Cut-Offs for Screening Prolonged QT Intervals From Fridericia's Formula in Children and Adolescents

Hazeki, Daisuke; Yoshinaga, Masao; Takahashi, Hideto; Tanaka, Yuji; Haraguchi, Yasue; Abé, Mayumi; Koga, Masami; Fukushige, Tomoko; Nagashima, Masami

doi:10.1253/circj.cj-09-0979

Cited by 37 publications

(18 citation statements)

References 10 publications

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“…Pediatric cardiologists who participated in the program used age-and sex-specific criteria using an exponential formula (QT/RR 0.31 ) 21 or Fridericia formula. 22 In the screening program, cardiologists use computer-based QTc values as a reference because all ECG machines used in Japan are generally equipped with a function for automated measurement of QT intervals. However, manual measurement using the tangent method is usually applied to obtain QT intervals in Japan.…”

Section: Diagnosis Of Lqts and Screening Of Qt Intervals In The Schoomentioning

confidence: 99%

Genetic Characteristics of Children and Adolescents With Long-QT Syndrome Diagnosed by School-Based Electrocardiographic Screening Programs

Yoshinaga

Kucho

Jav

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Original ArticleBackground-A school-based electrocardiographic screening program has been developed in Japan. However, few data are available on the genetic characteristics of pediatric patients with long-QT syndrome who were diagnosed by this program. Methods and Results-A total of 117 unrelated probands aged ≤18 years were the subjects who were referred to our centers for genetic testing. Of these, 69 subjects diagnosed by the program formed the screened group. A total of 48 subjects were included in the clinical group and were diagnosed with long-QT syndrome-related symptoms, familial study, or by chance. Mutations were classified as radical, of high probability of pathogenicity, or of uncertain significance. Two subjects in the clinical group died. Genotypes were identified in 50 (72%) and 23 (48%) of subjects in the screened and clinical groups, respectively. Of the KCNQ1 or KCNH2 mutations, 31 of 33 (94%) in the screened group and 14 of 15 (93%) in the clinical group were radical and of high probability of pathogenicity. Prevalence of symptoms before (9/69 versus 31/48; P<0.0001) and after (12/69 versus 17/48; P=0.03) diagnosis was significantly lower in the screened group when compared with that in the clinical group although the QTc values, family history of long-QT syndrome, sudden death, and follow-up periods were not different between the groups. Conclusions-These data suggest that the screening program may be effective for early diagnosis of long-QT syndrome that may allow intervention before symptoms. In addition, screened patients should have follow-up equivalent to clinically identified patients. Thus, the aim of the present study was to determine the genetic characteristics of pediatric patients with LQTS who were diagnosed by a school-based screening program and whose genetic testing was performed and to compare results with subjects who visited hospitals because of the presence of LQTS-related symptoms, familial history, or who were diagnosed by chance. Methods Study PopulationThe study population included 117 unrelated probands ≤18 years of age who were referred to the Department of Pediatrics, Kagoshima University Hospital, Japan, between November 1993 and March 2005 or to the National Hospital Organization Kagoshima Medical Center from April 2005 to December 2012 for genetic evaluation. The population included 69 subjects who were screened by a school-based ECG screening program (Table 1). In the present study, LQTS-related symptoms were defined as syncope, aborted cardiac arrest, or sudden cardiac death at <30 years old. Subjects were divided into 2 groups on the basis of index events: subjects who were diagnosed by the schoolbased ECG screening program (screened group) and those who visited hospitals because of the presence of symptoms and family history or who were diagnosed by chance (clinical group; Table 1). Diagnosis of LQTS and Screening of QT Intervals in the School-based ECG Screening ProgramThe present study was a retrospective study, and diagnosis of LQTS and screening for prolo...

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Section: Diagnosis Of Lqts and Screening Of Qt Intervals In The Schoomentioning

confidence: 99%

Genetic Characteristics of Children and Adolescents With Long-QT Syndrome Diagnosed by School-Based Electrocardiographic Screening Programs

Yoshinaga

Kucho

Jav

et al. 2014

Circ: Arrhythmia and Electrophysiology

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“…As in adults, data generally indicate that <5% of children have a QTc interval >450 ms. 44,79,97 In addition, as noted above, studies of siblings of children with long QT syndrome found increased risk of cardiovascular events at QTc intervals of 460 to 500 ms, though reported cases of torsades de pointes in children prescribed methadone are rare. Given the potential for increased risk and the availability of alternative opioids, the panel suggests that clinicians apply similar QTc parameters for use of methadone in children as in adults, until more evidence is available.…”

Section: Baseline Electrocardiogramsmentioning

confidence: 90%

Methadone Safety: A Clinical Practice Guideline From the American Pain Society and College on Problems of Drug Dependence, in Collaboration With the Heart Rhythm Society

Chou

Cruciani

Fiellin

et al. 2014

The Journal of Pain

204

188

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Methadone is used for the treatment of opioid addiction and for treatment of chronic pain. The safety of methadone has been called into question by data indicating a large increase in the number of methadone-associated overdose deaths in recent years that has occurred in parallel with a dramatic rise in the use of methadone for chronic pain. The American Pain Society and the College on Problems of Drug Dependence, in collaboration with the Heart Rhythm Society, commissioned an interdisciplinary expert panel to develop a clinical practice guideline on safer prescribing of methadone for treatment of opioid addiction and chronic pain. As part of the guideline development process, the American Pain Society commissioned a systematic review of various aspects related Clinical practice guidelines are ''guides'' only and may not apply to all patients and all clinical situations. As part of a shared decision-making approach, it may be appropriate for the clinician to inform a patient that a particular recommendation may not be applicable, after considering all circumstances pertinent to that individual. This article is based on research conducted at the Oregon Evidence-based Practice Center (now the Pacific Northwest Evidence-based Practice Center) with funding from the American Pain Society (APS to safety of methadone. After a review of the available evidence, the expert panel concluded that measures can be taken to promote safer use of methadone. Specific recommendations include the need to educate and counsel patients on methadone safety, use of electrocardiography to identify persons at greater risk for methadone-associated arrhythmia, use of alternative opioids in patients at high risk of complications related to corrected electrocardiographic QTc interval prolongation, careful dose initiation and titration of methadone, and diligent monitoring and follow-up. Although these guidelines are based on a systematic review, the panel identified numerous research gaps, most recommendations were based on low-quality evidence, and no recommendations were based on high-quality evidence.Perspective: This guideline, based on a systematic review of the evidence on methadone safety, provides recommendations developed by a multidisciplinary expert panel. Safe use of methadone requires clinical skills and knowledge in use of methadone to mitigate potential risks, including serious risks related to risk of overdose and cardiac arrhythmias. M ethadone is a synthetic opioid used for the treatment of opioid addiction and for treatment of chronic pain. 15,61 The safety of methadone has been called into question by data indicating a large increase in the number of methadone-associated overdose deaths.38 This increase appears largely related to the dramatic rise in the use of methadone for chronic pain, though a small proportion of deaths occur in patients treated for opioid addiction. 21,37,68,76,91,103 Methadone poisoning deaths in the United States increased steadily from about 800 in 1999 to a high of about 5,500 in 2007; th...

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“…17 The QT interval was not analyzed in the present study. Instead, manually measured data from a prior study 18 were analyzed and the data are shown in Table S2. …”

Section: T-wave Amplitudementioning

confidence: 99%

Standard Values and Characteristics of Electrocardiographic Findings in Children and Adolescents

Yoshinaga

Iwamoto²,

Horigome

et al. 2018

Circ J

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Background:Reference values and the characteristics of the electrocardiographic (ECG) findings using a large number of subjects are lacking for children and adolescents. Methods and Results:A total of 56,753 digitally stored ECGs of participants in a school-based ECG screening system were obtained between 2006 and 2009 in Kagoshima, Japan. Each ECG was manually reviewed by 2 pediatric cardiologists and only ECGs with sinus rhythm were included. A final total of 48,401 ECGs from 16,773 1st (6 years old, 50% girls), 18,126 7th (12 years old, 51% girls), and 13,502 10th graders (15 years old, 52% girls) were selected. ECG variables showed differences in age and sex. However, the effects of age and sex on ECG variables such as the PQ interval, QRS voltage, and STJ segment were also different. The 98th percentile values of well-known surrogate parameters for ventricular hypertrophy in the present study were much higher than the conventional criteria. Conclusions:The present study of a large number of pediatric subjects showed that the effects of age and sex on ECG parameters are different, and that criteria for ventricular hypertrophy should be newly determined by age and sex. We have developed reference data for STJ segment elevation for children and adolescents. These findings are useful for creating guidelines and recommendations for interpretation of pediatric ECG.

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Cut-Offs for Screening Prolonged QT Intervals From Fridericia's Formula in Children and Adolescents

Cited by 37 publications

References 10 publications

Genetic Characteristics of Children and Adolescents With Long-QT Syndrome Diagnosed by School-Based Electrocardiographic Screening Programs

Genetic Characteristics of Children and Adolescents With Long-QT Syndrome Diagnosed by School-Based Electrocardiographic Screening Programs

Methadone Safety: A Clinical Practice Guideline From the American Pain Society and College on Problems of Drug Dependence, in Collaboration With the Heart Rhythm Society

Standard Values and Characteristics of Electrocardiographic Findings in Children and Adolescents

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