The Morphology of the QT Interval Predicts Torsade de Pointes During Acquired Bradyarrhythmias

• Published in: Journal of the American College of Cardiology Vol. 49; no. 3; pp. 320 - 328
• Main Authors: Topilski, Ian, MD, Rogowski, Ori, MD, Rosso, Rafael, MD, Justo, Dan, MD, Copperman, Yitschak, MD, Glikson, Michael, MD, FACC, Belhassen, Bernard, MD, Hochenberg, Marek, MD, Viskin, Sami, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 23-01-2007; Elsevier Science; Elsevier Limited
• Subjects: Age Distribution; Aged; Aged, 80 and over; Analysis of Variance; Biological and medical sciences; Bradycardia - diagnosis; Bradycardia - epidemiology; Bradycardia - therapy; Cardiac arrhythmia; Cardiac dysrhythmias; Cardiology; Cardiology. Vascular system; Cardiovascular; Case-Control Studies; Disease Progression; Electrocardiography; Female; Heart; Humans; Incidence; Internal Medicine; Logistic Models; Long QT Syndrome - diagnosis; Long QT Syndrome - epidemiology; Long QT Syndrome - therapy; Male; Medical sciences; Middle Aged; Pacemaker, Artificial; Potassium; Predictive Value of Tests; Reference Values; Retrospective Studies; Risk Assessment; ROC Curve; Severity of Illness Index; Sex Distribution; Torsades de Pointes - diagnosis; Torsades de Pointes - epidemiology; Torsades de Pointes - therapy; Variables; positive predictive value; early afterdepolarizations; TdP; electrocardiogram/electrocardiograph; long QT syndrome; LQTS; ROC; ECG; EADs; IQR; interquartile range; AVB; RR interval; receiver-operating characteristic; CAVB; atrioventricular block; PPV; torsade de pointes; time duration between 2 consecutive R waves of the electrocardiogram; complete atrioventricular block; QT interval; Wave burst; Arrhythmia; Acquired; Heart disease; Morphology; Prediction; Cardiovascular disease; Circulatory system; Cardiology; Phlebology; Excitability disorder
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2006.08.058

The Morphology of the QT Interval Predicts Torsade de Pointes During Acquired Bradyarrhythmias Ian Topilski, Ori Rogowski, Rafael Rosso, Dan Justo, Yitschak Copperman, Michael Glikson, Bernard Belhassen, Marek Hochenberg, Sami Viskin In a case-controlled study comparing 30 cases of acquired bradyarrhythmias complicated by torsade de pointes (TdP) and 113 cases with uncomplicated bradyarrhythmias, prolonged QT, corrected QT, and Tpeak -Tend intervals were strong predictors of TdP, with the best single discriminator being a prolonged Tpeak -Tend . The only parameter that proved to be independent from the QT interval and added to the prediction of TdP was the presence of “LQT2-like” notched T waves. A 2-step model, based on QT duration and the presence of LQT2-like T waves, identified patients at risk for TdP with a positive predictive value of 84%.