QT interval abnormalities: Risk factors and perioperative management in long QT syndromes and Torsades de Pointes

ORCiD

Adam M. Kaye: 0000-0002-7224-3322

Document Type

Article

Publication Title

Journal of Anesthesia

ISSN

1438-8359

Volume

27

Issue

4

DOI

10.1007/s00540-013-1564-1

First Page

575

Last Page

587

Publication Date

8-1-2013

Abstract

Electrophysiological abnormalities of the QT interval of the standard electrocardiogram are not uncommon. Congenital long QT syndrome is due to mutations of several possible genes (genotype) that result in prolongation of the corrected QT interval (phenotype). Abnormalities of the QT interval can be acquired and are often drug-induced. Torsades de Pointes (TP) is an arrhythmia that is a result of aberrant repolarization/QT abnormalities. If not recognized and corrected quickly, QT interval abnormalities may precipitate potentially fatal ventricular dysrhythmias. The main mechanism responsible for the development of QT prolongation is blockade of the rapid component of the delayed rectifier potassium current (I ), encoded for by the human-ether-a-go-go-related gene (hERG). The objectives of this review were (1) to describe the electrical pathophysiology of QT interval abnormalities, (2) to differentiate congenital from acquired QT interval abnormalities, (3) to describe the currently known risk factors for QT interval abnormalities, (4) to identify current drug-induced causes of acquired QT interval abnormalities, and (5) to recommend immediate and effective management strategies to prevent unanticipated dysrhythmias and deaths from QT abnormalities in the perioperative period. © 2013 Japanese Society of Anesthesiologists. kr

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