Fernandes Diogo de Almeida, Camões Guilherme de Freitas, Ferreira Diana, Queijo Carolina, Fontes-Ribeiro Carlos, Gonçalves Lino, Pina Rui, António Natália
Department of Cardiology, Coimbra Hospital and University Centre (CHUC), Coimbra 3000-075, Portugal.
Faculty of Medicine, University of Coimbra, Coimbra 3000-370, Portugal.
World J Emerg Med. 2023;14(6):454-461. doi: 10.5847/wjem.j.1920-8642.2023.104.
Long QT syndrome (LQTS) is a heterogeneous syndrome that may be congenital or, more frequently, acquired. The real-world prevalence of acquired LQTS (aLQTS) in the emergency department (ED) remains to be determined. The aim of this study was to determine prevalence of aLQTS and its impact on symptoms on ED admissions.
Electrocardiograms (ECG) of 5,056 consecutively patients admitted in the ED of a tertiary hospital between January 28 and March 17 of 2020 were reviewed. All patients with aLQTS were included. Clinical data with a focus on QT prolonging drugs and clinical factors were recorded. Statistical comparison was made between the groups with and without corrected QT (QTc) interval greater than 500 ms (value that is considered severely increased).
A total of 383 ECGs with prolonged QTc were recognized, corresponding to a prevalence of aLQTS at admission of 7.82%. Patients with aLQTS were more commonly men (53.3%) with an age of (73.49±14.79) years old and QTc interval of (505.3±32.4) ms. Only 20.4% of these patients with aLQTS were symptomatic. No ventricular arrhythmias were recorded. Patients with QT interval greater than 500 ms were more frequently female (59.5%; <0.001) and were more frequently on QT prolonging drugs (77.3%; =0.025). Main contributing factor was intake of antibiotics (odds ratio [] 4.680) followed by female gender ( 2.473) and intake of antipsychotics ( 1.925).
aLQTS is particularly prevalent in the ED. Female patients on antibiotics and antipsychotics are at particularly high risk. Efforts must be made to avoid, detect and treat aLQTS as early as possible.
长QT综合征（LQTS）是一种异质性综合征，可能是先天性的，更常见的是后天获得性的。急诊科（ED）中获得性LQTS（aLQTS）的实际患病率仍有待确定。本研究的目的是确定aLQTS的患病率及其对ED入院症状的影响。
回顾了2020年1月28日至3月17日期间在一家三级医院急诊科连续收治的5056例患者的心电图（ECG）。纳入所有aLQTS患者。记录重点关注延长QT的药物和临床因素的临床数据。对校正QT（QTc）间期大于500毫秒（该值被认为严重延长）和未大于500毫秒的两组进行统计学比较。
共识别出383份QTc延长的心电图，对应入院时aLQTS的患病率为7.82%。aLQTS患者男性更常见（53.3%），年龄为（73.49±14.79）岁，QTc间期为（505.3±32.4）毫秒。这些aLQTS患者中只有20.4%有症状。未记录到室性心律失常。QT间期大于500毫秒的患者女性更常见（59.5%；P<0.001），且更常使用延长QT的药物（77.3%；P=0.025）。主要促成因素是抗生素摄入（比值比[OR]4.680），其次是女性（OR 2.473）和抗精神病药物摄入（OR 1.925）。
aLQTS在急诊科尤为普遍。使用抗生素和抗精神病药物的女性患者风险特别高。必须努力尽早避免、检测和治疗aLQTS。
