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Ventricular Repolarization Dispersion is a Potential Risk for the Development of Life-Threatening Arrhythmia in Children with Hypertrophic Cardiomyopathy

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Abstract

The risk stratification and early interventions are necessary in patients with hypertrophic cardiomyopathy (HCM), as life-threatening arrhythmia (LTA) is a leading cause of death. This study aimed to explore whether an interval between the peak of the T wave to the end terminal of the T wave (Tp-e), which represents ventricular repolarization dispersion, could predict the risk for LTA in children with HCM. We analyzed electrocardiography at the first and last visits in children (aged < 15 years) with HCM, and compared Tp-e interval and the ratio of Tp-e interval to QT interval (Tp-e/QT) between children with and without LTA. We studied 25 children with HCM. During the follow-up of 85 (38–146) months, there were 7 children with LTA. The 5-year sudden cardiac death (SCD) risk was 1.4 (1.1–2.5) %, which suggested that our cohort consisted of patients at a lower risk for SCD. Age was significantly older in children with LTA compared to those without it (12.5 vs.1.0 years, P = 0.037), although sex, the presence of family history and symptoms at diagnosis, the maximum left ventricular wall thickness Z-score did not differ between the groups. At the last electrocardiography before LTA, corrected Tp-e interval and Tp-e/QT ratio were significantly greater in patients with LTA compared to those in patients without LTA (corrected Tp-e: 103 vs. 78 ms, P = 0.020; Tp-e/QT: 0.28 vs. 0.22, P = 0.046). Corrected Tp-e and Tp-e/QT ratio cutoff values of 91 ms and 0.28 yielded as the predictors for LTA with sensitivity of 85% and 72%, specificity of 71% and 89%, respectively. Prolonged absolute and corrected Tp-e intervals and an increase in the Tp-e/QT ratio can be useful predictors for LTA in children with HCM. We offer temporal assessments of ventricular repolarization dispersion to stratify the risk for the development of LTA/SCD among children with HCM.

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Authors and Affiliations

  1. Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, 1-8-1, Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-8501, Japan

    Naoko Tashiro, Jun Muneuchi, Hiroki Ezaki, Masaru Kobayashi, Hiromu Yamada, Yuichiro Sugitani & Mamie Watanabe

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  1. Naoko Tashiro
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  2. Jun Muneuchi
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  3. Hiroki Ezaki
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  4. Masaru Kobayashi
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  6. Yuichiro Sugitani
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  7. Mamie Watanabe
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Contributions

NT analyzed data and described the first draft. JM designed and conducted this study and reviewed the manuscript. HE and MK collected echocardiographic data. HY collected electrocardiographic data. YS and MW critically reviewed this manuscript.

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Correspondence to Jun Muneuchi.

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Ethical Approval

This retrospectively single-institutional cohort study was approved by the Institutional Ethics Committee of Kyushu Hospital, Japan Community Healthcare Organization (Approval Number 807).

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In all subjects, their parents or guardians provided informed consent for the procedures, but informed consent for this cohort study was waived owing to the retrospective nature.

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Tashiro, N., Muneuchi, J., Ezaki, H. et al. Ventricular Repolarization Dispersion is a Potential Risk for the Development of Life-Threatening Arrhythmia in Children with Hypertrophic Cardiomyopathy. Pediatr Cardiol 43, 1455–1461 (2022). https://doi.org/10.1007/s00246-022-02867-3

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