QTc Prolongation and Psychiatric Medications: An In-Depth Guide for the C-L Psychiatrist

Abstract: 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 Pre-conference 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 pre-recorded portion of the course will guide members through an in-depth evidence-based understanding of QTc prolongation and basic ECG interpretation. We will also include a pre-test so that attendees can check their baseline knowledge on the topic. In the live portion, we’ll start by providing an update on psychotropic medications at QTc, followed by focused discussions of risk assessment and monitoring. This will include updates in the literature from the past year, including evidence for newly approved medications and an in-depth review of newer concerns raised about lamotrigine. After the didactic portion of the live session, 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, atrial fibrillation and wide QRS complexes. We will also highlight some advanced topics that have not been covered in this course previously, including QTc in pregnancy and depolarization syndromes like Brugada syndrome.


We hope to present the second part of this course in-person, to allow for the use of sample ECG print-outs for the interactive portion, though will modify to a virtual setting as needed. Through a series of new 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: pregnant patients with QTc prolongation, new and more detailed information about methadone use in patients with substance-use disorders, and new cases focused on traditional settings such as resource-poor clinics, and the general hospital and intensive care units.


This skills course has been presented previously and has been well-attended and well-reviewed. We will have updated slides, new cases, and a flexible approach that can be adapted for the virtual setting as needed.

Agenda Overview:
Pre-recorded Session


0:00-0:25 Introduction of the Topic and Speakers and Overview of TdP and QTc Prolongation (Dr. Beach)


0:30-1:00 Basics of Cardiac Electrophysiology and ECG Interpretation (Dr. Celano)


1:00-2:00 Solutions to Clinical Cases (recommended for watching after the live portion)


Live Session


0:00-0:45 Psychopharmacology and QTc Prolongation (Drs. Beach and Celano)


0:50-1:25 Advanced ECG Interpretation and Approach to Risk Stratification and Mitigation (Dr. Funk)


1:30-1:45 Monitoring for Various Situations (Dr. Funk)


1:45-2:45 Interactive Practice ECG Interpretation (Dr. Funk)


2:45-3:30 Interactive Complex Clinical Cases (Panel)


3:30-4:00 Q&A (Panel)