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QTc Interval Calculator (Bazett / Fridericia / Framingham / Hodges)

The **rate-corrected QT interval (QTc)** standardises the measured QT for heart rate and is the core indicator for *long QT syndrome (LQTS), drug-induced QT prolongation and risk of ventricular arrhythmia / Torsades de Pointes (TdP)*. This tool reports the four corrections in routine clinical use side by side — **Bazett** (the most familiar but biased at high or low rates), **Fridericia** (cube-root; the preferred correction for *drug-induced QT prolongation* monitoring in modern cardiology), **Framingham** (linear regression) and **Hodges** (linear in HR) — and flags each value against sex-specific thresholds (*normal / borderline / prolonged / markedly prolonged*). Input accepts heart rate in *bpm* or the *RR interval in ms*.

Bazett

400

ms

Fridericia

400

ms

Framingham

400

ms

Hodges

400

ms

Formulas: Bazett QTc = QT / √RR; Fridericia = QT / ∛RR; Framingham = QT + 0.154 · (1 000 − RR); Hodges = QT + 1.75 · (HR − 60). RR and QT are handled in seconds / ms. **Bazett over-corrects at tachycardia and under-corrects at bradycardia** — modern cardiology (ESC, AHA/ACC) recommends Fridericia or Framingham as the first choice for *drug-induced QT prolongation* monitoring; Bazett is still ubiquitous in clinical practice. Men > 440 / women > 460 ms is prolonged; ≥ 500 ms is high risk for Torsades de Pointes (TdP). The tool only does the arithmetic — all clinical decisions belong to the responsible clinician.

Formula

RR_sec = 60 / HR_bpm = RR_ms / 1000 Bazett (1920): QTc = QT / √RR_sec Fridericia (1920): QTc = QT / ∛RR_sec Framingham (1992): QTc = QT + 0.154 × (1000 − RR_ms) [linear regression] Hodges (1983): QTc = QT + 1.75 × (HR_bpm − 60) [linear in HR] All QTc values are in milliseconds. RR = 60 / HR (HR 60 → RR 1000 ms; HR 100 → RR 600 ms). Clinical thresholds (adults): Normal men < 440 ms / women < 460 ms Borderline 440-470 ms (men) / 460-470 ms (women) Prolonged > 470 ms Markedly prolonged (high TdP risk) ≥ 500 ms

Frequently asked

Bazett gives QTc = 470 ms but Fridericia gives 445 ms — which is the "true" QTc?

**Both are QTc — different formulas have different biases; there is no single "true" QTc.** Your numbers (470 vs 445) suggest a heart rate well above 60 bpm — Bazett over-corrects at tachycardia, so its QTc is inflated; Fridericia's cube-root scaling has lower rate sensitivity and is a more balanced correction. **Modern practice (AHA/ACC/HRS 2017)**: (a) use Fridericia for **drug-QT monitoring** because it is less biased; (b) use Bazett for **clinical communication / reporting** because everyone is used to it; (c) **report both** — e.g. "QT 380 ms / QTcB 470 ms / QTcF 445 ms at HR 92". **Conclusion for your patient**: QTcF 445 ms is within the normal range; the Bazett 470 ms is rate-related over-correction. For a baseline before a QT-prolonging drug, the Fridericia value is the more trustworthy one and you can proceed.

Why is a QTc ≥ 500 ms considered "high risk"?

**Because QTc ≥ 500 ms has a *quantitative* dose-response relationship with Torsades de Pointes (TdP).** **Clinical data**: (a) large retrospective inpatient ECG studies (Drew 2010, Tisdale 2013) show TdP risk < 1 % when QTc is below 500 ms, around 2–5 % at 500–549 ms, and 5–15 % at ≥ 550 ms. (b) **Physiology**: prolonged QT reflects non-uniform ventricular myocyte repolarisation (abnormal recovery), which generates *early after-depolarisations (EADs)*; together with increased *dispersion of repolarisation* the EAD can trigger a re-entrant tachycardia → TdP. (c) **TdP natural history**: 5–10 % degenerate into ventricular fibrillation and sudden cardiac death. **Clinical action**: (1) at QTc ≥ 500 ms with a *new QT-prolonging drug* — stop the drug; (2) **correct electrolytes** (K⁺ ≥ 4.0 mEq/L, Mg²⁺ ≥ 2.0 mEq/L); (3) telemetry for 24–48 hours; (4) for ongoing TdP give IV MgSO₄ 1–2 g and consider isoproterenol to raise the heart rate and shorten QT. **Caveat**: 500 ms is a *relative* threshold — for a patient whose baseline QTc was 380 ms, jumping to 480 ms is already a 100 ms ΔQTc, and even though the absolute value is below 500 ms it warrants caution.

In atrial fibrillation the RR is irregular — how should I compute QTc?

**QTc in atrial fibrillation is a recognised hard problem — there is no single best method, but several practical approaches exist.** **The core difficulty**: every QTc formula (Bazett, Fridericia, etc.) assumes a stable RR; AF violates that assumption — each beat's QT depends on the preceding RR (RR-dependent QT adaptation) and the AF RR varies randomly by ±50 %. **Practical methods**: (1) **Mean-RR method**: measure ≥ 10 consecutive RR intervals, take the arithmetic mean, then apply Bazett / Fridericia. Simple and mainstream. (2) **Median-QT method**: measure 5–10 QT values and use the *median* as the representative QT, paired with the mean RR. More robust to outliers (artefacts, missed measurements). (3) **Paired-RR method** (Roden 1991): for each QT use the *directly preceding RR* — most accurate per beat but tedious. **Notes**: (a) For drug-QT monitoring in AF patients, first cardiovert back to sinus and obtain a baseline ECG. (b) Rhythm-control drugs such as high-dose amiodarone are known to prolong QT and need monitoring. (c) In AF, Fridericia is more stable than Bazett because cube-root scaling is less sensitive to RR variation. **ESC 2022 and AHA recommend the median approach but clinical practice is not standardised.**

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