Harvard Medical School, Boston, MA; VA Boston Healthcare System, Brockton, MA.
Harvard Medical School, Boston, MA; VA Boston Healthcare System, Brockton, MA.
J Acad Consult Liaison Psychiatry. 2021 Sep-Oct;62(5):501-510. doi: 10.1016/j.jaclp.2021.02.003. Epub 2021 Feb 13.
Assessment of the heart rate-corrected QT-interval on the 12-lead electrocardiogram when prescribing medications known to increase the risk of Torsades de Pointes has become a common part of consultation-liaison psychiatry practice.
Highlighted by a patient who experienced psychiatric decompensation due to inaccurate interpretation of QTc prolongation in the setting of a wide QRS complex, we aimed to describe the approach to QTc interpretation in patients with ventricular conduction delay.
We reviewed the current literature on the approach to assessment of prolonged repolarization in patients with ventricular conduction delay due to bundle branch block (BBB) and ventricular pacing.
Physicians of any specialty may perform initial electrocardiogram interpretation and should be proficient in the definition, recognition, and understanding of the basic pathophysiology of electrocardiographic abnormalities. We discuss current approaches to assessment of the QT-interval in patients with a wide QRS complex due to bundle branch block and ventricular pacing, including bivariate QTc modification, univariate QT-interval modifications, and use of the JT-interval.
The QT-interval is prolonged ipso facto in patients with a wide QRS complex from ventricular conduction delay/ventricular pacing and must be adjusted for QRS duration. Multiple formulae have been proposed to account for wide QRS complex in this setting with no single universally accepted methodology. We suggest the use of either the Bogossian formula or JT-interval followed by Hodges or Framingham heart-rate correction to adjust for a wide QRS complex. It is critical that the C-L psychiatrist be able to identify a wide QRS complex on the electrocardiogram, understand implications for accurate assessment of prolonged depolarization, and apply an appropriate correction methodology.
在为已知会增加尖端扭转型室性心动过速风险的药物开处方时，评估 12 导联心电图的心率校正 QT 间期已成为会诊联络精神病学实践的常见部分。
由于对宽 QRS 复合波中 QTc 延长的不准确解释，导致一位患者出现精神科失代偿，我们旨在描述心室传导延迟患者 QTc 解释的方法。
我们回顾了当前关于评估因束支传导阻滞（BBB）和心室起搏导致心室传导延迟患者复极延长的文献。
任何专业的医生都可以进行初始心电图解释，并且应该精通心电图异常的定义、识别和理解基本病理生理学。我们讨论了目前评估因束支传导阻滞和心室起搏导致宽 QRS 复合波患者 QT 间期的方法，包括双变量 QTc 修正、单变量 QT 间期修正和使用 JT 间期。
由于心室传导延迟/心室起搏导致宽 QRS 复合波的患者的 QT 间期实际上会延长，必须根据 QRS 持续时间进行调整。已经提出了多种公式来解释这种情况下的宽 QRS 复合波，但没有一种被普遍接受的单一方法。我们建议使用 Bogossian 公式或 JT 间期，然后使用 Hodges 或 Framingham 心率校正来调整宽 QRS 复合波。关键是 C-L 精神科医生能够在心电图上识别宽 QRS 复合波，理解准确评估延长去极化的影响，并应用适当的校正方法。
