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ARTICLE |

Prolonged QT-Interval Syndromes FREE

Arthur J. Moss, MD
[+] Author Affiliations

This article is one of a series sponsored by the American Heart Association.

Reprint requests to Box 653, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642 (Dr Moss).


JAMA. 1986;256(21):2985-2987. doi:10.1001/jama.1986.03380210081029
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PROLONGATION of the QT interval, either on a congenital or an acquired basis, is associated with an increased likelihood of malignant ventricular arrhythmias.1-3 Patients with QT prolongation frequently develop recurrent attacks of syncope or may present with sudden death. The malignant ventricular arrhythmias are characterized by rapid, irregular tachycardias that usually have a polymorphous configuration or a torsades de pointes pattern. The latter is a French term that describes the tachycardia as a "twisting of the points," so called because the QRS axis shifts back and forth around the baseline. Although polymorphous ventricular tachycardia and torsade frequently occur in the setting of QT prolongation, these malignant arrhythmias may also occur in the absence of a repolarization abnormality. Effective cardiac output and blood pressure are markedly impaired during torsades de pointes, with resultant syncope. Most tachyarrhythmic episodes terminate spontaneously with return of consciousness, but some may degenerate into ventricular fibrillation,

REFERENCES

Moss AJ, Schwartz PJ:  Delayed repolarization (QT or QTU prolongation) and malignant ventricular arrhythmias . Mod Concepts Cardiovasc Dis 1982;;51:85-90.
Bhandari AK, Scheinman M:  The long QT syndrome . Mod Concepts Cardiovasc Dis 1985;; 54:45-50.
Surawicz B, Knoebel SB:  Long QT good, bad or indifferent? J Am Coll Cardiol 1984;;4:398-413.
Jervell A, Lange-Nielsen F:  Congenital deaf mutism, functional heart disease with prolongation of the QT interval, and sudden death . Am Heart J 1957;;54:59-68.
Levine SA, Woodworth CR:  Congenital deaf mutism, prolonged QT interval, syncopal attacks and sudden death . N Engl J Med 1958;;259:412-417.
Romano C, Gemme G, Pongiglione R:  Aritmie cardiache rare dell'eta pediatrica: II. Accessi sincopali per fibrillazione ventricolare parossistica . Clin Pediatr 1963;;45:656-661.
Ward OC:  New familial cardiac syndrome in children . J Ir Med Assoc 1964;;54:103-106.
Moss AJ, Schwartz PJ, Crampton RS, et al:  The long QT syndrome: A prospective international study . Circulation 1985;;71:17-21.
Schwartz PJ, Periti M, Malliani A:  The long QT syndrome . Am Heart J 1975;;89:378-390.
Levine JH, Spear JF, Guarnieri T, et al:  Cesium chloride-induced long QT syndrome: Demonstration of afterdepolarization and triggered activity in vivo . Circulation 1985;;72:1092-1103.
Locati E, Schwartz PJ, Moss AJ, et al:  Longterm survival after left cervico-thoracic sympathectomy in high-risk long QT syndrome patients with refractory ventricular arrhythmias , abstracted. J Am Coll Cardiol 1986;;7:235A.
Reynolds EW, Vander Ark CR:  Quinidine syncope and delayed repolarization syndromes . Mod Concepts Cardiovasc Dis 1976;;55:117-122.
Kay GN, Plumb VJ, Arciniegas JG, et al:  Torsade de pointes: The long-short initiating sequence and other clinical features: Observations in 32 patients . J Am Coll Cardiol 1983;;2:806-807.
Burda C:  Electrocardiographic abnormalities induced by thioridazine . Am Heart J 1968;;76:153-156.
Isner JM, Sours HE, Paris AL, et al:  Sudden unexpected death in avid dieters using the liquidprotein-modified-fast diet . Circulation 1979;; 60:1401-1412.
Isner JM, Roberts WC, Heymsfield SB, et al:  Anorexia nervosa and sudden death . Ann Intern Med 1985;;102:49-55.
Moss AJ:  Caution: Very-low-calorie diets can be deadly . Ann Intern Med 1985;;102:121-122.

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Moss AJ, Schwartz PJ:  Delayed repolarization (QT or QTU prolongation) and malignant ventricular arrhythmias . Mod Concepts Cardiovasc Dis 1982;;51:85-90.
Bhandari AK, Scheinman M:  The long QT syndrome . Mod Concepts Cardiovasc Dis 1985;; 54:45-50.
Surawicz B, Knoebel SB:  Long QT good, bad or indifferent? J Am Coll Cardiol 1984;;4:398-413.
Jervell A, Lange-Nielsen F:  Congenital deaf mutism, functional heart disease with prolongation of the QT interval, and sudden death . Am Heart J 1957;;54:59-68.
Levine SA, Woodworth CR:  Congenital deaf mutism, prolonged QT interval, syncopal attacks and sudden death . N Engl J Med 1958;;259:412-417.
Romano C, Gemme G, Pongiglione R:  Aritmie cardiache rare dell'eta pediatrica: II. Accessi sincopali per fibrillazione ventricolare parossistica . Clin Pediatr 1963;;45:656-661.
Ward OC:  New familial cardiac syndrome in children . J Ir Med Assoc 1964;;54:103-106.
Moss AJ, Schwartz PJ, Crampton RS, et al:  The long QT syndrome: A prospective international study . Circulation 1985;;71:17-21.
Schwartz PJ, Periti M, Malliani A:  The long QT syndrome . Am Heart J 1975;;89:378-390.
Levine JH, Spear JF, Guarnieri T, et al:  Cesium chloride-induced long QT syndrome: Demonstration of afterdepolarization and triggered activity in vivo . Circulation 1985;;72:1092-1103.
Locati E, Schwartz PJ, Moss AJ, et al:  Longterm survival after left cervico-thoracic sympathectomy in high-risk long QT syndrome patients with refractory ventricular arrhythmias , abstracted. J Am Coll Cardiol 1986;;7:235A.
Reynolds EW, Vander Ark CR:  Quinidine syncope and delayed repolarization syndromes . Mod Concepts Cardiovasc Dis 1976;;55:117-122.
Kay GN, Plumb VJ, Arciniegas JG, et al:  Torsade de pointes: The long-short initiating sequence and other clinical features: Observations in 32 patients . J Am Coll Cardiol 1983;;2:806-807.
Burda C:  Electrocardiographic abnormalities induced by thioridazine . Am Heart J 1968;;76:153-156.
Isner JM, Sours HE, Paris AL, et al:  Sudden unexpected death in avid dieters using the liquidprotein-modified-fast diet . Circulation 1979;; 60:1401-1412.
Isner JM, Roberts WC, Heymsfield SB, et al:  Anorexia nervosa and sudden death . Ann Intern Med 1985;;102:49-55.
Moss AJ:  Caution: Very-low-calorie diets can be deadly . Ann Intern Med 1985;;102:121-122.
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