QTc interval-dependent body posture in pediatrics

Reynisson, Björn; Tanghöj, Gustaf; Naumburg, Estelle

doi:10.1186/s12887-020-1959-8

Cited by 5 publications

(10 citation statements)

References 30 publications

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“…by exercise test or by postural manoeuvres, as was the case in the data that we presented. Therefore, while it is possible to agree with Reynisson et al [ 13 ] that judging ECGs recorded in the standing position increases the sensitivity of LQTS diagnoses, our data show that this increase of sensitivity comes at a very high cost of substantially decreased specificity.…”

Section: Discussionsupporting

confidence: 85%

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Problems with Bazett QTc correction in paediatric screening of prolonged QTc interval

et al. 2020

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Background Bazett formula is frequently used in paediatric screening for the long QT syndrome (LQTS) and proposals exist that using standing rather than supine electrocardiograms (ECG) improves the sensitivity of LQTS diagnosis. Nevertheless, compared to adults, children have higher heart rates (especially during postural provocations) and Bazett correction is also known to lead to artificially prolonged QTc values at increased heart rates. This study assessed the incidence of erroneously increased QTc values in normal children without QT abnormalities. Methods Continuous 12-lead ECGs were recorded in 332 healthy children (166 girls) aged 10.7 ± 2.6 years while they performed postural manoeuvring consisting of episodes (in the following order) of supine, sitting, standing, supine, standing, sitting, and supine positions, each lasting 10 min. Detailed analyses of QT/RR profiles confirmed the absence of prolonged individually corrected QTc interval in each child. Heart rate and QT intervals were measured in 10-s ECG segments and in each segment, QTc intervals were obtained using Bazett, Fridericia, and Framingham formulas. In each child, the heart rates and QTc values obtained during supine, sitting and standing positions were averaged. QTc durations by the three formulas were classified to < 440 ms, 440–460 ms, 460–480 ms, and > 480 ms. Results At supine position, averaged heart rate was 77.5 ± 10.5 beat per minute (bpm) and Bazett, Fridericia and Framingham QTc intervals were 425.3 ± 15.8, 407.8 ± 13.9, and 408.2 ± 13.1 ms, respectively. At sitting and standing, averaged heart rate increased to 90.9 ± 10.1 and 100.9 ± 10.5 bpm, respectively. While Fridericia and Framingham formulas showed only minimal QTc changes, Bazett correction led to QTc increases to 435 ± 15.1 and 444.9 ± 15.9 ms at sitting and standing, respectively. At sitting, Bazett correction identified 51, 4, and 0 children as having the QTc intervals 440–460, 460–480, and > 480 ms, respectively. At sitting, these numbers increased to 118, 11, and 1, while on standing these numbers were 151, 45, and 5, respectively. Irrespective of the postural position, Fridericia and Framingham formulas identified only a small number (< 7) of children with QT interval between 440 and 460 ms and no children with longer QTc. Conclusion During screening for LQTS in children, the use of Bazett formula leads to a high number of false positive cases especially if the heart rates are increased (e.g. by postural manoeuvring). The use of Fridericia formula can be recommended to replace the Bazett correction not only for adult but also for paediatric ECGs.

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Section: Discussionsupporting

confidence: 85%

“…when screening children for congenital long QT syndrome (LQTS). Recently, a proposal was published to use ECG during standing rather than supine position to increase the sensitivity of LQTS screening [ 13 ]. Bazett formula was used in the data supporting this proposal.…”

Section: Introductionmentioning

confidence: 99%

Problems with Bazett QTc correction in paediatric screening of prolonged QTc interval

et al. 2020

View full text Add to dashboard Cite

show abstract

“…by exercise test or by postural manoeuvres, as was the case in the data that we presented. Therefore, while it is possible to agree with Reynisson et al [12] that judging ECGs recorded in the standing position increases the sensitivity of LQTS diagnoses, our data show that this increase of sensitivity comes at a very high cost of substantially decreased speci city.…”

Section: Subject-speci C Qt/rr Relationshipssupporting

confidence: 84%

“…almost two thirds) when sitting and standing recordings were analysed, respectively. Projecting these results into clinical practice makes it clear that any screening strategy would easily be overwhelmed by a substantial number of false positive cases (these were probably not encountered by Reynisson et al [12] because of the relatively small number of their control cases).…”

Section: Subject-speci C Qt/rr Relationshipsmentioning

confidence: 99%

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Problems with Bazett QTc Correction in Paediatric Screening of Prolonged QTc Interval

Andršová

Hnatkova

Helánová

et al. 2020

Preprint

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BackgroundBazett formula is frequently used in paediatric screening for the long QT syndrome (LQTS) and proposals exist that using standing rather than supine electrocardiograms (ECG) improves the sensitivity of LQTS diagnosis. Nevertheless, compared to adults, children have higher heart rates (especially during postural provocations) and Bazett correction is also known to lead to artificially prolonged QTc values at increased heart rates. This study assessed the incidence of erroneously increased QTc values in normal children without QT abnormalities.MethodsContinuous 12-lead ECGs were recorded in 332 healthy children (166 girls) aged 10.7±2.6 years while they performed postural manoeuvring consisting of episodes (in the following order) of supine, sitting, standing, supine, standing, sitting, and supine positions, each lasting 10 minutes. Detailed analyses of QT/RR profiles confirmed the absence of prolonged individually corrected QTc interval in each child. Heart rate and QT intervals were measured in 10-second ECG segments and in each segment, QTc intervals were obtained using Bazett, Fridericia, and Framingham formulas. In each child, the heart rates and QTc values obtained during supine, sitting and standing positions were averaged. QTc durations by the three formulas were classified to <440 ms, 440-460 ms, 460-480 ms, and >480 ms. ResultsAt supine position, averaged heart rate was 77.5±10.5 beat per minute (bpm) and Bazett, Fridericia and Framingham QTc intervals were 425.3±15.8, 407.8±13.9, and 408.2±13.1 ms, respectively. At sitting and standing, averaged heart rate increased to 90.9±10.1 and 100.9±10.5 bpm, respectively. While Fridericia and Framingham formulas showed only minimal QTc changes, Bazett correction led to QTc increases to 435±15.1 and 444.9±15.9 ms at sitting and standing, respectively. At sitting, Bazett correction identified 51, 4, and 0 children as having the QTc intervals 440-460, 460-480, and >480 ms, respectively. At sitting, these numbers increased to 118, 11, and 1, while on standing these numbers were 151, 45, and 5, respectively. Irrespective of the postural position, Fridericia and Framingham formulas identified only a small number (<7) of children with QT interval between 440 and 460 ms and no children with longer QTc.ConclusionDuring screening for LQTS in children, the use of Bazett formula leads to a high number of false positive cases especially if the heart rates are increased (e.g. by postural manoeuvring). The use of Fridericia formula can be recommended to replace the Bazett correction not only for adult but also for paediatric ECGs.

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Decreased ventricular repolarization variability in one-year-olds of gestational diabetes mothers

Schmidt,

Hammer,

Malberg

et al. 2024

Progress in Pediatric Cardiology

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QTc interval-dependent body posture in pediatrics

Cited by 5 publications

References 30 publications

Problems with Bazett QTc correction in paediatric screening of prolonged QTc interval

Problems with Bazett QTc correction in paediatric screening of prolonged QTc interval

Problems with Bazett QTc Correction in Paediatric Screening of Prolonged QTc Interval

Decreased ventricular repolarization variability in one-year-olds of gestational diabetes mothers

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