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Effects of cisapride on QT interval in children
A Khongphatthanayothin1, J Lane, D Thomas
1Department of Pediatrics, Childrens Hospital Los Angeles, California 90027, USA.
Insights
Cisapride use in children slightly increases the QT interval, a measure of heart electrical activity. While the incidence of prolonged QT interval is low, other factors may contribute to cardiac risks.
Area of Science:
- Pediatric Cardiology
- Clinical Pharmacology
Background:
- Recent reports link cisapride to torsade de pointes and heart block in children.
- Prolonged QT interval is a known risk factor for serious cardiac arrhythmias.
- The safety of cisapride in pediatric populations requires further investigation.
Purpose of the Study:
- To prospectively evaluate the impact of cisapride on the QT interval in children.
- To determine the incidence of prolonged corrected QT (QTc) interval and T wave abnormalities.
Main Methods:
- Prospective study involving 101 children receiving cisapride.
- Electrocardiography performed before and after cisapride administration in 30 children.
- Electrocardiography performed after cisapride initiation in 71 children.
- Assessment of corrected QT (QTc) interval and T wave morphology.
Main Results:
- Cisapride significantly increased the mean QTc interval by 15.5 +/- 4.6 msec (p = 0.002).
- 13% of children (13 out of 101) exhibited a QTc interval > 440 msec or abnormal T wave morphology.
- In patients with repolarization abnormalities, 85% had other contributing factors for prolonged QT.
Conclusions:
- Cisapride administration is associated with a modest increase in the QT interval in children.
- The incidence of a significantly prolonged QTc interval (> 440 msec) is low.
- Concomitant factors often coexist in children with cisapride-associated repolarization abnormalities.
Abstract:
Recent reports of torsade de pointes and heart block associated with prolonged QT interval in children receiving cisapride raise questions about its safety. We prospectively examined the effects of cisapride on the QT interval in children. Electrocardiography was performed on 30 children before and after cisapride was administered. An additional 71 children underwent electrocardiography only after starting cisapride. The incidence of a corrected QT (QTc) interval > 440 msec or a marked abnormality in T wave morphology was determined in all 101 children. Cisapride significantly lengthened the QTc with a mean increase of 15.5 +/- 4.6 msec (mean +/- SEM, p = 0.002 in the 30 children with baseline electrocardiographs. Twelve of the 101 patients were found to have a QTc > 440 msec, and one had a new prominent notched T wave in all leads. In these 13 (13%) patients with repolarization abnormalities, other factors that might contribute to a long QT were noted in 11 (85%) patients. We conclude that cisapride use in children is associated with a modest increase in QT interval. The incidence of QTc > 440 msec is low. Most children with long QTc have other factors that could compound the effects of cisapride.