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Holter Electrocardiographic Approach to Predicting Outcomes of Pediatric Patients With Long QT Syndrome
Masao Yoshinaga1,2, Yumiko Ninomiya1, Yuji Tanaka1
1Department of Pediatrics, National Hospital Organization Kagoshima Medical Center.
Insights
The maximum Holter QTc value effectively predicts cardiac events in pediatric long QT syndrome (LQTS) patients identified through screening. This finding aids in managing LQTS risk in children.
Area of Science:
- Cardiology
- Pediatrics
- Genetics
Background:
- Long QT syndrome (LQTS) is a cardiac channelopathy often diagnosed through electrocardiographic screening in pediatric populations.
- Early identification and risk stratification are crucial for preventing adverse cardiac events in children with LQTS.
Purpose of the Study:
- To investigate the clinical characteristics of pediatric LQTS patients identified via screening.
- To evaluate the predictive value of electrocardiographic parameters, specifically QTc intervals, for cardiac events in these patients.
Main Methods:
- Retrospective analysis of 207 pediatric patients with a Schwartz score ≥3.5 from April 2005 to March 2019.
- Inclusion of resting 12-lead and Holter electrocardiograms, focusing on maximum resting QTc and maximum Holter QTc values.
- Utilized receiver operating characteristic (ROC) curve analysis to assess the prognostic value of QTc for cardiac events.
Main Results:
- 87% of pediatric LQTS patients were diagnosed through screening programs.
- The incidence of cardiac events after initial hospital visit was 4%.
- Maximum Holter QTc, unlike maximum resting QTc, was a significant predictor of future cardiac events (P=0.02) in multivariate analysis.
Conclusions:
- The maximum Holter QTc interval is a valuable tool for predicting cardiac events in pediatric patients diagnosed with long QT syndrome.
- Holter monitoring provides superior prognostic information compared to resting ECGs for assessing LQTS risk in children.
Background:
This study was performed to clarify the clinical findings of pediatric patients diagnosed with long QT syndrome (LQTS) through electrocardiographic screening programs and to predict their outcome using Holter electrocardiographic approaches.
Methods And Results:
This retrospective study included pediatric patients with a Schwartz score of ≥3.5 who visited the National Hospital Organization Kagoshima Medical Center between April 2005 and March 2019. Resting 12-lead and Holter electrocardiograms were recorded at every visit. The maximum resting QTc and maximum Holter QTc values among all recordings were used for statistical analyses. To test the prognostic value of QTc for the appearance of cardiac events after the first hospital visit, receiver operating characteristic curves were used to calculate the area under the curve (AUC). Among 207 patients, 181 (87%) were diagnosed through screening programs. The prevalence of cardiac events after the first hospital visit was 4% (8/207). Among QTc at diagnosis, maximum resting QTc, and maximum Holter QTc, only maximum Holter QTc value was a predictor (P=0.02) of cardiac events after the hospital visit in multivariate regression analysis. The AUC of the maximum Holter QTc was significantly superior to that of maximum resting QTc.
Conclusions:
The maximum Holter QTc value can be used to predict the appearance of symptoms in pediatric patients with LQTS.
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