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Published on: April 5, 2011
Corrected QT Interval in Children With Brain Death
Jennifer Plymale1, Jeanny Park, Joanne Natale
1Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, WI, 53226, USA. jplymale@chw.org
Insights
QT interval prolongation is common in pediatric brain death patients. This study found corrected QT intervals (QTc) are significantly longer in these children than in healthy populations, aiding donor acceptability assessments.
Area of Science:
- Pediatric Cardiology
- Neurology
- Critical Care Medicine
Background:
- QT interval prolongation is recognized in adult brain injury but less documented in children.
- Brain death in pediatric patients presents unique challenges for cardiac assessment.
Purpose of the Study:
- To determine the range of QT intervals in children diagnosed with brain death.
- To hypothesize that the corrected QT interval (QTc) is prolonged in pediatric brain death patients compared to normal populations.
Main Methods:
- Retrospective analysis of electrocardiograms (ECGs) from children (<18 years) diagnosed with brain death (1995-2007).
- Inclusion criteria: previously healthy, normal echocardiogram, at least one ECG.
- QT and RR intervals measured; corrected QT (QTc) calculated using Bazett's method.
Main Results:
- Thirty-seven pediatric patients met inclusion criteria.
- Mean QTc was 452 (61) ms, significantly longer than in normal pediatric populations.
- Multivariate analysis identified female sex and hypokalemia as associated with QTc prolongation.
Conclusions:
- QTc is normally distributed but significantly prolonged in pediatric brain death.
- Findings suggest potential pediatric cardiac donors with isolated QTc prolongation may be acceptable.
- Further research into genetic channelopathies is warranted for comprehensive donor evaluation.
Abstract:
Prolongation of the QT interval is a well-documented finding in adults with severe brain injury. However, QT prolongation has not been well documented in the pediatric population with brain injury. Our objective was to determine the range of QT intervals in children with the diagnosis of brain death, hypothesizing that the QT interval corrected for heart rate (QTc) is longer in this population than in a normal population. All previously healthy children (<18 years) dying in our hospital from 1995 to 2007 with a diagnosis of brain death and at least one electrocardiogram (ECG) with normal anatomy by echocardiogram were included. Admission details, past medical and family history, demographic data, and laboratory data were collected. The QT and preceding RR intervals from three sinus beats on a standard 12-lead ECG were measured. The QTc was calculated with the Bazett method, and the values were averaged. Thirty-seven patients met inclusion criteria. Five had event histories concerning for possible underlying rhythm disturbances; data analysis was performed with and without these patients. The QTc data were normally distributed. The mean (SD) QTc for the entire cohort was 452 (61) ms. Excluding the five patients, it was 449 (62) ms. On multivariate analysis, sex (QTc female < male) and hypokalemia were associated with QTc prolongation. QTc in children with brain death is normally distributed but significantly longer than QTc in normal children. Until rapid genetic testing for channelopathies is universally available, our findings suggest that potential pediatric cardiac donors with isolated prolongation of the QTc in this setting may be acceptable in the absence of other exclusionary criteria.
