Prolonged QTc and Prevention of Torsades de Pointes Clinical Pathway — Inpatient

Risk Factors and Conditions Associated with Prolonged QTc

Modifiable Risk Factors	Electrolyte Abnormalities Hypokalemia, Hypocalcemia, Hypomagnesemia Metabolic acidosis QTc prolonging medications
Conditions and Diseases Associated with Prolonged QTc	Congenital, inherited cardiac channelopathies with long QT phenotype including long QT syndrome (LQTS) Heart failure, Cardiomyopathy, Myocarditis, Acute myocardial infarction History of ventricular arrhythmias Ventricular tachycardia Frequent ventricular ectopy/ premature ventricular complexes Recurrent unexplained syncope Therapies, conditions associated with Cytokine Release Syndrome, such as CAR T-Cell therapy Eating disorders Persistent or refractory electrolyte abnormalities (↓K, ↓Ca, ↓Mg) Drug(s) known to prolong QT interval Overdose with unknown drugs Renal Disease Renal failure, acute kidney injury, renal replacement therapy Neurologic conditions Seizure, increased intracranial pressure Stroke, subarachnoid hemorrhage, head trauma within preceding 7 days Sepsis Diabetic ketoacidosis Pheochromocytoma

Modifiable Risk Factors

Electrolyte Abnormalities
- Hypokalemia, Hypocalcemia, Hypomagnesemia
Metabolic acidosis
QTc prolonging medications

Conditions and Diseases Associated with Prolonged QTc

Congenital, inherited cardiac channelopathies with long QT phenotype including long QT syndrome (LQTS)
Heart failure, Cardiomyopathy, Myocarditis, Acute myocardial infarction
History of ventricular arrhythmias
- Ventricular tachycardia
- Frequent ventricular ectopy/ premature ventricular complexes

Recurrent unexplained syncope

Therapies, conditions associated with Cytokine Release Syndrome, such as
CAR T-Cell therapy

Eating disorders

Persistent or refractory electrolyte abnormalities (↓K, ↓Ca, ↓Mg)
Drug(s) known to prolong QT interval
Overdose with unknown drugs

Renal Disease
- Renal failure, acute kidney injury, renal replacement therapy
Neurologic conditions
- Seizure, increased intracranial pressure
- Stroke, subarachnoid hemorrhage, head trauma within preceding 7 days
Sepsis
Diabetic ketoacidosis
Pheochromocytoma

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Prolonged QTc and Prevention of Torsades de Pointes Clinical Pathway — Inpatient

Risk Factors and Conditions Associated with Prolonged QTc

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Prolonged QTc and Prevention of Torsades de Pointes — Risk Factors and Conditions Associated with Prolonged QTc — Clinical Pathway: Inpatient

Prolonged QTc and Prevention of Torsades de Pointes Clinical Pathway — Inpatient

Risk Factors and Conditions Associated with Prolonged QTc