Phenotypes of Overdiagnosed Long QT Syndrome

BACKGROUND Long QT syndrome (LQTS) predisposes individuals to arrhythmic syncope or seizure, sudden cardiac arrest, or sudden cardiac death (SCD). Increased physician and public awareness of LQTS-associated warning signs and an increase in electrocardiographic screening programs may contribute to overdiagnosis of LQTS.OBJECTIVES This study sought to identify the diagnostic miscues underlying the continued overdiagnosis of LQTS.METHODS Electronic medical records were reviewed for patients who arrived with an outside diagnosis of LQTS but were dismissed as having normal findings subsequently. Data were abstracted for details on referral, clinical history, and both cardiologic and genetic test results.RESULTS Overall, 290 of 1,841 (16%) patients with original diagnosis of LQTS (174 [60%] female; mean age at first Mayo Clinic evaluation, 22 +/- 14 years; mean QTc interval, 427 +/- 25 milliseconds) were dismissed as having normal findings. The main cause of LQTS misdiagnosis or overdiagnosis was a prolonged QTc interval secondary to vasovagal syncope (n = 87; 30%), followed by a seemingly positive genetic test result for a variant in 1 of the main LQTS genes (n = 68; 23%) that was ultimately deemed not to be of clinical significance. Furthermore, patients received misdiagnoses because of a positive family history of SCD that was deemed unrelated to LQTS (n = 46; 16%), isolated/transient QT prolongation (n = 44; 15%), or misinterpretation of the QTc interval as a result of inclusion of the U-wave (n = 40, 14%).CONCLUSIONS Knowing the 5 main determinants of discordance between a previously rendered diagnosis of LQTS and full diagnostic reversal or removal (vasovagal syncope, pseudo-positive genetic test result in LQTS-causative genes, family history of SCD, transient QT prolongation, and misinterpretation of the QTc interval) increases awareness and provides critical guidance to reduce this burden of overdiagnosed LQTS. (J Am Coll Cardiol 2023;81:477-486) (c) 2023 by the American of Foundation.

Automated summary

This study reveals that the main causes of overdiagnosis of Long QT syndrome (LQTS) are prolonged QTc interval due to vasovagal syncope, mistaken positive genetic test results, unrelated family history of sudden cardiac death (SCD), isolated/transient QT prolongation, and misinterpretation of QTc interval. Understanding these determinants can increase awareness and provide critical guidance to reduce the burden of overdiagnosed LQTS.