Table 2.

Data required for case submission

Demographics

Age at event/date of birth

Sex

Ancestry (self-reported)

Event history

Date and time of event

Nature of event: type A, B, or C (see algorithm; ECG documentation required)

Medications

Drug therapy (any) and dosage

Culprit drug(s)

Date and time of culprit drug(s) administration

Outcome (survival/death)

ECG findings

Acute event

Arrhythmia documentation

QRS, QT, RR, QTcB, immediately prior to event

Documentation of at least partial resolution of QT prolongation with therapy and cessation of culpable drug exposure