Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, United States of America.
Department of Medicine, Stony Brook University Hospital, Stony Brook, NY, United States of America.
J Electrocardiol. 2022 Jan-Feb;70:13-18. doi: 10.1016/j.jelectrocard.2021.11.029. Epub 2021 Nov 19.
QT interval prolongation is a known risk factor for development of malignant ventricular arrhythmias. Measurement of the QT interval is difficult in the setting of ventricular pacing (VP), which can prolong depolarization and increase the QT interval, overestimating repolarization time. VP and cardiac resynchronization therapies have become commonplace in modern cardiac care and may contribute to repolarization heterogeneity and subsequent increased risk for ventricular arrhythmias including Torsades de Pointes. It is imperative for the clinician caring for acutely ill cardiac patients to understand the relationship between QT interval prolongation, both drug-induced and pacing-induced, and repolarization changes with subsequent ventricular arrhythmia risk. In this review, we discuss the components of QT interval assessment for arrhythmogenic risk including arrhythmogenic QT prolongation, methods for adjusting the QT interval to identify repolarization changes, methods to adjust for heart rate, and propose a framework for medication management to assess for drug-induced long QT syndrome in patients with VP.
QT 间期延长是恶性室性心律失常发展的已知危险因素。在心室起搏（VP）的情况下，QT 间期的测量较为困难，因为 VP 可延长去极化并增加 QT 间期，从而高估复极时间。VP 和心脏再同步治疗在现代心脏护理中已变得很普遍，可能导致复极异质性增加，随后室性心律失常的风险增加，包括尖端扭转型室性心动过速。对于照顾急性心脏疾病患者的临床医生来说，了解 QT 间期延长（包括药物诱导和起搏诱导）与复极变化之间的关系以及随后的室性心律失常风险至关重要。在这篇综述中，我们讨论了评估心律失常风险的 QT 间期的组成部分，包括致心律失常性 QT 延长、调整 QT 间期以识别复极变化的方法、调整心率的方法，并提出了一个药物管理框架，以评估接受 VP 的患者的药物诱导长 QT 综合征。
