Holter Recordings at Initial Assessment for Long QT Syndrome: Relationship to Genotype Status and Cardiac Events
Background: The relationship of Holter recordings of repolarization length to outcome in long QT syndrome (LQTS) is unknown. Methods: Holter recordings and initial 12 lead ECG QTc were related to outcome in 101 individuals with LQTS and 28 gene-negative relatives. Mean QTc (mQTc) and mean RTPc (R-wa...
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| Language: | English |
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MDPI AG
2022-05-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/9/5/164 |
| _version_ | 1797498926670020608 |
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| author | Kathryn E. Waddell-Smith Alexandra A. Chaptynova Jian Li Jackie R. Crawford Halina Hinds Jonathan R. Skinner |
| author_facet | Kathryn E. Waddell-Smith Alexandra A. Chaptynova Jian Li Jackie R. Crawford Halina Hinds Jonathan R. Skinner |
| author_sort | Kathryn E. Waddell-Smith |
| collection | DOAJ |
| description | Background: The relationship of Holter recordings of repolarization length to outcome in long QT syndrome (LQTS) is unknown. Methods: Holter recordings and initial 12 lead ECG QTc were related to outcome in 101 individuals with LQTS and 28 gene-negative relatives. Mean QTc (mQTc) and mean RTPc (R-wave to peak T-wave, mRTPc) using Bazett correction were measured, analyzing heart rates 40 to 120 bpm. Previously reported upper limit of normal (ULN) were: women and children (<15 years), mQTc 454, mRTPc 318 ms; men mQTc 446 ms, mRTPc 314 ms. Results: Measurements in LQTS patients were greatly prolonged; children and women mean mQTc 482 ms (range 406–558), mRTPc 351 ms (259–443); males > 15 years mQTc 469 ms (407–531), mRTPc 338 ms (288–388). Ten patients had cardiac arrest (CA), and 24 had arrhythmic syncope before or after the Holter. Holter values were more closely related to genotype status and symptoms than 12 lead QTc, e.g., sensitivity/specificity for genotype positive status, mRTPc > ULN (89%/86%); CA, mRTPc > 30 ms over ULN (48%/100%). Of 34 symptomatic (CA/syncope) patients, only 9 (26%) had 12 lead QTc > 500 ms, whereas 33/34 (94%) had an mRTPc or mQTc above ULN. In 10 with CA, all Holter measurements were > 15 ms above ULN, but only two had 12 lead QTc > 500 m. Conclusions: Holter average repolarization length, particularly mRTPc, reflects definite LQTS status and clinical risk better than the initial 12 lead QTc. Values below ULN indicate both a low risk of having LQTS and a low risk of cardiac events in the small percentage that do. |
| first_indexed | 2024-03-10T03:40:15Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-10T03:40:15Z |
| publishDate | 2022-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-27005a5226774c96bec079deb5e4eb772023-11-23T11:33:04ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252022-05-019516410.3390/jcdd9050164Holter Recordings at Initial Assessment for Long QT Syndrome: Relationship to Genotype Status and Cardiac EventsKathryn E. Waddell-Smith0Alexandra A. Chaptynova1Jian Li2Jackie R. Crawford3Halina Hinds4Jonathan R. Skinner5Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, SA 5042, AustraliaDepartment of Paediatrics, Child and Youth Health, University of Auckland, Auckland 1010, New ZealandDepartment of Paediatrics, Child and Youth Health, University of Auckland, Auckland 1010, New ZealandThe Cardiac Inherited Disease Group, New ZealandGreen Lane Paediatric and Congenital Cardiac Services, Starship Children’s Hospital, Auckland 1023, New ZealandDepartment of Paediatrics, Child and Youth Health, University of Auckland, Auckland 1010, New ZealandBackground: The relationship of Holter recordings of repolarization length to outcome in long QT syndrome (LQTS) is unknown. Methods: Holter recordings and initial 12 lead ECG QTc were related to outcome in 101 individuals with LQTS and 28 gene-negative relatives. Mean QTc (mQTc) and mean RTPc (R-wave to peak T-wave, mRTPc) using Bazett correction were measured, analyzing heart rates 40 to 120 bpm. Previously reported upper limit of normal (ULN) were: women and children (<15 years), mQTc 454, mRTPc 318 ms; men mQTc 446 ms, mRTPc 314 ms. Results: Measurements in LQTS patients were greatly prolonged; children and women mean mQTc 482 ms (range 406–558), mRTPc 351 ms (259–443); males > 15 years mQTc 469 ms (407–531), mRTPc 338 ms (288–388). Ten patients had cardiac arrest (CA), and 24 had arrhythmic syncope before or after the Holter. Holter values were more closely related to genotype status and symptoms than 12 lead QTc, e.g., sensitivity/specificity for genotype positive status, mRTPc > ULN (89%/86%); CA, mRTPc > 30 ms over ULN (48%/100%). Of 34 symptomatic (CA/syncope) patients, only 9 (26%) had 12 lead QTc > 500 ms, whereas 33/34 (94%) had an mRTPc or mQTc above ULN. In 10 with CA, all Holter measurements were > 15 ms above ULN, but only two had 12 lead QTc > 500 m. Conclusions: Holter average repolarization length, particularly mRTPc, reflects definite LQTS status and clinical risk better than the initial 12 lead QTc. Values below ULN indicate both a low risk of having LQTS and a low risk of cardiac events in the small percentage that do.https://www.mdpi.com/2308-3425/9/5/164long QT syndromeHolter monitorrisk stratificationdiagnosis |
| spellingShingle | Kathryn E. Waddell-Smith Alexandra A. Chaptynova Jian Li Jackie R. Crawford Halina Hinds Jonathan R. Skinner Holter Recordings at Initial Assessment for Long QT Syndrome: Relationship to Genotype Status and Cardiac Events Journal of Cardiovascular Development and Disease long QT syndrome Holter monitor risk stratification diagnosis |
| title | Holter Recordings at Initial Assessment for Long QT Syndrome: Relationship to Genotype Status and Cardiac Events |
| title_full | Holter Recordings at Initial Assessment for Long QT Syndrome: Relationship to Genotype Status and Cardiac Events |
| title_fullStr | Holter Recordings at Initial Assessment for Long QT Syndrome: Relationship to Genotype Status and Cardiac Events |
| title_full_unstemmed | Holter Recordings at Initial Assessment for Long QT Syndrome: Relationship to Genotype Status and Cardiac Events |
| title_short | Holter Recordings at Initial Assessment for Long QT Syndrome: Relationship to Genotype Status and Cardiac Events |
| title_sort | holter recordings at initial assessment for long qt syndrome relationship to genotype status and cardiac events |
| topic | long QT syndrome Holter monitor risk stratification diagnosis |
| url | https://www.mdpi.com/2308-3425/9/5/164 |
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