QT interval and sudden death in the elderly during hospitalization
Authors:
Ján Šuba ml.; Jakub Bořucký; Martin Dúbrava
Authors‘ workplace:
I. klinika geriatrie, Lekárska fakulta, Univerzita Komenského, Univerzitná nemocnica, Bratislava, Slovenská republika
Published in:
Geriatrie a Gerontologie 2025, 14, č. 1: 5-9
Category:
Original Article
doi:
https://doi.org/10.61568/geri/50-6457/20250217/139903
Overview
Long QT syndrome (LQT) and the resulting ventricular tachycardia known as torsades de pointes type (dP) are a significant cause of sudden cardiac death. LQT is also an independent risk factor for all-cause and cardiovascular mortality. Especially in the elderly there is often a cumulation of factors favoring the QT prolongation. The aim of our study was to determine the risk profile for prolongation of the corrected QT interval (QTc) in seniors with sudden unexplained death during hospitalization. In 2018, we identified 20 such cases at our department. We analyzed the last QT interval before death and several relevant risk factors of LQT. Prolongation of the QTc interval was very frequent: in 60% of patients and clinically significant QT prolongation > 500 ms in 20%. We found a certain correlation between the length of the QTc interval and hypocalcemia (p = 0.552; ns), decreasing glycemia was more weakly correlated (p = 0.382; ns), the total number of used risky drugs was not correlated (p = 0.134; ns). However, each patient was taking at least one drug with the LQT risk. In total there were 17 such drugs used by our patients. Despite the lack of autopsy and the absence of documentation of terminal TdP, we assume that several of the patients may have died as a result of TdP. In clinical practice, it is relevant to identify prolongation of the QTc interval and reduce the risks of LQT/TdP.
Keywords:
geriatrics – sudden death – QT interval – polymorbidity – torsades de pointes
Sources
1. Viskin S, Rosovski U, Sands AJ, et al. Inaccurate electrocardiographic interpretation of long QT: the majority of physicians cannot recognize a long QT when they see one. Heart Rhythm 2005; 2(6): 569–574.
2. Indraratna P, Tardo D, Delves M, et al. Measurement and management of QT interval prolongation for general physicians. J Gen Int Med 2020; 35(3): 865–873.
3. Postema PG, Wilde AA. The measurement of the QT interval. Curr Cardiol Rev 2014; 10(3): 287–294.
4. Viskin S. The QT interval: too long, too short or just right. Heart Rhythm 2009; 6: 711–715.
5. Campleman SL, Brent J, Pizon AF, et al. Drug-specific risk of severe QT prolongation following acute drug overdose. Clin Toxicol 2020; 58(12): 1326–1334.
6. Abdelsayed M, Bytyçi I, Rydberg A, et al. Left ventricular contraction duration is the most powerful predictor of cardiac events in LQTS. A systematic review and meta-analysis. J Clin Med 2020; 9(9): 2820.
7. Vandael E, Vandenberk B, Vandenberghe J, et al. V. Risk factors for QTc-prolongation: systematic review of the evidence. Int J Clin Pharmacol 2017; 39(1): 16–25.
8. Giudicessi JR, Wilde AA, Ackerman MJ. The genetic architecture of long QT syndrome. A critical reappraisal. Trends Cardiovasc Med 2018; 28(7): 453–464.
9. Esen AM, Barutcu I, Melek M, et al. Comparison of QT interval duration and dispersion in elderly population versus healthy young subjects. Clin Auton Res 2004; 14(6): 408–411.
10. Rautaharju PM, Zhou SH, Wong S, et al. Sex differences in the evolution of the electrocardiographic QT interval with age. Can J Cardiol 1992; 8(7): 690–695.
11. Levis JT. ECG diagnosis: hypokalemia. Perm J 2012; 16(2): 57.
12. Tang JKK, Rabkin SW. Hypocalcemia-induced QT interval prolongation. Cardiology 2022; 147(2): 191–195.
13. Van Laecke S. Hypomagnesemia and hypermagnesemia. Acta Clin Belgica 2019; 74(1): 41–47.
14. Andersen A, Jørgensen PG, Knop FK, et al. Hypoglycaemia and cardiac arrhythmias in diabetes. Ther Adv Endocrinol Metabol 2020; 11: 2042018820911803.
15. Bakiner O, Ertorer ME, Haydardedeoglu FE, et al. Subclinical hypothyroidism is characterized by increased QT interval dispersion among women. Med Princ Pract 2008; 17(5): 390–394.
16. Drew BJ, Ackerman MJ, Funk M, et al. Prevention of torsade de pointes in hospital settings: a scientific statement from the American Heart Association and the American College of Cardiology Foundation. J Am Coll Cardiol 2010; 55(9): 934–947.
17. Woosley R. Risk Categories for drugs that prolong QT & induce Torsades de Pointes (TdP) Arizona. AZCERT Arizona Center for Education and Research on Therapeutics. Dostupné na: https://www.crediblemeds.org/druglist.
18. TeBay C, Hill AP, Windley MJ. Metabolic and electrolyte abnormalities as risk factors in drug-induced long QT syndrome. Biophys Rev 2022; 14(1): 353–367.
19. Straus SM, Kors JA, De Bruin ML, et al. Prolonged QTc interval and risk of sudden cardiac death in a population of older adults. J Am Coll Cardiol 2006; 47(2): 362–367.
20. Moreno-Gutiérrez PA, Gaviria-Mendoza A, Cañón MM, et al. High prevalence of risk factors in elderly patients using drugs associated with acquired torsades de pointes chronically in Colombia. Br J Clin Pharmacol 2016; 82(2): 504–511.
Labels
Geriatrics General practitioner for adults Orthopaedic prostheticsArticle was published in
Geriatrics and Gerontology
2025 Issue 1
Most read in this issue
- Collaboration between physician and clinical pharmacist in a geriatric patient with oral medication use disorder
- QT interval and sudden death in the elderly during hospitalization
- Long-term caring for senior family members has negative consequences for informal caregivers
- Editorial