Long QT syndrome

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Treatments and drugs

By Mayo Clinic staff

Treatment for inherited long QT syndrome can involve medications, medical devices, surgery or lifestyle changes. The goal of treatment is either to prevent the long QT heart from ever beating out of control or to prevent sudden death.

It's often possible to eliminate drug-induced long QT syndrome simply by switching medications, with your doctor's direction. Some people, however, may need additional treatment.

Medications
Medications used to treat long QT syndrome include:

  • Beta blockers. Examples of these heart drugs include nadolol (Corgard) and propranolol (Inderal). These drugs slow the heart rate and make the dangerous rhythm associated with long QT syndrome less likely. They work by blunting the way a long QT syndrome-affected heart reacts to adrenaline in times of stress, fear or exertion.
  • Mexiletine. In people with a form of long QT syndrome called LQT3, taking this anti-arrhythmic drug in combination with propranolol may help shorten the Q-T interval.
  • Potassium. Potassium is a mineral in your body, derived from your diet, that's important for the health of your heart's electrical system. Potassium supplements may improve the heart's recharging system and may be helpful for people with certain forms of long QT syndrome.
  • Fish oil. Supplementation with heart-healthy fish oil (omega-3 fatty acid) may help stabilize abnormal heart rhythms.

Your doctor may suggest treatment for long QT syndrome even if you don't experience frequent signs or symptoms of the disorder.

If you do need treatment, take the medications your doctor prescribes for long QT syndrome as directed. While medications won't cure the condition, they provide some protection against potentially fatal disruptions of your heart rhythm. You may need to take a medication such as a beta blocker indefinitely.

Medical devices and surgical procedures
Your doctor may consider two other treatments for you:

  • A pacemaker or implantable cardioverter-defibrillator (ICD). These devices, which are implanted under the skin of your chest, can stop a potentially fatal arrhythmia. An ICD continuously monitors your heartbeat and will deliver electrical shocks to restore a normal heart rhythm when necessary.

  • Left cardiac sympathetic denervation surgery. In this procedure, specific nerves in your chest are surgically removed. These nerves are part of the body's sympathetic nervous system, which controls automatic functions in the body including regulation of heart rhythm. Left cardiac sympathetic denervation surgery significantly reduces the risk of sudden death.

    This surgery is generally reserved for people considered at high risk of sudden death, people who do not tolerate their medications or have a fainting spell despite their medications, and people who have an implanted ICD. Left cardiac sympathetic denervation surgery may significantly reduce the frequency of ICD shocks.

Lifestyle changes
In addition to medications or surgery, your doctor may recommend some lifestyle changes to reduce your chances of a long QT syndrome-related fainting spell. These could include avoiding strenuous exercise or contact sports, reducing loud, startling noises, and staying away from situations that could make you excited or angry.

Work with your doctor to balance these lifestyle recommendations against the clear, heart-healthy benefits of an active lifestyle. In some circumstances, it may be possible to stay fully active in sports, including competitive sports, after carefully reviewing the risks and benefits with your doctor.

If your symptoms are mild or don't occur very often, your doctor may recommend only lifestyle changes as treatment for your condition.

Lifestyle and home remedies Tests and diagnosis
References
  1. Ackerman MJ, et al. Congenital long QT syndrome. In: Gussak I, et al. Electrical Diseases of the Heart; Genetics, Mechanisms, Treatment, Prevention. New York, NY.: Springer; 2008:462.
  2. Priori SG. Genetics of cardiac arrhythmias. In: Libby P, et al, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/book/player/book.do?method=display&type=bookPage&decorator=header&eid=4-u1.0-B978-1-4160-4106-1..50012-1--cesec6&uniq=174957165&isbn=978-1-4160-4106-1&sid=927975209#lpState=open&lpTab=contentsTab&content=4-u1.0-B978-1-4160-4106-1..50012-1--cesec1%3Bfrom%3Dtoc%3Btype%3DbookPage%3Bisbn%3D978-1-4160-4106-1. Accessed Dec. 10, 2009.
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  14. Genetic testing: Where to start. The Sudden Arrhythmia Death Syndromes (SADS) Foundation. http://www.sads.org/index.php/General/Where-to-Start.html. Accessed Feb. 6, 2010.
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  18. Farnsworth MM, et al. When I go in to wake them ... I Wonder: Parental perceptions about congenital long QT syndrome. Journal of the American Academy of Nurse Practitioners. 2006;18:284.
  19. Ackerman MJ (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 1, 2010.
  20. Anand RG, et al. The role of fish oil in arrhythmia prevention. Journal of Cardiopulmonary Rehabilitation and Prevention. 2008;28:92.
DS00434 March 2, 2010

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