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Pathophysiology at Altitudes
Prolongation of the Corrected QT Complex – A Cause of Sudden Cardiac Death in the Mountain Environment?
  1. Dr J S Windsor1⇑,
  2. GW Rodway, College of Nursing and School of Medicine2,
  3. R Mukherjee1,
  4. PG Firth, Department of Anesthesia and Critical Care3,
  5. M Shattock4 and
  6. HE Montgomery
  1. 1UCL Centre for Altitude, Space and Extreme Environment Medicine Institute of Human Health and Performance, University College London, Charterhouse Building, Archway Campus, Highgate Hill, London
  2. 2University of Utah, Salt Lake City, Utah, USA
  3. 3Massachusetts General Hospital, Boston, Massachusetts, USA
  4. 4Cardiovascular Division, The Rayne Institute, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London
  1. UCL Centre for Altitude, Space and Extreme Environment Medicine, Institute of Human Health and Performance, University College London, Charterhouse Building, Archway Campus, Highgate Hill, London N19 5LW 00 44 207 288 3890 00 44 207 288 3892

Abstract

In the mountain environment sudden cardiac death (SCD) has been shown to be responsible for the deaths of up to 52% of downhill skiers and 30% of hikers. The majority of SCD’s are precipitated by a ventricular arrhythmia. Although most are likely to result from structural abnormalities associated with conditions such as ischaemic heart disease, a small but significant number may be due to abnormalities in ion channel activity, commonly known as, “channelopathies”. Channelopathies have the potential to lengthen the time between ventricular depolarisation and repolarisation that can result in prolongation of the corrected QT interval (QTc) and episodes of polymorphic ventricular tachycardia (PVT) and eventually, ventricular fibrillation. This review examines the factors that prolong the QTc interval in the mountain environment and outlines a practical framework for preventing the life threatening arrhythmias that are associated with this condition.

https://doi.org/10.1136/jramc-157-01-11

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