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Title: The incidence, predictors and outcomes of QTc prolongation in critically ill patients.
Austin Authors: Russell, Hollie;Churilov, Leonid ;Toh, Lisa ;Eastwood, Glenn M ;Bellomo, Rinaldo 
Affiliation: Melbourne Medical School (Austin Clinical School), The University of Melbourne, Victoria, Australia
Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne, Australia
Centre for Integrated Critical Care, The University of Melbourne, Victoria, Australia
Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
Intensive Care
Issue Date: Dec-2019 2019-09-15
Publication information: Journal of Critical Care 2019; 54: 244-249
Abstract: To study the incidence, predictors and outcomes of QTc prolongation (≥500 ms) during ICU admission. Prospective observational study of patients admitted to a tertiary ICU during a two-month period. We obtained daily data on QTc intervals and arrhythmias from ICU monitors. We performed univariate and multivariable analyses to compare patients who did or did not experience QTc prolongation. Of the 257 patients, 93 (36.2%) developed ≥1 episode of QTc ≥500 ms. Such patients had higher APACHE II scores (p < .001), received more QT-prolonging medications (p = .002), and more frequently developed non-sustained (<8 beats, p = .007) and sustained ventricular tachycardia (≥8 beats; p < .001). However, after adjustment for confounders, there was no independent association between QTc duration and odds of ventricular tachyarrhythmia (OR = 0.921 [0.593-1.431], p = .715). Moreover, 98% of ventricular tachyarrhythmias resolved spontaneously. Patients with QTc prolongation had longer ICU (p < .001) and hospital length-of-stay (p = .002), and greater ICU (p = .030) and in-hospital mortality (p = .015). No patient experienced sustained Torsades de Pointes or died from ventricular arrhythmia. A QTc ≥500 ms likely represents a marker of illness severity modulated by several risk factors, and carries no independent association with clinically-significant ventricular tachyarrhythmias. Thus, cessation of QT-prolonging medications to prevent arrhythmias may lack clinical benefit.
DOI: 10.1016/j.jcrc.2019.09.014
PubMed URL: 31630074
Type: Journal Article
Subjects: Critically ill
Torsades de Pointes
Ventricular arrhythmia
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