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Comparison of QT dispersion before and after PDA device closure in pediatrics
Mohammad Reza Khalilian1, Mehdi Ziaratban1, Parinaz Alizadeh1
1Department of Pediatrics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Insights
Closing the patent ductus arteriosus (PDA) in children significantly reduces QT dispersion (QTd), a marker for arrhythmia risk. Pulmonary arterial hypertension (PAH) does not impede this beneficial effect on ventricular repolarization.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Electrophysiology
Background:
- QT dispersion (QTd) is a recognized risk assessment criterion for arrhythmias in congenital heart disease.
- Pulmonary arterial hypertension (PAH) exacerbates arrhythmia risk by disrupting ventricular repolarization.
- The impact of PDA device closure on QTd, especially in the presence of PAH, requires further investigation.
Purpose of the Study:
- To evaluate changes in QT dispersion (QTd) following patent ductus arteriosus (PDA) device closure.
- To determine the influence of pulmonary arterial hypertension (PAH) on QTd modifications post-PDA closure.
Main Methods:
- A cohort of 97 pediatric patients undergoing PDA device closure was studied.
- Echocardiography, ECGs (measuring QTc, QTd, PR intervals) were performed pre-procedure and at 3 months post-procedure.
- Patients were stratified into high PAH and normal PAH groups for comparative analysis.
Main Results:
- PDA device closure led to significant reductions in both QTc and QTd in the overall patient group.
- Both the normal PAH and high PAH groups exhibited significant decreases in QTc, QTd, and PR intervals post-intervention.
- These findings indicate a consistent improvement in ventricular repolarization parameters regardless of PAH severity.
Conclusions:
- Left-to-right shunting through a PDA impacts ventricular repolarization, with a more pronounced effect in cases of pulmonary hypertension.
- PDA device closure effectively normalizes repolarization parameters, including QT dispersion, even in the presence of significant pulmonary hypertension.
Background:
Numerous studies have shown that QT dispersion (QTd) can be a suitable criterion for risk assessment of arrhythmia in patients with congenital heart disease. Pulmonary arterial hypertension (PAH) increases the risk of cardiac arrhythmia by changing ventricular repolarization homogeneity. In this study, we assessed QTd changes after PDA device closure and the effect of PAH on these changes.
Methods:
Between October 2018 and March 2021, 97 patients (48 males; 49 females; mean age 31.36 ± 4.26 months; range 3 months to 14 years) who satisfied the primary inclusion criteria and did not meet the exclusion criteria and underwent PDA device closure intervention were included in the study. Echocardiography was performed before the procedure. QT corrected (QTc), and QTd and PR intervals were measured according to the patients' standard 12-lead ECGs in two periods, preoperative (1 day) and after (3 months).
Results:
In the general group, QTc and QTd decreased significantly after PDA closure. Based on our classification of the patients in two groups of high PAP and normal PAP, the three parameters QTc, QTd, and PR interval were assessed separately in the two groups. All three parameters decreased significantly in the normal PAP and high PAP groups.
Conclusions:
However, a left-to-right shunt through the patent ductus arteriosus can affect ventricular repolarization; this effect seems to be particularly more significant when there is pulmonary hypertension.
