variability: Implications for effective ECG monitoring in clinical practice

Hnatkova

Malik

2019

Noninvasive Electrocardiol

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Pharmaceuticals that prolong ventricular repolarization may be proarrhythmic in susceptible patients. While this fact is well recognized, schemes for sequential QTc interval monitoring in patients receiving QT‐prolonging drugs are frequently overlooked or, if implemented, underutilized in clinical practice. There are several reasons for this gap in day‐to‐day clinical practice. One of these is the perception that serially measured QTc intervals are subject to substantial variability that hampers the distinction between potential proarrhythmic signs and other sources of QTc variability. This review shows that substantial part of the QTc variability can be avoided if more accurate methodology for electrocardiogram collection, measurement, and interpretation is used. Four aspects of such a methodology are discussed. First, advanced methods for QT interval measurement are proposed including suggestion of multilead measurements in problematic recordings such as those in atrial fibrillation patients. Second, serial comparisons of T‐wave morphologies are advocated instead of simple acceptance of historical QTc measurements. Third, the necessity of understanding the pitfalls of heart rate correction is stressed including the necessity of avoiding the Bazett correction in cases of using QTc values for clinical decisions. Finally, the frequently overlooked problem of QT‐heart rate hysteresis is discussed including the possibility of gross QTc errors when correcting the QT interval for simultaneously measured short‐term heart rate.

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Conundrum of Clinical QTc Monitoring

Malik

2022

Drug Saf

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Provider Response to QTc Prolongation on Standard 12‐Lead EKG: Do We Notice or Do We Care?

Cited by 7 publications

References 21 publications

Influence of heart rate correction formulas on QTc interval stability

Influence of heart rate correction formulas on QTc interval stability

Sources of QTc variability: Implications for effective ECG monitoring in clinical practice

Conundrum of Clinical QTc Monitoring

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