Journal of Anesthesia

, Volume 27, Issue 4, pp 575–587 | Cite as

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

  • Alan David Kaye
  • Jacqueline Volpi-Abadie
  • J. Michael Bensler
  • Adam M. Kaye
  • James H. Diaz
Review Article

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 kr), 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.

Keywords

QT prolongation Anesthetics Torsade de Pointes 

Notes

Conflict of interest

Alan David Kaye received honoraria from Depomed and research funding from Depomed. J. Michael Bensler received honoraria from Boehringer Ingelheim and is on the advisory board for Medtronics. Jacqueline Volpi Abadie, Adam M. Kaye, and James H. Diaz report no conflicts of interest.

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Copyright information

© Japanese Society of Anesthesiologists 2013

Authors and Affiliations

  • Alan David Kaye
    • 1
  • Jacqueline Volpi-Abadie
    • 1
    • 2
  • J. Michael Bensler
    • 3
    • 4
  • Adam M. Kaye
    • 5
  • James H. Diaz
    • 1
  1. 1.Department of AnesthesiologyLSU School of MedicineNew OrleansUSA
  2. 2.Department of AnesthesiologyAlton Ochsner ClinicNew OrleansUSA
  3. 3.Jackson Heart ClinicBaptist HospitalJacksonUSA
  4. 4.Cardiovascular Consultants of NevadaHendersonUSA
  5. 5.Thomas J. Long School of Pharmacy and Health Sciences University of the PacificStocktonUSA

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