Diagnostic Value of the TpTe Interval in Children with Ventricular Arrhythmias.

Joanna Jaromin,Agnieszka Kulawik,Lesław Szydłowski,Grażyna Markiewicz-Łoskot

doi:10.3390/ijerph182212194

Abstract

Background: The changes in the period of ventricular repolarization, i.e., QT interval, QTp (Q-Tpeak) and TpTe interval (Tpeak–Tend), make it possible to assess the electrical instability of the heart muscle, which may lead to the development of life-threatening ventricular arrhythmia. The aim of the study was to determine and evaluate the use of differences in T-wave morphology and durations of repolarization period parameters (QT, TpTe) in resting ECGs for children with ventricular arrhythmias. Methods: The retrospective analysis was made of the disease histories of 80 examined children with resting ECGs, which were admitted to the Children’s Cardiology Department. The study group consisted of 46 children aged 4 to 18 with ventricular arrhythmias and the control group consisted of 34 healthy children between 4 and 18 years of age, with no arrhythmias. Results: The duration of the TpTe interval was significantly (p < 0.001) longer in the group of children with ventricular arrhythmia with abnormal T-wave (bactrian/bifid, humid/biphasic) compared to the TpTe interval in children with ventricular arrhythmia with the normal repolarization period. The duration of the TpTe (p < 0.001), QTcB (p < 0.001) and QTcF (p < 0.001) intervals were significantly longer in the group of children with ventricular arrhythmias and with abnormal T-wave compared to the values of the TpTe, QTcB, and QTcF intervals of the control group with normal morphology of the repolarization period. Only the duration of the TpTe interval was significantly (p = 0.020) longer in the group of children with ventricular arrhythmia without clinical symptoms. Conclusions: Children with benign ventricular arrhythmias recorded on a standard ECG with prolonged TpTe and QT intervals and abnormal T-wave morphology require systematic and frequent cardiac check up with long term ECG recordings due to the possibility of future more severe ventricular arrhythmias. Further follow-up studies in even larger groups of patients are necessary to confirm the values of these repolarization parameters in clinical practice.

Highlights

The aim of the study was to determine in the standard ECG electrocardiographic values of repolarization period parameters, i.e., the TpTe interval (Tpeak–Tend) and QT interval, corrected Bazett (QTcB) and Fridericia (QTcF) formulas with the assessment of T-wave morphology in a group of children with ventricular arrhythmias and in children in the control group, as well as the assessment of the possibility of using differences in T-wave morphology and durations of repolarization period parameters (QT, TpTe) determined in the standard ECG in the examined groups of children in predicting the risk of a more serious arrhythmia
In the 12-lead ECG performed at admission, 12 (27%) children with ventricular arrhythmia had single premature ventricular beats (Table 1)
In 22% of children with ventricular arrhythmia, abnormal T-waves in lead V4, V5, and V6 were observed in the standard ECG: bactrian/bifid T-waves in five children (11%) and humid/biphasic T-waves in five children

Summary

Introduction

Arrhythmias are an important clinical problem in the developmental population and a common cause of hospitalization. Their clinical course is most often asymptomatic, with no tangible cardiovascular abnormalities. Premature ventricular beats in the standard ECG may be recorded in 0.3–2.2% of newborns, infants, and children with normal circulatory system [1]. About 50% of children and adolescents with mild ventricular arrhythmias (spontaneously disappearing in about 48–65% of children), arrhythmia is of unknown etiology without coexisting overt, organic, or primarily electrophysiological heart disease [2]. The severity of ventricular arrhythmias can be manifested in chest pain, rapid heartbeat, dizziness, blurred vision (‘darkness’ in front of the eyes), Int. J.

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