• Hollie Russell, Leonid Churilov, Lisa Toh, Glenn M Eastwood, and Rinaldo Bellomo.
• Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne, Australia; Melbourne Medical School (Austin Clinical School), The University of Melbourne, Victoria, Australia.
• J Crit Care. 2019 Dec 1; 54: 244-249.

PurposeTo study the incidence, predictors and outcomes of QTc prolongation (≥500 ms) during ICU admission.MethodsProspective observational study of patients admitted to a tertiary ICU during a two-month period. We obtained daily data on QTc intervals and arrhythmias from ICU monitors. We performed univariate and multivariable analyses to compare patients who did or did not experience QTc prolongation.ResultsOf the 257 patients, 93 (36.2%) developed ≥1 episode of QTc ≥500 ms. Such patients had higher APACHE II scores (p < .001), received more QT-prolonging medications (p = .002), and more frequently developed non-sustained (<8 beats, p = .007) and sustained ventricular tachycardia (≥8 beats; p < .001). However, after adjustment for confounders, there was no independent association between QTc duration and odds of ventricular tachyarrhythmia (OR = 0.921 [0.593-1.431], p = .715). Moreover, 98% of ventricular tachyarrhythmias resolved spontaneously. Patients with QTc prolongation had longer ICU (p < .001) and hospital length-of-stay (p = .002), and greater ICU (p = .030) and in-hospital mortality (p = .015). No patient experienced sustained Torsades de Pointes or died from ventricular arrhythmia.ConclusionsA QTc ≥500 ms likely represents a marker of illness severity modulated by several risk factors, and carries no independent association with clinically-significant ventricular tachyarrhythmias. Thus, cessation of QT-prolonging medications to prevent arrhythmias may lack clinical benefit.Copyright © 2019 Elsevier Inc. All rights reserved.

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