Clinical Autonomic Research

, Volume 9, Issue 2, pp 109–112

Electrocardiographic repolarization abnormalities in familial dysautonomia: an indicator of cardiac autonomic dysfunction

  • Julie S. Glickstein
  • Felicia B. Axelrod
  • Deborah Friedman
Research Paper

Abstract

Objective: Electrocardiographic repolarization intervals were evaluated to determine the extent of cardiac autonomic dysfunction in patients with familial dysautonomia (FD) and to determine if any of these intervals could serve as a possible predicotr of clinical symptoms.

Methods: Thirty-seven electrocardiograms of patients with FD were retrospectively evaluated. QT, JT, rate-corrected QT and JT intervals were calculated as well as QT and QTC dispersion. Results were compared to normative data and electrocardiograms of 20 age-matched control subjects.

Observations: In the FD group, prolongation of QTC(>450 msec) was noted in 5/37 (13.5%) patients, as compared to 0/20 normal controls (p=NS), and prolongation of JTc (>340 msec) in 16/37 (43.3%) patients, as compared to 0/20 normal controls (p<0.001). QT and QTC dispersion were abnormal in 3/37 (8.1%) and 5/37 (13.5%), respectively. In the 16 FD patients with prolonged JTc, six had a positive history of syncope, whereas none of the 21 with normal JTc had syncope or symptoms suggesting arrhythmia (p<0.003). The positive predictive value of having syncope or symptoms suggestive of arrhythmia with an abnormal JTc is 37.5% (95% CI [15%, 65%]). The negative predictive value is 100% (95% CI [87%, 100%]).

Conclusion: In the FD population, the electrocardiographic measure of repolarization that was most frequently abnormal was the JTc interval. Prolongation of the JTc interval was significantly more frequent than prolongation of the QTC interval (p<0.001) QT and QTC dispersions were less significantly affected in the FD population, indicating uniform ventricular recovery time. These results suggest that a prolonged JTc interval may be a more sensitive indicator of abnormal ventricular repolarization and cardiac autonomic dysfunction. Due to the known sympathetic denervation inherent in patients with FD, they are at risk for unopposed parasympathetic predominance. FD patients, therefore, are more likely to have brady arrhythmias and asystole rather than polymorphic ventricular tachycardia. The increased incidence of syncope in patients with prolonged JTc suggests that this measure may serve as a helpful marker to predict which FD patients are at increased risk of serious clinical sequelae including bradyarrhythmias with asystole or sudden death.

Keywords

familial dysautonomia cardiac autonomic dysfunction ECG repolarization abnormalities 

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Copyright information

© Lippincott Williams & Wilkins 1999

Authors and Affiliations

  • Julie S. Glickstein
    • 3
  • Felicia B. Axelrod
    • 1
  • Deborah Friedman
    • 2
  1. 1.The Department of Pediatrics, New York University Medical CenterNew York University School of MedicineNew York
  2. 2.Department of Pediatrics, Division of Pediatric CardiologyThe New York HospitalNew York
  3. 3.Department of Pediatrics, Division of Pediatric CardiologyMontefiore Medical CenterBronxUSA

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