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Approach to prolonged QT interval in paediatric and neonatal patients
Giacomo Buratti1, Sudeep Shrestha2, Marieke Donne2
1Diana Princess of Wales Hospital, Grimsby, UK. Giacomo.Buratti2@gmail.com.
European Journal of Pediatrics
|November 20, 2025
Summary
Congenital Long QT Syndrome (LQTS) is a dangerous heart condition in children. This guide offers pediatricians a clear approach to diagnosing and managing prolonged QT intervals, improving early care.
Area of Science:
- Cardiology
- Pediatrics
- Genetics
Background:
- Congenital Long QT Syndrome (LQTS) is a life-threatening cardiac channelopathy causing sudden death in young individuals.
- It's characterized by delayed myocardial repolarization, leading to a prolonged QT interval and increased risk of ventricular arrhythmias like Torsades de Pointes.
- Diagnosis relies on QTc duration, clinical features, and family history (Schwartz score), with QTc >500 ms strongly supporting LQTS.
Purpose of the Study:
- To provide a practical, step-by-step approach for pediatricians and neonatologists to recognize, measure, and manage prolonged QT intervals in children.
- To address common pitfalls and offer actionable clinical decision points for early management.
- To enhance confidence and consistency in managing potential LQTS cases before specialist cardiology review.
Main Methods:
- Review of current literature and clinical guidelines on Long QT Syndrome in paediatric populations.
- Analysis of diagnostic criteria, including QTc measurement and the Schwartz score.
- Exploration of management strategies tailored to paediatric subgroups (neonates, children, athletes) and those with comorbidities.
Main Results:
- A structured approach to QTc interval assessment in infants and children is crucial, with an upper limit of normal generally considered 460 ms.
- Accurate measurement and early work-up are essential to prevent misdiagnosis and ensure timely intervention.
- Specific considerations are needed for neonates, children, athletes, and those with conditions like anorexia nervosa or hypothermia.
Conclusions:
- Early recognition and appropriate management of prolonged QT intervals in children are critical for preventing adverse outcomes.
- This guideline aims to equip general pediatricians and neonatologists with the necessary tools for confident initial assessment and management.
- Improved diagnostic consistency can lead to safer early management and better outcomes for young patients with potential LQTS.
Keywords:
ArrhythmiaElectrocardiographyLong QT syndromeNeonatologyPaediatric cardiologyProlonged QT intervalMore Related Videos
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