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Electrocardiographic depolarization and repolarization: long-term after Kawasaki disease
N S Dahdah1, E Jaeggi, A Fournier
1Division of Pediatric Cardiology, Sainte-Justine Hospital, Université de Montréal, 3175 Côte Sainte-Catherine, Montréal, H3T 1C5, Québec, Canada.
Insights
Long-term Kawasaki disease (KD) patients with persistent coronary aneurysms show altered myocardial electrical potentials. These changes in depolarization and repolarization may increase ventricular arrhythmia risk.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Electrophysiology
Background:
- Kawasaki disease (KD) is a leading cause of acquired heart disease in children.
- Coronary artery aneurysms are a significant complication of KD.
- Long-term sequelae of KD, particularly regarding cardiac electrical activity, require further investigation.
Purpose of the Study:
- To evaluate myocardial electric potentials in patients with Kawasaki disease long after the initial diagnosis.
- To assess differences in signal-averaged electrocardiography (SAECG) and QT dispersion based on the resolution of coronary aneurysms.
Main Methods:
- Signal-averaged electrocardiography (SAECG) and QT dispersion parameters were measured in three groups of patients: persistent coronary aneurysm (Group I), late resolution (>3 months) (Group II), and early resolution (Group III).
- Patients were studied years after initial KD diagnosis.
- Statistical comparisons were made between the groups.
Main Results:
- Patients with persistent coronary aneurysms (Group I) exhibited significantly lower RMS40 values on SAECG compared to Groups II and III.
- Global QT dispersion was significantly greater in Group I compared to Group III.
- Trends towards increased QT dispersion were observed in Group I, though not always statistically significant.
Conclusions:
- Persistent coronary artery aneurysms long-term after Kawasaki disease are associated with altered myocardial depolarization and repolarization.
- These electrical alterations may serve as risk factors for ventricular arrhythmias in the growing KD patient population.
Abstract:
To assess myocardial electric potentials late after Kawasaki disease (KD) we measured signal-averaged electrocardiography (SAECG) and QT dispersion parameters. Thirteen patients with persistent coronary aneurysm (group I), 12 with late resolution of the aneurysm (>3 months) (group II), and 13 with early resolution (group III) were studied 7.9 +/- 3.9, 6.7 +/- 3.9, and 7.2 +/- 3.6 years after the initial diagnosis (p = NS). In group I, myocardial infarction occurred in one patient during the acute illness, and coronary thrombosis in another; all except two patients had giant aneurysm (n = 8) and/or stenosis (n = 7). At 40-Hz high-pass filter SAECG, terminal 40-msec root mean square amplitude (RMS40) was significantly lower in group I versus II and III (64.1 +/- 40.8 microV, 79.9 +/- 47.2 microV, and 115 +/- 65.4 microV, respectively; p <0.05). Global QT dispersion was significantly greater in group I versus III (52 +/- 11 msec and 37 +/- 11 msec, respectively; p <0.05), but not in comparison to group II (45 +/- 13 msec). The same trend was present for rate-corrected QT dispersion, without reaching statistical significance (84.0 +/- 34, 71.5 +/- 31, and 61.8 +/- 21 respectively). Both depolarization and repolarization parameters are altered in patients with persistent coronary artery aneurysms long-term after KD. This may represent risk factors for developing ventricular arrhythmia in a growing population.
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