Advertisement

Pediatric Cardiology

, Volume 14, Issue 1, pp 23–27 | Cite as

Altered cardiac repolarization during exercise in congenital aortic stenosis

  • Vittoria Bastianon
  • Franco Del Bolgia
  • Mario Boscioni
  • Viviana Gobbi
  • M. Cristina Marzano
  • Vincenzo Colloridi
Original Articles

Summary

The incidence of sudden death in children with congenital aortic stenosis (CAS) varies between 4 and 20%. In several syndromes sudden death is associated with a long QT interval in the electrocardiogram (ECG). The aim of the study was to evaluate the cardiac repolarization in CAS during stress.

We included 40 children and young persons, 20 with CAS and 20 healthy controls. All underwent echocardiographic study and treadmill stress test. The QT and relative RR intervals were measured in leads II and V6 at rest and during exercise at preselected heart rates. Mean values of QT were compared by analysis of variance, Student'st-test, and linear regression method.

No statistically significant differences in the resting ECG were found between the two groups, whereas during exercise the mean QT of the CAS group was significantly longer than in the controls (p<0.05), except at a heart rate of 140±5. Our study demonstrates that patients with CAS have transiently altered cardiac repolarization when there are sudden variations in heart rate.

Such a defect could predispose patients with CAS to fatal arrhythmias and sudden death.

Key Words

Congenital aortic valvar stenosis Sudden death QT interval Cardiac repolarization Treadmill exercise test in children 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Ahnve S (1985) QT interval prolongation in acute myocardial infarction.Eur Heart J 6, (Suppl): 85–95Google Scholar
  2. 2.
    Ahnve S, Vallin H (1982) Influence of heart rate and inhibition of autonomic tone on the QT interval.Circulation 65: 435–439Google Scholar
  3. 3.
    Amold L, Page J, Attwell D, Cannel M, Eisner DA (1982) The dependence on heart rate of the human ventricular action potential duration.Cardiovasc Res 16: 547–551Google Scholar
  4. 4.
    Attwell D, Cohen I, Eisner DA (1981) The effects of heart rate on the action potential of guinea pig and human ventricular muscle.J Physiol 313: 439–461Google Scholar
  5. 5.
    Attwell D, Lee JA (1988) A cellular basis for the primary long QT syndromes.Lancet 8595: 1136–1139Google Scholar
  6. 6.
    Boudoulas H, Sohn YH, O'Neil W, Brown R, Weissler AM (1982) The QT>QS2 syndrome: a new mortality risk indicator in coronary artery disease.Am J Cardiol 50: 1229–1235Google Scholar
  7. 7.
    Boyett MR, Jewell BR (1980) Analysis of the effects of changes in rate and rhythm upon electrical activity in the heart.Prog Biophys Mol Biol 36: 1–52Google Scholar
  8. 8.
    Chandramouli B, Ehmke DA, Laver RM (1975) Exercise-induced electrocardiographic changes in children with congenital aortic stenosis.J Pediatr 87: 725–730Google Scholar
  9. 9.
    Cohen LS, Friedman WF, Braunwald E (1972) Natural history of mild congenital aortic stenosis elucidated by serial hemodynamic studies.Am J Cardiol 30: 1–5Google Scholar
  10. 10.
    El Said G, Galioto FM, Mullins CE, McNamara DG (1972) Natural hemodynamic history of congenital aortic stenosis in childhood.Am J Cardiol 30: 6–12Google Scholar
  11. 11.
    Friedman WF, Modlinger J, Morgan JR (1971) Serial hemodynamic observation in asymptomatic children with valvular aortic stenosis.Circulation 43: 91–97Google Scholar
  12. 12.
    Gillilan RE, Pamer WP, Kahn MI, Bouchard RJ, Warbassa JR (1979) The prognostic value of systolic time intervals in angina pectoris patients.Circulation 60: 268–275Google Scholar
  13. 13.
    Heissenbuttel RH, Bigger JT Jr (1970) The effect of oral quinidine on intraventricular conduction in man. Correlation of plasma quinidine with changes in QRS duration.Am Heart J 80: 453–462Google Scholar
  14. 14.
    Hossack KF, Neutze JM, Lowe JB, Barratt-Boyes BG (1980). Congenital valvar aortic stenosis, natural history and assessment for operation.Br Heart J 43: 561–573Google Scholar
  15. 15.
    Jervell A, Lange Nielsen F (1957) Congenital deaf-mutism and functional heart disease with prolongation of the QT interval and sudden cardiac death.Am Heart J 54: 59–60Google Scholar
  16. 16.
    Josephson ME, Caracta AR, and Lau SH, Gallagher JJ, Damato AB (1973) Electrophysiological evaluation of disopyramide in man.Am Heart J 86: 771–780Google Scholar
  17. 17.
    Kiely B (1974) Sudden death in young patients with congenital aortic stenosis.Pediatrics 53:481–489Google Scholar
  18. 18.
    Krovetz LJ, Kurlinski JP (1976) Subendocardial blood flow in children with congenital aortic stenosis.Circulation 54:961–965Google Scholar
  19. 19.
    Lambert EC, Menon VA, Wagner HR, Vlad P (1974) Sudden unexpected death from cardiovascular disease in children.Am J Cardiol 34:89–96Google Scholar
  20. 20.
    Lepeschkin E, Surawicz B (1952) The measurement of the QT interval on the electrocardiogram.Circulation 6:378–388Google Scholar
  21. 21.
    Lewis AB, Heymann MA, Stanger P, Hoffman JIE, Rudolph AM (1974) Evaluation of subendocardial ischemia in valvar aortic stenosis in children.Circulation 49:978–984Google Scholar
  22. 22.
    Olsson SB (1972) Right ventricular monophasic action potentials during regular rhythm.Acta Scand 191:145–157Google Scholar
  23. 23.
    Romano G, Gemine G, Pontiglione R (1963) Aritmie cardiache rare dell'età pediatrica.Clin Pediatr 45:656–664Google Scholar
  24. 24.
    Schwartz LS, Goldfisher J, Sprague GJ, Schwarz SP (1960) Syncope and sudden death in aortic stenosis.Am J Cardiol 23:647–658Google Scholar
  25. 25.
    Schwartz PI, Wolf S (1978) QT interval as a predictor of sudden death in patients with myocardial infarction.Circulation 57:1074–1077Google Scholar
  26. 26.
    Schwartz PJ, Locati E (1985) The idiopathic long QT syndrome: pathogenetic mechanism and therapy.Eur Heart J 6(Suppl):103–114Google Scholar
  27. 27.
    Schwartz PJ, Periti M, Malliani A (1975) The long QT syndrome.Am Heart J 89:378–390Google Scholar
  28. 28.
    Shah RS, Fisher JT (1962) Early electrocardiographic changes and left heart strain in congenital aortic stenosis.Circulation 25:363–368Google Scholar
  29. 29.
    Surawicz B (1967) Relationship between electrocardiogram and electrolytes.Am Heart J 73:814–834Google Scholar
  30. 30.
    Surawicz B (1972) The pathogenesis and clinical significance of primary T-wave abnormalities. In: Schlant RC, Hurst JW (eds)Advances in electrocardiograph 1972. Grune & Stratton, New York, pp 377–421Google Scholar
  31. 31.
    Thornback P, Fowler RS (1975) Sudden unexpected death in children with congenital heart disease.Can Med Assoc J 113:745–748Google Scholar
  32. 32.
    Thurman Johnson C, Cowan M (1986) Relationship between the prolonged QT interval and ventricular fibrillation.Heart Lung 15:141–150Google Scholar
  33. 33.
    Trautwein W, Kassebaum DG, Nelson RM, Hecht HM (1962) Electrophysiological study of human heart muscle.Circulation Res 10:306–312Google Scholar
  34. 34.
    Trenouth RS, Phelps NC, Neill WA (1976) Determinants of left ventricular hypertrophy and oxygen supply in chrome aortic valve disease.Circulation 53:644–650Google Scholar
  35. 35.
    Weisler AM, O'Neill WW, Sohn YH, Stack RS, Chew PC, Reed AH (1981) Prognostic significance of systolic time intervals in patients recovered from myocardial infarction.Am J Cardiol 48:995–1002Google Scholar
  36. 36.
    Yanowitz R, Preston JB, Abildskov JA (1966) Functional distribution of right and left stellate innervation of the ventricles: production of neurogenic electrocardiographic changes by unilateral alteration of sympathetic tone.Circ Res 18:416–428Google Scholar

Copyright information

© Springer-Verlag New York Inc. 1993

Authors and Affiliations

  • Vittoria Bastianon
    • 1
  • Franco Del Bolgia
    • 2
  • Mario Boscioni
    • 1
  • Viviana Gobbi
    • 1
  • M. Cristina Marzano
    • 1
  • Vincenzo Colloridi
    • 1
  1. 1.Department of Clinica PediatricaUniversità “La Sapienza” Policlinico “Umberto I”RomaItaly
  2. 2.Department of Human PhysiologyII. University of Rome “Tor Vergata”RomeItaly

Personalised recommendations