QT-Zeit – Was fange ich eigentlich damit an?

Abstract

The assessment of the QT interval has been an integral part of ECG interpretation since the first descriptions of long QT syndrome by Wolff in 1950 and by Jervell and Lange-Nielsen in 1957. The correct measurement of the QT interval as well as a correct interpretation of the causes and of the clinical consequences of a QT prolongation, however, may be difficult even for trained internists and cardiologists. In this review, we give an overview on physiological determinants of cardiac repolarization, its marker in the surface ECG – the QT interval –, methods to correctly assess QT interval duration, causes for pathologically prolonged QT intervals, and resulting clinical consequences. A correct measurement of the QT interval should be performed by using the „tangent method“, excluding possible U waves. A heart rate correction formula should be employed to determine the heart rate corrected QT interval (QTc).

Many factors, which may prolong the QT interval, should be checked whenever a QTc prolongation is observed. These include drugs, electrolyte imbalances, hormonal influence, and comorbidities. The correct management of a patient with (genetically determined) LQTS starts with a risk stratification based on genotype, ECG phenotype, clinical history, age, sex, concomitant diseases, drug therapies, and family history for syncope or sudden cardiac death. The therapeutic approaches for LQTS are multimodal. Prevention is the basis of the therapy and includes avoiding known risk factors / and potentially QT-prolonging drugs, and a pharmacological treatment with non-selective beta blockers. According to the risk profile and to the patient’s lifestyle the implantation of an ICD or a pacemaker should be considered.

Ein Blick auf das EKG, und die Diagnose ist klar…? Doch so leicht ist es nicht: Wegen der klinischen Bedeutung der QT-Zeit muss man hier besonders genau hinschauen – und messen! In diesem Beitrag finden Sie einen Überblick über die Physiologie der kardialen Repolarisation und deren Marker im Oberflächen-EKG (QT-Zeit), pathophysiologische Ursachen bei QT-Alteration sowie Hinweise zur korrekten Messung und resultierende klinische Konsequenzen.

Schlüsselwörter

QT-Intervall - Long-QT-Syndrom - Tangentenmethode - Risikostratifizierung

Key words

QT interval - long QT syndrome - tangent method - risk stratification

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