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JACC April 5, 2011

Volume 57, Issue 14

CONGENITAL CARDIOLOGY SOLUTIONS

(ADULT CONGENITAL AND PEDIATRIC CARDIOLOGY)
THE RESPONSE OF THE CORRECTED QT INTERVAL TO HYPERVENTILATION IN PEDIATRIC PATIENTS
ACC Poster Contributions
Ernest N. Morial Convention Center, Hall F
Monday, April 04, 2011, 3:30 p.m.-4:45 p.m.

Session Title: Pediatric Cardiology: Electrophysiology

Abstract Category: 41 Pediatric Cardiology
Session-Poster Board Number: 1132-442
Authors: Jennifer KE Whitham, Yue-Hin Loke, Lauren E. Sterrett, Eric S. Ebenroth, Marcus S. Schamberger, Joyce E. Hubbard, Riley Hospital for
Children, Indianapolis, IN
Background: The corrected QT (QTc) interval has been observed to prolong with hyperventilation during routine exercise stress testing, however
this phenomenon has never been investigated in scientific literature. We sought to characterize how the QTc interval responds to hyperventilation in
the healthy pediatric population.
Methods: A retrospective review was performed on 166 otherwise healthy pediatric patients who were referred for exercise stress testing with
symptoms of syncope, palpitations, or chest pain. None of these patients were subsequently diagnosed with long QT syndrome. A baseline supine
ECG, supine hyperventilation ECG, baseline seated ECG, and seated hyperventilation ECG performed during a standard Bruce Protocol exercise stress
test were reviewed by at least two different blinded observers. Measurements obtained included RR interval and QT interval which were then used to
calculate QTc interval using Bazetts formula.
Results: The average patient age was 13.1+/- 9 years, with 92 males and 74 females. The R-value for interobserver correlation was 0.77. Average
supine and seated QTc intervals were 420 msec which both increased during hyperventilation to 450 msec and 440 msec, respectively. While sitting,
8.9% of patients had a QTc value greater than 450msec compared to 32% of patients during seated hyperventilation (p<0.001). While supine, 6.9%
of patients had a QTc value greater than 450msec compared to 43% of patients during supine hyperventilation (p<0.001).
Conclusion: In response to hyperventilation, the QTc interval using Bazetts formula shows statistically significant prolongation from rest in the
healthy pediatric population. Therefore, care should be taken before employing diagnostic tests in the work up for long QT syndrome in those
patients whom are hyperventilating during an electrocardiogram.

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