Face Immersion in Cold Water Induces Prolongation of the QT Interval and T-Wave Changes in Children With Nonfamilial Long QT Syndrome

Yoshinaga, Masao; Kamimura, Junko; Fukushige, Tomoko; Kusubae, Ryo; Shimago, Atsushi; Nishi, Junichiro; Kono, Yukiharu; Nomura, Yoshio; Miyata, Koichiro

doi:10.1016/s0002-9149(99)00131-9

Cited by 48 publications

(29 citation statements)

References 18 publications

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“…[12][13][14] The initiation of drug therapy for these young patients is controversial because many pediatric cardiologists consider that few young LQTS patients without a past history have experienced new cardiac events after diagnosis. The objective of the present study, then, was to examine the characteristics of Japanese pediatric patients with LQTS and to determine the predictive factors for cardiac events after diagnosis in these young patients with and without a past history of cardiac events.…”

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Who Is at Risk for Cardiac Events in Young Patients With Long QT Syndrome?

Yoshinaga

Nagashima

Shibata

et al. 2003

Circ J

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ong QT syndrome (LQTS) is a rare disease characterized by prolonged ventricular repolarization and a high risk for cardiac events including sudden cardiac death. 1 Mutations causing LQTS have been identified in 5 genes, each encoding a cardiac ion channel and its regulatory subunit. [2][3][4][5] Most cases of LQTS that come to the attention of physicians are either symptomatic or familial. [6][7][8] Recent studies have reported that life-threatening arrhythmias in LQTS patients tend to occur under specific circumstances (eg, exercise, emotion, and sleep/rest without arousal) in a gene-specific manner. 9 Beta-blocker therapy is reported to be effective in preventing LQTS-related cardiac events in these patients, but they continue to occur while patients are on the prescribed medication. 10 A recent report has reported a gender reference in the electrocardiographic (ECG) response to -blockers in patients with LQTS. 11 A screening program conducted for Japanese children (1st, 7th and 10th grades) has uncovered large numbers of children with LQTS both without a family history and without a history of LQTS-related cardiac events at the Circulation Journal Vol.67, December 2003 time of diagnosis. 12-14 The initiation of drug therapy for these young patients is controversial because many pediatric cardiologists consider that few young LQTS patients without a past history have experienced new cardiac events after diagnosis. The objective of the present study, then, was to examine the characteristics of Japanese pediatric patients with LQTS and to determine the predictive factors for cardiac events after diagnosis in these young patients with and without a past history of cardiac events. Methods Subjects and DataA questionnaire was sent to 111 hospitals where the trustee(s) of the Japanese Society of Pediatric Cardiology and Cardiac Surgery were working. Subjects were those who visited one of those hospitals from January 1997 to August 2000 and who were less than 20 years old at the time of diagnosis. Characteristics of the subjects obtained from the survey included the following: past history of LQTS-related cardiac events, ECG findings, clinical and family history for diagnosis of LQTS according to the criteria of Schwartz et al, 15 cardiac events during the period after diagnosis and medication. When medication was prescribed, those patients were re-surveyed for compliance. Subjects were classified into 2 groups on the basis of the presence or absence of a past history of LQTS-related cardiac events at the time of diagnosis. The index events for diagnosis were classified as follows: (1) Who Is at Risk for Cardiac Events in Young PatientsWith Long QT Syndrome?Masao Yoshinaga, MD*; Masami Nagashima, MD; Toshimitsu Shibata, MD; Ichiro Niimura, MD; Mitsuo Kitada, MD; Toshiaki Yasuda, MD; Mari Iwamoto, MD; Junko Kamimura, MD; Mayu Iino, MD; Hitoshi Horigome, MD; Masashi Seguchi, MD; Sumi Aiba, MD; Naomi Izumida, MD; Takashi Kimura, MD; Hiroya Ushinohama, MD; Junichiro Nishi, MD*; Yukiharu Kono, MD*; Yuichi Nomura, MD*; Ko...

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confidence: 99%

Who Is at Risk for Cardiac Events in Young Patients With Long QT Syndrome?

Yoshinaga

Nagashima

Shibata

et al. 2003

Circ J

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“…The face immersion test comprises immersing the subject's face in cold water at a temperature of 10°C after maximal inspiration. 17 A 3-lead ECG (V4, V5, and V6) was obtained on a recorder (FCP-4711, Fukuda Denshi, Tokyo, Japan) throughout the testing period at a paper speed of 25 mm/s. 17 The QT intervals of the 3 successive beats before the test, at the maximum heart rate, and at the minimum heart rate (or at the heart rate with maximally prolonged QT intervals) were measured.…”

Section: Face Immersion Testmentioning

confidence: 99%

“…17 A 3-lead ECG (V4, V5, and V6) was obtained on a recorder (FCP-4711, Fukuda Denshi, Tokyo, Japan) throughout the testing period at a paper speed of 25 mm/s. 17 The QT intervals of the 3 successive beats before the test, at the maximum heart rate, and at the minimum heart rate (or at the heart rate with maximally prolonged QT intervals) were measured. The study was approved by the institutional review committee and all participants gave informed consent.…”

Section: Face Immersion Testmentioning

confidence: 99%

“…17 It was manually measured from the onset of the QRS complex to the end of the T wave by one of authors (MY). The interleader coefficient of variability was 1.9% of the mean QT interval.…”

Section: Qt Measurementsmentioning

confidence: 99%

“…A face immersion test was reported to induce an abnormally prolonged QT interval and notched T waves in children and adolescent with LQTS, 17 suggesting that the same test would induce a prolongation of the TDR in these young patients. We used the face immersion test to examine the QT intervals and compare the T wave configuration on ECG before and after treatment with the aim of determining whether the interval representative of TDR based on the experimental study can be adapted for use in the clinical setting, assuming that the decrease in the QTc interval after treatment is associated with a decrease in the TDR.…”

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Interval Representative of Transmural Dispersion of Repolarization in Children and Young Adolescents With Congenital Long QT Syndrome

Haraguchi

Yoshinaga

Jav

et al. 2005

Circ J

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ong QT syndrome (LQTS) is a rare disorder characterized by prolonged ventricular repolarization and a high risk of cardiac events, including sudden cardiac death. 1,2 Among the mutations thus far identified in specific ion channel genes causing LQTS, 3-6 KCNQ1 and KCNH2 have been most commonly identified, and they are known to cause the LQT1 and LQT2 forms, respectively. Recent studies have reported that LQTS-related cardiac events tend to occur under specific circumstances in a genespecific manner. 7 In the LQT1 form, exercise and swimming are the most common triggers, whereas in the LQT2 form they are strong emotions, sleep, and rest. 7 Results of experimental studies suggest that the interval between the peak and the end of the T wave in a transmural electrocardiogram (ECG) reflects the transmural dispersion of repolarization (TDR) when a normal upright T wave is present, and that TDR is linked to the genesis of torsade de pointes. [8][9][10] When complex (inverted, notched or biphasic, and triphasic) T waves are present, the interval from the nadir of the initial negative T wave to the end of the T wave is representative of the TDR. 11 However, the definition of the interval representative of TDR on a clinical surface ECG remains a subject of controversy when the T wave shows a notched or a bifid configuration. [12][13][14][15][16] There has not been a clinical report of the use of the interval from the nadir of the initial negative T wave to the end of the T wave as the definition of the interval representative of TDR when the notched or a bifid T wave is present.A face immersion test was reported to induce an abnormally prolonged QT interval and notched T waves in children and adolescent with LQTS, 17 suggesting that the same test would induce a prolongation of the TDR in these young patients. We used the face immersion test to examine the QT intervals and compare the T wave configuration on ECG before and after treatment with the aim of determining whether the interval representative of TDR based on the experimental study can be adapted for use in the clinical setting, assuming that the decrease in the QTc interval after treatment is associated with a decrease in the TDR. Methods Study PopulationInclusion criteria for the present study were children and adolescents with LQTS who had been treated and undergone a face immersion test before and after treatment. The 3 boys and 2 girls comprised 3 cases of the LQT1 form (KCNQ1 mutation; 2 families) and 2 of the LQT2 form (KCNH2 mutation, 2 families) ( Table 1). ControlsTo determine the normal range of the QT intervals during the face immersion test, 31 control children and adolescents (23 boys, 8 girls; mean age, 12 years; range, 6-17 years) were also examined. Normal ranges were defined as the mean ± 2SD. Background It has been shown experimentally that the interval from the nadir of the initial negative T wave to the end of the T wave is representative of transmural dispersion of repolarization (TDR) when complex T waves are present. In the clinical setting,...

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Macroscopical, Microscopical, and Laboratory Findings in Drowning Victims

Lunetta

Modell

Forensic Pathology Reviews

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Face Immersion in Cold Water Induces Prolongation of the QT Interval and T-Wave Changes in Children With Nonfamilial Long QT Syndrome

Cited by 48 publications

References 18 publications

Who Is at Risk for Cardiac Events in Young Patients With Long QT Syndrome?

Who Is at Risk for Cardiac Events in Young Patients With Long QT Syndrome?

Interval Representative of Transmural Dispersion of Repolarization in Children and Young Adolescents With Congenital Long QT Syndrome

Macroscopical, Microscopical, and Laboratory Findings in Drowning Victims

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