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*.
QT must be a positive number (ms); heart rate / RR likewise.
Bazett
400
ms
Fridericia
400
ms
Framingham
400
ms
Hodges
400
ms
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
- · **Bazett remains the most ubiquitous formula but has known bias.** QTc = QT / √RR was published by Henry Bazett in 1920 and is the default on every automatic ECG machine, so it is the value clinicians and board exams know best. **Known issues**: (a) **over-corrects at tachycardia** — at HR > 100 bpm Bazett systematically overshoots, generating false "QTc 480" alarms; (b) **under-corrects at bradycardia** — at HR < 50 bpm Bazett undershoots and hides true QT prolongation. **Modern consensus (AHA/ACC/HRS 2017, ESC 2022)**: use **Fridericia (QT / ∛RR)** for **drug-QT monitoring** because its rate sensitivity is lowest; report Bazett alongside on standard ECGs because that is the value the literature and education are built on.
- · **QT measurement itself is variable.** Strictly QT = QRS onset to end of T wave, but (a) the *visual end of T* is fuzzy if U waves overlap or T-wave amplitude is low — inter-observer error can reach ±20 ms; (b) lead choice matters — II or V5 (longest QT) is conventional; (c) the *tangent method* (slope tangent to T descending limb intersecting baseline) is the most reproducible manual method; (d) machine QT values need to be *human-verified*, especially with bizarre QRS morphology or ST elevation. **For drug-QT monitoring**: tracking the same lead, same observer and same method serially matters more than the absolute value.
- · **No single formula is unbiased across the whole HR range.** Hodges and Fridericia are most stable at 50–120 bpm; Bazett is acceptable at 60–90 bpm; Framingham works best at moderate rates (70–100 bpm). At **extreme HR** (< 40 or > 150 bpm) all four formulas fail — repeat the ECG at a more physiological rate, or in the EP lab use an individualised *QT/RR slope* correction. In **atrial fibrillation**: RR is irregular — use the mean RR of ≥ 10 consecutive beats, or take the *median* of 5–10 QT values as the representative value.
- · **Clinical decision-making in LQTS and drug-induced QT prolongation**: (a) **Before starting a QT-prolonging drug** get a baseline ECG. If baseline Bazett QTc > 480 ms (men or women) avoid strong QT-prolonging agents (amiodarone, sotalol, methadone, quetiapine, ondansetron, ciprofloxacin etc.). (b) **24–72 hours after starting** a new drug, repeat the ECG. ΔQTc > 60 ms or absolute QTc ≥ 500 ms means stop and reassess. (c) **Electrolytes**: correct hypokalaemia (K⁺ < 4.0 mEq/L) and low magnesium — always. (d) **CredibleMeds** (crediblemeds.org) maintains the up-to-date QT-drugs list in four risk tiers: Known TdP risk, Possible, Conditional, and Avoid in congenital LQTS.
- · **References**: (1) Bazett HC. *Heart* 1920;7:353-70; (2) Fridericia LS. *Acta Med Scand* 1920;53:469-86; (3) Sagie A, Larson MG, Goldberg RJ, et al. *Am J Cardiol* 1992;70:797-801 (Framingham); (4) Hodges M, Salerno D, Erlien D. *J Electrocardiol* 1983;16:17-24; (5) Drew BJ, Ackerman MJ, Funk M, et al. AHA/ACC/HRS Scientific Statement on prevention of Torsades de Pointes in hospital settings. *Circulation* 2010;121:1047-1060 — updated *Circulation* 2017;136:e273-e344; (6) Priori SG, et al. ESC 2022 Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. *Eur Heart J* 2022;43:3997-4126; (7) CredibleMeds QTdrugs List — University of Arizona (regularly updated).
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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