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The delayed heart-to-mediastinum (<jats:italic>H<\/jats:italic>\/<jats:italic>M<\/jats:italic>) ratio obtained from 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy is a marker of cardiac sympathetic nervous (CSN) activity and has been proposed as a prognostic marker of severe aortic stenosis (AS). However, the association between prolonged QTc and CSN overactivity in patients with AS remains unclear. This study retrospectively analyzed 83 patients with severe AS who underwent electrocardiography, echocardiography, and 123I-MIBG scintigraphy. Prolonged QTc was defined as QTc\u2009&gt;\u2009450 and\u2009&gt;\u2009470\u00a0ms in men and women, respectively. CSN overactivity was defined as delayed <jats:italic>H<\/jats:italic>\/<jats:italic>M<\/jats:italic> ratio\u2009&lt;\u20092.2 and washout rate (WR)\u2009&gt;\u200934%. Prolonged QTc was detected in 14 patients, and these patients had higher left ventricular (LV) mass index and lower LV ejection fraction as compared to those with normal QTc. A significantly higher proportion of patients with prolonged QTc demonstrated CSN overactivity (<jats:italic>p<\/jats:italic>\u2009=\u20090.02). In addition, the prolonged QTc group had a lower delayed <jats:italic>H<\/jats:italic>\/<jats:italic>M<\/jats:italic> ratio and higher WR. QTc was inversely correlated with the delayed <jats:italic>H<\/jats:italic>\/<jats:italic>M<\/jats:italic> ratio in men (<jats:italic>r<\/jats:italic>\u2009=\u2009\u2009\u2212\u20090.53, <jats:italic>p<\/jats:italic>\u2009=\u20090.02) and women (<jats:italic>r<\/jats:italic>\u2009=\u2009\u2009\u2212\u20090.29, <jats:italic>p<\/jats:italic>\u2009=\u20090.02). QTc was positively correlated with WR in men (<jats:italic>r<\/jats:italic>\u2009=\u20090.55, <jats:italic>p<\/jats:italic>\u2009=\u20090.01) and women (<jats:italic>r<\/jats:italic>\u2009=\u20090.42, <jats:italic>p<\/jats:italic>\u2009=\u20090.001). Multivariate analysis identified age and prolonged QTc as significantly associated with CSN overactivity. Thus, prolonged QTc is associated with CSN overactivity, as assessed using 123I-MIBG scintigraphy in patients with severe AS.<\/jats:p>","DOI":"10.1007\/s00380-025-02550-6","type":"journal-article","created":{"date-parts":[[2025,5,11]],"date-time":"2025-05-11T08:01:01Z","timestamp":1746950461000},"page":"1048-1057","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Prolonged corrected QT interval is associated with cardiac sympathetic nervous function overactivity in patients with severe aortic stenosis: assessment by 123I-metaiodobenzylguanidine myocardial scintigraphy"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8340-8594","authenticated-orcid":false,"given":"Yukihiro","family":"Fukuda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshifumi","family":"Nishio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hironori","family":"Miyazaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiyuki","family":"Okada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hironori","family":"Ueda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinya","family":"Takahashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukiko","family":"Nakano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,11]]},"reference":[{"key":"2550_CR1","doi-asserted-by":"publisher","first-page":"1735","DOI":"10.1056\/NEJMp030035","volume":"348","author":"MR Zile","year":"2003","unstructured":"Zile MR, Gaasch WH (2003) Heart failure in aortic stenosis\u2014improving diagnosis and treatment. 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