QT Interval Prolongation and Cardiac Arrhythmias
Summary
The QT interval on the surface electrocardiogram spans ventricular depolarisation to repolarisation, and its prolongation signifies delayed recovery of ventricular excitability. Both congenital and acquired forms of QT prolongation predispose to life-threatening arrhythmias, most notably torsade de pointes, which may degenerate into ventricular fibrillation and sudden cardiac death. Congenital long QT syndromes arise from mutations in genes encoding cardiac ion channels or their accessory subunits, affecting currents such as the slowly activating delayed rectifier (IKs) and the rapidly activating delayed rectifier (IKr). Acquired prolongation is commonly drug-induced or related to electrolyte disturbances and systemic illnesses. Accurate measurement and correction for heart rate are essential for diagnosis, while risk stratification incorporates genetic background, comorbidities and medication history. Management ranges from avoiding QT-prolonging agents and correcting metabolic derangements to targeted therapies including beta-blockers, left cardiac sympathetic denervation and implantable defibrillators in high-risk individuals. Advances in cellular modelling, high-throughput variant mapping and dynamic QT analysis are refining our understanding of repolarisation mechanisms and improving prognostic assessment.
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QT Interval Prolongation and Cardiac Arrhythmias publication trend
The graph below shows the total number of articles in qt interval prolongation and cardiac arrhythmias across all publications each year (not limited to Nature Index journals).
Technical terms
QT interval: The time from onset of ventricular depolarisation to completion of repolarisation on the electrocardiogram.
QTc: QT interval corrected for heart rate, enabling standardised comparison across different heart rates.
Torsade de pointes: A form of polymorphic ventricular tachycardia with characteristic twisting QRS morphology, often precipitated by prolonged QT intervals.
IKs: The slowly activating delayed rectifier potassium current that contributes to the later phase of ventricular repolarisation.
IKr: The rapidly activating delayed rectifier potassium current critical for early ventricular repolarisation and repolarisation reserve.
Action potential duration (APD): The time interval during which a cardiomyocyte remains electrically active, commonly measured to 90% repolarisation (APD90).
References
- The electrophysiologic effects of KCNQ1 extend beyond expression of IKs: evidence from genetic and pharmacologic block. Cardiovascular Research (2024).
- High-throughput functional mapping of variants in an arrhythmia gene, KCNE1, reveals novel biology. Genome Medicine (2024).
- Characteristics, predictors and outcomes of new-onset QT prolongation in sepsis: a multicenter retrospective study. Critical Care (2024).
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