The quest for the mechanisms of the sudden infant death syndrome: doubts and progress.

Schwartz, Peter J.

doi:10.1161/01.cir.75.4.677

Cited by 78 publications

(32 citation statements)

References 21 publications

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“…Sudden death has been reported as a common cause of death in type 1 diabetic patients affected by autonomic neuropathy (23). Based on the observations of long QT syndrome (26) and sudden infant death (27), it has been postulated that QT prolongation predisposes cardiac arrhythmias and sudden death.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Q-T Interval Dispersion in Type 1 Diabetes and Its Relation With Cardiac Ischemia

Veglio¹,

Giunti²,

Stevens³

et al. 2002

Diabetes Care

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OBJECTIVE -The interlead variation in duration of the Q-T interval on the surface electrocardiogram (Q-T interval dispersion [QTd]) has been shown to predict mortality in type 2 diabetic patients. We evaluated the prevalence of QTd prolongation in the EURODIAB population and its relation to corrected Q-T interval (QTc), sex, age, duration of diabetes, blood glucose control, and complications.RESEARCH DESIGN AND METHODS -A total of 3,042 type 1 diabetic patients were studied. QTc was calculated according to the Bazett's formula; QTc Ͼ0.44 s was considered abnormally prolonged. QTd was calculated using the difference between the maximum and the minimum QTc in any thoracic lead. QTd Ͼ0.080 s was considered abnormally prolonged.RESULTS -The prevalence of an increased QTd was 7%. A significant relation was observed between QTd prolongation and diastolic blood pressure (P Ͻ 0.05). A higher prevalence of QTd prolongation was observed in patients with ischemic heart disease (P ϭ 0.004), whereas no relationship was observed with retinopathy, albumin excretion rate, or measures of somatic and autonomic neuropathy. QTc and QTd were significantly related (P ϭ 0.001); however, a proportion of patients with normal QTd showed a prolonged QTc (Ͼ0.44 s).CONCLUSIONS -In patients with type 1 diabetes, QTd is associated with ischemic heart disease and diastolic blood pressure but not neuropathy. Although QTd is statistically related to duration of QTc, increased QTd and increased QTc identify different patients, and their predictive value deserves prospective evaluation. Diabetes Care 25:702-707, 2002T he Q-T interval in the electrocardiogram (ECG) reflects the total duration of ventricular myocardial depolarization and repolarization. It has been shown that a prolonged Q-T interval is associated with sudden death and poor survival in healthy subjects (1) and in a variety of clinical conditions, including newly diagnosed type 2 diabetes (2), nephropathy (3), and type 1 diabetes (4,5).The observation that the Q-T interval exhibits a certain degree of spatial variability on the epicardial surface (6) has led to the hypothesis that differences in the duration of the Q-T interval between ECG leads may reflect heterogeneity in recovery of excitability (7). Based on the evidence that nonuniform repolarization provides a substrate for the development of malignant ventricular arrhythmias (8), variation in the duration of the Q-T interval has been advocated as a more predictive marker of arrhythmias and mortality than the maximum duration of the Q-T interval (9).The interlead variation in duration of the Q-T interval on the surface ECG has been referred to as Q-T interval length dispersion or Q-T dispersion (QTd). It has been shown that the QTd is predictive of mortality in normal subjects and different groups of patients. Increased QTd has been described in patients with recent myocardial infarction (10), long Q-T syndrome (9,11), heart failure (12), and hypertrophic cardiomyopathy (13). Furthermore, QTd has been related to arrhythmia and ...

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Section: Discussionmentioning

confidence: 99%

Prevalence of Q-T Interval Dispersion in Type 1 Diabetes and Its Relation With Cardiac Ischemia

Veglio¹,

Giunti²,

Stevens³

et al. 2002

Diabetes Care

View full text Add to dashboard Cite

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“…[4][5][6] Sudden infant death syndrome is multifactorial in origin 7 ; however, genetic studies have shown that ≈10% of cases diagnosed as sudden infant death syndrome carry functionally significant genetic mutations in LQTS genes. 8,9 Electrocardiographic screening in infants may permit early detection of a substantial percentage of patients at risk for sudden infant death syndrome.…”

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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“…4 This debate led many to revisit the literature regarding SIDS and its possible pathophysiologic origins as a terminal respiratory event as opposed to death resulting from a cardiac arrhythmia. [5][6][7][8][9][10] What was lost during the debate was the idea that QT prolongation may be a marker of vulnerable infants with autonomic instabilityrather thandenotingthenatureor mechanism of the terminal event itself. 7 It is well known that the brainstem is the major regulatory site for respiration, cardiovascular function, sleep, and arousal and that dysfunction in any 1 of these areas influences the other regulatory systems.…”

Section: Discussionmentioning

confidence: 99%

QTc Interval Prolongation and Severe Apneas Associated With a Change in Infant Positioning

et al. 2013

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For more than a decade there has been considerable interest in the role of QT interval prolongation in the pathogenesis of sudden infant death syndrome. It has been proposed that the QT interval is a surrogate marker for autonomic instability and can be used to identify infants at risk for significant morbidity and mortality, including sudden infant death syndrome. We present the case of an infant that experienced a significant increase in his QTc, as detected by continuous QTc monitoring in the NICU after repositioning from a supine to prone position. This increase from a 413 ± 6 millisecond baseline average to 500 milliseconds was sustained for 2 hours and associated with clinically relevant apnea that ultimately required repositioning of the infant back to the supine position. Repositioning resulted in an immediate decrease of the QTc back to the previous baseline and termination of the apneic events. This case demonstrates an example of how the use of continuous QTc monitoring in the NICU setting may be used to detect QTc-accentuating factors in real time and identify situations that cause perturbations in an infant’s autonomic nervous system.

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The quest for the mechanisms of the sudden infant death syndrome: doubts and progress.

Cited by 78 publications

References 21 publications

Prevalence of Q-T Interval Dispersion in Type 1 Diabetes and Its Relation With Cardiac Ischemia

Prevalence of Q-T Interval Dispersion in Type 1 Diabetes and Its Relation With Cardiac Ischemia

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

QTc Interval Prolongation and Severe Apneas Associated With a Change in Infant Positioning

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