QTc Prolongation and Psychotropic Medications: An In-depth Guide for the C-L Psychiatrist

Psychiatrists routinely prescribe psychotropic drugs that may prolong cardiac repolarization, thereby increasing the risk for Torsades de Pointes (TdP), a potentially fatal cardiac arrythmia. The corrected QT interval (QTc) on the 12-lead electrocardiogram (ECG) is the most widely accepted benchmark of TdP risk and has drawn significant attention amongst prescribers of psychotropic medications. Over the past decade, psychiatrists have witnessed the swinging-pendulum-effect of approaches to QTc prolongation and psychopharmacology, from unwitting disregard to marked hypervigilance.

In this experiential preconference skills course, we will provide all of the tools necessary to empower the C-L psychiatrist to confidently use the ECG to guide clinical decision-making. The first half of the course will guide members through an in-depth evidence-based understanding of QTc prolongation, basic and advanced ECG interpretation, psychotropic medications, risk assessment and monitoring. This will include updates in the literature from the past year, including evidence for newly approved medications. In the second half of the course, participants will get hands-on practice with brand new cases involving measurement of the QTc, appropriate applications for different QTc correction formulae, and an approach to more complex patients including those with pacemakers, implantable cardioverter defibrillators and wide QRS complexes. We will also highlight some advanced topics that have not been covered in this course previously, including QT dispersion and T wave morphology.

Given the virtual format, we plan to email materials to participants ahead of time, including sample ECG printouts, which will allow them to work through problems remotely. Through a series of interactive clinical cases, which will become increasingly complex as the learner becomes more confident, we will discuss high-yield strategies for various practice settings and populations, including: outpatient public and community psychiatry settings, resource-poor clinics, patients with substance-use disorders, patients with complex cardiac disease, and the general hospital and intensive care unit setting.

This skills course has been presented previously and has been well-attended and well-reviewed. We were disappointed last year to not have a chance to present the interactive portion and are excited for that opportunity this year. We will have updated slides, new cases, and an adapted approach that we feel will work well over the virtual platform.