QTc interval prolongation and QTc dispersion in children and adolescents with type 1 diabetes

Suys, Bert; Huybrechts, Sophie; Wolf, Daniël De; Beeck, L. Op De; Matthys, Dirk; Overmeire, Bart Van; Caju, M. V. L. Du; Rooman, Raoul

doi:10.1067/mpd.2002.125175

Cited by 52 publications

(47 citation statements)

References 32 publications

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“…Although we did not include non-diabetic subjects as controls, our findings are consistent with studies in type 1 diabetic adults showing an increased likelihood of prolonged QTc compared with those without diabetes [21,22,23]. A recent study of children and adolescents reported a similar increased rate of prolonged QTc during daytime ECG monitoring in type 1 diabetic patients (23%) compared with matched control subjects (3%) [24]. While it may be difficult to compare QTc values between studies [11], figures from a large normative database indicate that prolonged QTc (>440 ms) is unusual in healthy children [25,26].…”

Section: Discussionsupporting

confidence: 88%

Prolonged cardiac repolarisation during spontaneous nocturnal hypoglycaemia in children and adolescents with type 1 diabetes

et al. 2004

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Aims/hypothesis. It has been postulated that hypoglycaemia-related cardiac dysrhythmia and, in particular, prolonged cardiac repolarisation, may contribute to increased mortality rates in children and adolescents with type 1 diabetes. Methods. We examined the prevalence of prolonged QT interval on ECG during spontaneous hypoglycaemia in 44 type 1 diabetic subjects (aged 7-18 years), and explored the relationships between serial overnight measurements of QT interval corrected for heart rate (QTc) and serum glucose, potassium and epinephrine levels. Each subject underwent two overnight profiles; blood was sampled every 15 min for glucose measurements and hourly for potassium and epinephrine. Serial ECGs recorded half-hourly between 23.00 and 07.00 hours were available on 74 nights: 29 with spontaneous hypoglycaemia (defined as blood glucose <3.5 mmol/l) and 45 without hypoglycaemia.Results. Mean overnight QTc was longer in females than in males (412 vs 400 ms, p=0.02), but was not related to age, diabetes duration or HbA 1 c. Prolonged QTc (>440 ms) occurred on 20 out of 74 (27%) nights, with no significant differences between male and female subjects, and was more prevalent on nights with hypoglycaemia (13/29, 44%) than on nights without (7/45, 15%, p=0.0008). Potassium levels were lower on nights when hypoglycaemia occurred (minimum potassium 3.4 vs 3.7 mmol/l, p=0.0003) and were inversely correlated with maximum QTc (r=−0.40, p=0.03). In contrast, epinephrine levels were not higher on nights with hypoglycaemia and were not related to QTc. Conclusions/interpretation. In young type 1 diabetic subjects, prolonged QTc occurred frequently with spontaneous overnight hypoglycaemia and may be related to insulin-induced hypokalaemia.

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Section: Discussionsupporting

confidence: 88%

Prolonged cardiac repolarisation during spontaneous nocturnal hypoglycaemia in children and adolescents with type 1 diabetes

et al. 2004

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“…Moreover, increased dispersion of ventricular repolarization occurs in diabetic patients5, 6, 7, 8, 10 with an important implication on propensity to develop electrical disturbances 4, 13, 15, 16. To test the possibility that prolonged electrical recovery with hyperglycemia was associated with increased repolarization variability and rhythm disturbances, the degree of temporal dispersion of myocardial repolarization and susceptibility to develop arrhythmias were quantified.…”

Section: Resultsmentioning

confidence: 99%

“…Prolongation of the QT interval and increased dispersion of repolarization have been observed in the diabetic population,4, 5, 6, 7, 8, 9, 10 and these variables, together with intervening comorbidities,11 represent critical substrates for the occurrence of electrical disturbances 4, 12, 13, 14, 15, 16, 17. But whether alterations at the cellular level contribute to protracted electrical recovery and repolarization variability with diabetes remain to be determined.…”

Section: Introductionmentioning

confidence: 99%

Reduction in Kv Current Enhances the Temporal Dispersion of the Action Potential in Diabetic Myocytes: Insights From a Novel Repolarization Algorithm

Meo

Meste

Signore

et al. 2016

JAHA

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BackgroundDiabetes is associated with prolongation of the QT interval of the electrocardiogram and enhanced dispersion of ventricular repolarization, factors that, together with atherosclerosis and myocardial ischemia, may promote the occurrence of electrical disorders. Thus, we tested the possibility that alterations in transmembrane ionic currents reduce the repolarization reserve of myocytes, leading to action potential (AP) prolongation and enhanced beat‐to‐beat variability of repolarization.Methods and ResultsDiabetes was induced in mice with streptozotocin (STZ), and effects of hyperglycemia on electrical properties of whole heart and myocytes were studied with respect to an untreated control group (Ctrl) using electrocardiographic recordings in vivo, ex vivo perfused hearts, and single‐cell patch‐clamp analysis. Additionally, a newly developed algorithm was introduced to obtain detailed information of the impact of high glucose on AP profile. Compared to Ctrl, hyperglycemia in STZ‐treated animals was coupled with prolongation of the QT interval, enhanced temporal dispersion of electrical recovery, and susceptibility to ventricular arrhythmias, defects observed, in part, in the Akita mutant mouse model of type I diabetes. AP was prolonged and beat‐to‐beat variability of repolarization was enhanced in diabetic myocytes, with respect to Ctrl cells. Density of Kv K+ and L‐type Ca2+ currents were decreased in STZ myocytes, in comparison to cells from normoglycemic mice. Pharmacological reduction of Kv currents in Ctrl cells lengthened AP duration and increased temporal dispersion of repolarization, reiterating features identified in diabetic myocytes.ConclusionsReductions in the repolarizing K+ currents may contribute to electrical disturbances of the diabetic heart.

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“…Karavanaki & Baum (8) reported reduced papillary adaptation in darkness in 13.8% of children with diabetes compared with 5.8% of controls; 50% of these children also had impaired heart rate variation. Suys et al (18) found evidence of cardiac dysfunction in a significant proportion of children and adolescents with diabetes: diabetic children had significantly longer QTc intervals and a significantly larger QTc dispersion than controls. Vazeou et al (19) failed to find a correlation between autonomic function and gastrointestinal symptoms in children and teenagers with diabetes, nor an effect of mild-to-moderate hyperglycemia on gastrointestinal motility.…”

Section: Epidemiologymentioning

confidence: 99%

New insights in diabetic autonomic neuropathy in children and adolescents

Verrotti

Loiacono

Mohn

et al. 2009

European Journal of Endocrinology

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Diabetic autonomic neuropathy (DAN) represents a major complication of diabetes mellitus but there is considerable uncertainty about its incidence, prevalence, pathogenesis, diagnosis, and prognosis. There are conflicting opinions about the pathogenesis of DAN: the 'classical hypothesis' has been supplemented by some new insights. Clinical symptoms of autonomic neuropathy do not generally occur until long after the onset of diabetes. DAN seems to be detectable even in asymptomatic children and adolescents with diabetes and is associated with the most serious consequences, such as cardiovascular dysfunction. Because of its association with a variety of adverse outcomes, including cardiovascular deaths, cardiovascular autonomic neuropathy is the most clinically important and well-studied form of DAN. No form of therapy in DAN has been identified that provides unequivocal, safe, and effective stabilization or reversal of the condition, just a near normal control of blood glucose in the early years after the onset of diabetes that may delay the development of clinically significant nerve impairment. This article reviews recent developments in knowledge of epidemiology, pathogenesis, clinical symptoms, diagnosis, and therapy of DAN.

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QTc interval prolongation and QTc dispersion in children and adolescents with type 1 diabetes

Cited by 52 publications

References 32 publications

Prolonged cardiac repolarisation during spontaneous nocturnal hypoglycaemia in children and adolescents with type 1 diabetes

Prolonged cardiac repolarisation during spontaneous nocturnal hypoglycaemia in children and adolescents with type 1 diabetes

Reduction in Kv Current Enhances the Temporal Dispersion of the Action Potential in Diabetic Myocytes: Insights From a Novel Repolarization Algorithm

New insights in diabetic autonomic neuropathy in children and adolescents

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