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Evaluation of the QT Interval in Patients with Drug-induced QT Prolongation and Torsades de Pointes
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  • Philipp Krisai,
  • Konstantinos Vlachos,
  • F. Daniel Ramirez,
  • Yosuke Nakatani,
  • Takashi Nakashima ,
  • Takamitsu Takagi,
  • Tsukasa Kamakura,
  • Elodie Surget,
  • Clémentine André,
  • Ghassen Cheniti,
  • Nicolas Welte,
  • Remi Chauvel,
  • Romain Tixier,
  • Josselin Duchateau,
  • Thomas Pambrun,
  • Nicolas Derval,
  • Mélèze Hocini,
  • Pierre Jais,
  • Michel Haissaguerre,
  • Frederic Sacher
Philipp Krisai
Centre Hospitalier Universitaire de Bordeaux
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Konstantinos Vlachos
Evangelismos General Hospital of Athens
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F. Daniel Ramirez
Centre Hospitalier Universitaire de Bordeaux Hopital Cardiologique
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Yosuke Nakatani
University of Toyama
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Takashi Nakashima
1. Electrophysiology and Ablation Unit and L’Institut de rythmologie et modélisation cardiaque (LIRYC)
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Takamitsu Takagi
Yokosuka Kyosai Hospital
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Tsukasa Kamakura
National Cerebral and Cardiovascular Center
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Elodie Surget
Centre Hospitalier Universitaire de Bordeaux
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Clémentine André
CHU Trousseau
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Ghassen Cheniti
Hôpital Cardiologique du Haut Lévêque
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Nicolas Welte
CHU Bordeaux, Hopital Haut Leveque
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Remi Chauvel
CHU Bordeaux, Hopital Haut Leveque
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Romain Tixier
Centre Hospitalier Universitaire de Bordeaux
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Josselin Duchateau
IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-/ Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit / Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045
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Thomas Pambrun
Hôpital Cardiologique du Haut-Lévêque
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Nicolas Derval
Centre Hospitalier Universitaire de Bordeaux
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Mélèze Hocini
Hôpital Cardiologique du Haut-Lévèque
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Pierre Jais
Centre Hospitalier Universitaire de Bordeaux
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Michel Haissaguerre
Hopital Cardiologique du Haut-Leveque
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Frederic Sacher
Bordeaux University Hospital
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Peer review status:ACCEPTED

10 May 2020Submitted to Journal of Cardiovascular Electrophysiology
11 May 2020Submission Checks Completed
11 May 2020Assigned to Editor
14 May 2020Reviewer(s) Assigned
26 May 2020Review(s) Completed, Editorial Evaluation Pending
26 May 2020Editorial Decision: Revise Minor
15 Jun 20201st Revision Received
16 Jun 2020Submission Checks Completed
16 Jun 2020Assigned to Editor
16 Jun 2020Reviewer(s) Assigned
26 Jun 2020Review(s) Completed, Editorial Evaluation Pending
06 Jul 2020Editorial Decision: Accept

Abstract

Background Data on the optimal location of the ECG leads for the diagnosis of drug-induced long QT syndrome (diLQTS) with Torsades de Pointes (TdP) are lacking. Methods We systematically reviewed the literature for ECGs of patients with diLQTS and subsequent TdP. We assessed T-wave morphology in each lead and measured the longest QT interval in the limb and chest leads in a standardized fashion. Results Of 84 patients, 61.9% were female and mean age was 58.8 years. QTc was significantly longer in chest versus limb leads (mean (standard deviation) 671 (102) vs 655 (97) ms, p=0.02). Using only limb leads for QT interpretation, 18 (21.4%) ECGs were non-interpretable: 10 (11.9%) due to too flat T-waves, 7 (8.3%) due to frequent, early PVCs and 1 (1.2%) due to too low ECG recording quality. In the chest leads, ECGs were non-interpretable in 9 (10.7%) patients: 6 (7.1%) due to frequent, early PVCs, 1 (1.2%) due to insufficient ECG quality, 2 (2.4%) due to missing chest leads but none due to too flat T-waves. The most common T-wave morphologies in the limb leads were flat (51.0%), broad (14.3%) and late peaking (12.6%) T-waves. Corresponding chest lead morphologies were inverted (35.5%), flat (19.6%) and biphasic (15.2%) T-waves. Conclusions Our results indicate that QT evaluation by limb leads only underestimates the incidence of diLQTS experiencing TdP and favors the screening using both limb and chest lead ECG.