The QT interval throughout the first 6 months of life: a prospective study.

Schwartz, Peter J.; Montemerlo, Massimo; Facchini, Mario; Salice, Patrizia; Rosti, D; Poggio, G; Giorgetti, R

doi:10.1161/01.cir.66.3.496

Cited by 136 publications

(73 citation statements)

References 36 publications

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“…The corresponding 98th percentile QTc values for the cisapride treated groups were: 504 ms; 458 ms; and 451 ms, respectively. Thirty of the 64 group 1 cisapride patients (46.9%) had a QTc Bazett's formula value beyond 455 ms. 11 Of these 30 infants, 2 had a QTc value Ͼ480 ms and in another 2 infants the QTc value was Ͼ500 ms (505 ms and 507 ms). Two of the group 2 cisapride patients had a QTc Bazett's formula value above 455 ms (457 ms in both) and none in the cisapride group 3 patients.…”

Section: Resultsmentioning

confidence: 98%

Effects of Cisapride on Corrected QT Interval, Heart Rate, and Rhythm in Infants Undergoing Polysomnography

Benatar

Feenstra

Decraene³

et al. 2000

Pediatrics

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ABSTRACT. Objective. To evaluate the effects of cisapride, a prokinetic gastrointestinal drug, on the electrocardiographic QT interval, heart rate, and rhythm in infants during routine 8-hour polysomnography. Reported electrocardiogram (ECG) and rhythm disturbances in a small number of patients with the use of cisapride provided the impetus for this prospective study.Study Design. Two hundred fifty-two infants born at term were enrolled. Of these, 134 were on cisapride therapy for suspected gastroesophageal reflux and 118 were not on cisapride and served as controls. Cisapride-treated and control infants were from the outset divided into 3 age groups; group 1: under 3 months of age; group 2: between 3 and 6 months of age; and group 3: >6 months of age. Continuous ECG bipolar limb lead I recording, saturation monitoring, and electroencephalography were conducted. QT intervals and heart rate were measured at hourly intervals.Results. Cisapride doses were: group 1 mean, 0.80 mg/kg/day (range: 0.38 -1.55); group 2 mean, 0.80 mg/kg/ day (range: 0.23-1.38); and group 3 mean, 0.72 mg/kg/day (range: 0.32-1.41). Heart rate was higher in the younger infants, with a gradual decrease with age. No difference in heart rate was detected between the cisapride and control groups. The QTc interval in patients in group 1 was statistically longer than the controls, when applying both Bazett's and Hodges' formulae for QT correction. The other age groups did not differ. No arrhythmia or atrioventricular conduction abnormalities were observed.Conclusion. Infants under 3 months of age on cisapride treatment had significantly longer QTc intervals (with Bazett's formula, the 98th percentile was 504 ms in the cisapride group vs 447 ms in controls). The clinical significance and risk of the increased QTc interval in these infants are unclear and need further evaluation and risk stratification. Meanwhile, cisapride should be judiciously prescribed in infants <3 months of age. Pediatrics 2000;106(6). URL: http://www.pediatrics.org/ cgi/content/full/106/6/e85; QT interval, QTc, cisapride, heart rate, heart rhythm, infants.ABBREVIATIONS. ECG, electrocardiogram; CYP, cytochrome P-450. C isapride, a prokinetic agent used in adults and children with gastrointestinal motility disorders, has been reported in some patients to increase the QT interval on the electrocardiogram (ECG). 1-3 Prolongation of the electrocardiographic QT interval may be either congenital 4 -6 or acquired. 7 Acquired prolongation of the QT interval can be caused by electrolyte disturbances (commonly hypokalemia and hypocalcemia), hypothermia, central nervous system injury, malnutrition, organophosphate poisoning, and medication. Medications that have been implicated include tricyclic antidepressants, macrolide antibiotics, phenothiazines, and antiarrhythmic agents. 7 The QT interval on the ECG represents the period from the beginning of depolarization (QRS complex) to the end of repolarization (T wave) of the ventricles. There are at least 5 different genes responsible for ...

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Section: Resultsmentioning

confidence: 98%

Effects of Cisapride on Corrected QT Interval, Heart Rate, and Rhythm in Infants Undergoing Polysomnography

Benatar

Feenstra

Decraene³

et al. 2000

Pediatrics

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“…9 Manoach et al showed that the ECG of newborn mice with a prolonged QT interval is similar to that of mouse embryos in the intermediate stage, while the ECG in normal newborns resembles that of the prenatal fetus. 10 Fein et al demonstrated a good correlation between the number of undifferentiated myoblasts in the ventricular walls and typical prolongation of the QT interval in rats and mice.…”

Section: Discussionmentioning

confidence: 99%

Isolated Non-Compaction of the Ventricular Myocardium Associated With Long QT Syndrome A Report of 2 Cases

Ogawa

Nakamura

Terano

et al. 2009

Circ J

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solated non-compaction of the ventricular myocardium (INCVM) is a relatively newly defined disorder of the endomyocardium characterized by prominent ventricular trabeculations and deep intertrabecular recesses. 1 Clinical manifestations include a depressed left ventricular (LV) function, ventricular arrhythmia, and systemic embolization. 2,3 INCVM has been reported to be associated with several electrocardiographic changes such as ST depression and flat or negative T waves, bundle branch block, and Wolff-Parkinson-White (WPW) syndrome. [2][3][4] To the best of our knowledge, a long QT interval has not been reported on previously.We report 2 cases of INCVM with long QT syndrome (LQTS). Case Report Patient 1The patient was a boy aged 1 day old, who had no family history of sudden death or arrhythmia, and electrocardiograms (ECGs) of his parents showed no abnormality. He was born normally in a maternity hospital at the gestational age of 38 weeks. The Apgar score was 8 points at 1 min after birth. He was given low-dose oxygen because of slight cyanosis. At 13 h after birth, he showed tachypnea and systemic cyanosis.When he was admitted to our hospital, his condition was severe. His respiratory rate was 60 breaths/min and heart rate was 130 beats/min. His systolic blood pressure was 60 mmHg. His head and face was edematous. No heart murmur was audible. Hepatosplenomegaly was not recognized.Blood gas analysis indicated severe metabolic acidosis; the base excess was -9.2 mmol/L and pH was 7.305. Both AST and CK were elevated. In particular, CK was as high as 2,830 IU/L. Mild hypocalcemia (7.8 mg/dl) was present and other serum electrolytes including magnesium (2.3 mg/dl) were within normal limits. A physical examination and laboratory data showed marked stress during gestation or circulatory shock of an unknown cause. A chest X-ray revealed cardiomegaly, and the cardiothoracic ratio (CTR) was 68%. The ECG on admission showed left bundle branch block (LBBB) and a long QT time (Figure 1). An echocardiography showed that the ventricular myocardium was thickened and that the endocardial trabeculation was prominent at the apex, especially in the right ventricle. There were no congenital heart defects, and the ejection fraction of the left ventricle (LVEF) was 10%.A few minutes after supplemental calcium infusion, polymorphic ventricular tachycardia (VT) with torsades de pointes and sustained VT were detected on an ECG moniter (Figure 1). Lidocaine 1 mg/kg was infused initially, but it was ineffective. Even though cardioversion was performed several times, it had only a transient effect on resolving polymorphic and sustained VT. After 1 mmol/kg MgSO4 was administered, sustained VT was resolved, and MgSO4 was infused at a rate of 0.1 mmol · kg -1 · h -1 to prevent sustained VT with torsades de pointes.After VT was resolved, the LVEF was gradually improved to 60% and the CTR based on a chest X-ray was normalized at the age of 4 days. An ECG showed a narrow QRS pattern, not a bundle branch block, and QTc was still prolonged to...

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“…10 Studies of infants in Italy and a recent study of infants in Japan have shown that QTc intervals were longest at ≈2 months of age. 11,12 A large study conducted in Italy showed that the prevalence of LQTS might be close to 1:2000 13 ; however, no studies have been conducted outside Europe. In Japan, medical examinations during infancy are mandatory, and medical examinations at 1 month of age are currently performed on all infants.…”

Section: Clinical Perspective On P 938mentioning

confidence: 99%

Electrocardiographic Screening of 1-Month-Old Infants for Identifying Prolonged QT Intervals

Yoshinaga

Ushinohama

Sato

et al. 2013

Circ: Arrhythmia and Electrophysiology

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Background-Neonatal electrocardiographic screening is used to screen infants with prolonged QT intervals, as previously shown in whites. However, this procedure needs to be confirmed in other ethnic groups. Methods and Results-In 8 areas in Japan, an ECG was recorded in 4285 infants at 1-month medical checkup. A prospective study showed that a provisional criterion of QTc ≥470 ms was appropriate for infants. To assess the validity of the criterion, all infants with a QTc between 460 and 470 ms were followed up. Five infants had a QTc ≥470 ms. Four infants were diagnosed with prolonged QT intervals from follow-up ECGs. Four infants showed no symptoms and did not have a family history of long-QT syndrome. Two infants showed progressive prolongation of QT intervals, and medication was started. Genetic testing was performed in 3 of 4 infants with prolonged QT intervals, and it revealed a KCNH2 mutation (3065 delT, L1021fs+34X) in 1 infant. One infant with a QTc ≥470 ms and 2 infants with a QTc between 460 and 470 ms showed a decline in their QTc values during follow-up. The study screened another infant with Wolff-Parkinson-White syndrome who was diagnosed with noncompaction before symptoms appeared. Conclusions-Neonatal electrocardiographic screening can identify infants likely to be affected by long-QT syndrome in the Japanese population, as already shown in whites. This screening may also be useful in identifying other important cardiac diseases.

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The QT interval throughout the first 6 months of life: a prospective study.

Cited by 136 publications

References 36 publications

Effects of Cisapride on Corrected QT Interval, Heart Rate, and Rhythm in Infants Undergoing Polysomnography

Effects of Cisapride on Corrected QT Interval, Heart Rate, and Rhythm in Infants Undergoing Polysomnography

Isolated Non-Compaction of the Ventricular Myocardium Associated With Long QT Syndrome A Report of 2 Cases

Electrocardiographic Screening of 1-Month-Old Infants for Identifying Prolonged QT Intervals

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