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Electrocardiographic RR and QT Interval Variability in Patients with Atrial Septal Defect and Healthy Children

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Abstract

Atrial septal defect is a common congenital heart disease. In patients with atrial septal defect, left-to-right shunting increases the right atrial and right ventricular preload. This pathological change affects sinus node automaticity and myocardial depolarization and repolarization, and has the potential to evoke arrhythmogenic substrates. We examined the effect of atrial septal defect on sinus node automaticity and myocardial repolarization by investigating the variability in the repolarization interval, namely the QT variability index (QTVI) and variability ratio (VR). This retrospective study included 38 patients (mean age, 2.2 ± 1.9 years; mean left-to-right shunt ratio, 2.1 ± 0.70) and 40 age-matched healthy control subjects evaluated from 2008 to 2015. QTVI was calculated using the ratio of the repolarization parameter variance to heart rate variance, and VR was calculated as the ratio of the standard deviation (SD) of QT intervals to the SD of RR intervals on electrocardiography. There was a significant difference in the SD of all normal RR intervals, heart rate variance, VR, and QTVI of control subjects or patients with low shunt ratio compared with patients with high shunt ratio (all P < 0.05). Linear regression analysis revealed strong positive correlations between the left-to-right shunt ratio and VR (r = 0.662, P < 0.0001) or QTVI (r = 0.808, P < 0.0001). These repolarization indices provide information on alteration of sinus node autonomic control and the pathophysiology of myocardial repolarization, and could be used as a noninvasive indicator of the shunt ratio in children with atrial septal defect.

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Acknowledgements

We thank Dr. Tsuneaki Sadanaga for his excellent comments, and we thank Mr. Hirofumi Kusuki and Miss. Yuri Mizutani for their technical assistance.

Funding

This study was supported in part by the Japan Society for the Promotion of Science (KAKENHI) (#26350944).

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Authors and Affiliations

  1. Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan

    Yoshihiko Eryu, Tadayoshi Hata, Arisa Nagatani, Yuri Funamoto, Hidetoshi Uchida, Masayuki Fujino, Hiroko Boda, Masafumi Miyata & Tetsushi Yoshikawa

  2. Graduate School of Health Sciences, Fujita Health University, Toyoake, Japan

    Tadayoshi Hata

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  1. Yoshihiko Eryu
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  2. Tadayoshi Hata
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  3. Arisa Nagatani
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  4. Yuri Funamoto
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  6. Masayuki Fujino
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  8. Masafumi Miyata
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  9. Tetsushi Yoshikawa
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Correspondence to Tadayoshi Hata.

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Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from the children’s parents/guardians included in the study.

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Eryu, Y., Hata, T., Nagatani, A. et al. Electrocardiographic RR and QT Interval Variability in Patients with Atrial Septal Defect and Healthy Children. Pediatr Cardiol 38, 582–587 (2017). https://doi.org/10.1007/s00246-016-1551-z

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  • DOI: https://doi.org/10.1007/s00246-016-1551-z

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