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The T wave as a marker of dispersion of ventricular repolarization in premature infants before and while on treatment with the IKr channel blocker cisapride

Published online by Cambridge University Press:  15 August 2006

Avram Benatar
Affiliation:
Department of Pediatric Cardiology, Academic Hospital, Free University of Brussels, Brussels, Belgium
Filip Cools
Affiliation:
Department of Neonatology, Academic Hospital, Free University of Brussels, Brussels, Belgium
Tine Decraene
Affiliation:
Department of Pediatric Cardiology, Academic Hospital, Free University of Brussels, Brussels, Belgium
Adel Bougatef
Affiliation:
Department of Neonatology, Academic Hospital, Free University of Brussels, Brussels, Belgium
Yvan Vandenplas
Affiliation:
Department of Pediatric Gastroenterology, Academic Hospital, Free University of Brussels, Brussels, Belgium
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Abstract

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Aims: Measurement of electrocardiographic intervals to assess dispersion in ventricular repolarization may be helpful in the assessment of the risk of ventricular arrhythmia. We measured QTc, QT dispersion, and T wave intervals in premature infants before and while on treatment with the IKr blocker cisapride as markers for dispersion in ventricular repolarization. Methods and Results: We enrolled 15 non-ventilated premature infants with a mean gestational age of 30.5 weeks, ranging from 26.5 to 33.5 weeks, and mean postnatal age of 24 days, with a range from 5 to 51 days. A digital 12 lead electrocardiogram was recorded prior to and 3 days after administering cisapride at a dose of 0.8mg/kg/day. Serum electrolytes were simultaneously measured. Electrocardiographic measurements before and after included: QT, QTc Bazett, QT dispersion, R–R, T wave interval peak to end, T wave interval peak to end/onset Q to T wave peak, T wave axis, T wave maximum voltage and QRS–T angle. A paired t test and analysis of variance was used to compare the variables before and during treatment. The QTc, T wave interval peak to end and the ratio T wave interval peak to end/onset Q to T peak increased significantly following treatment with cisapride. Results expressed as before and during treatment were for QTc: 429 (65) ms versus 454 (29) ms p < 0.02; for T wave interval peak to end: 65 (11) ms versus 103 (24) p < 0.01, for the ratio T wave interval peak to end/onset Q to T peak: 0.32 (0.06) versus 0.55 (0.16) p < 0.001. Treatment with the IKr blocker did not significantly alter the QT dispersion, T wave voltage, angle or QRS–T angle. Conclusion: The interval from the peak to the end of the T wave and the ratio of this value to the onset Q to T peak interval, represents regional dispersion of repolarization across the ventricular wall. This is a potentially useful clinical index in the assessment of arrhythmic risk in premature infants being treated by blockade of the IKr channels.

Type
Original Article
Copyright
2002 Cambridge University Press