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Normative Heart-Rate Corrected Values for Repolarisation Length From Holter Recordings in Children and Adults - 08/10/20

Doi : 10.1016/j.hlc.2019.12.006 
Kathryn E. Waddell-Smith, MBBS, PhD, FRACP a, b, c, Alexandra A. Chaptynova b, Jian Li, BSc, MBChB a, Jackie R. Crawford, NZCS a, Halina Hinds, BAS c, Jonathan R. Skinner, MD, FHRS a, b, c,
a Green Lane Paediatric and Congenital Cardiac Services, Starship Children’s Hospital Auckland New Zealand 
b The University of Auckland, Department of Child Health, Auckland, New Zealand 
c Green Lane Cardiovascular Services, Auckland City Hospital, Auckland, New Zealand 

Corresponding author at: Green Lane Paediatric and Congenital Cardiac Services, Starship Children’s Hospital, Private Bag 92024, Auckland 1142, New Zealand. Tel.: +64 9 3074949; Fax: +64 9 6310785;Green Lane Paediatric and Congenital Cardiac ServicesStarship Children’s HospitalPrivate Bag 92024Auckland1142New Zealand

Abstract

Background

Normative values for heart-rate corrected repolarisation length are not available in children and are scarce in adults. We wished to define repeatability and normative values of Holter recording measurements of repolarisation length in healthy individuals using a commercially available system, and compare measurements with those from 12-lead electrocardiograms (ECGs).

Methods

Twenty-four-hour (24-) Holter recordings were made on 99 Healthy volunteers: 52 children (7 months to 14 years) and 47 adults (≥15 yrs). Mean and peak values of QTc, and RTPc (R-wave to peak T-wave) were assessed. Bazett heart rate correction was employed for each measurement and only heart rates between 40 and 120 bpm were analysed. The end of the T-wave was defined from the zero-crossing point. QTc was also determined from 12-lead ECGs from the same population by manual measurement recording the longest QTc of leads 2 and V5. The tangent technique was used to define the end of the T-wave.

Results

Interobserver repeatability: mean QTc ±15 ms (CI 3.5%), peak QTc ±25 ms (CI 4.5%), mean RTPc ±3 ms (CI 1%), peak RTPc ±44 ms (CI 11%). Mean values were very similar for <15 years and all females and were therefore amalgamated: mean (±2 SD); mean QTc 424 ms (394–454), mean RTPc 291ms (263–319). Values were lower in males ≥15 years; (mean QTc 408 ms (370–446), p<0.01; mean RTPc 274 ms (234–314), p<0.01. The highest mean QTc value was 467 ms in an adult female. QTc from 12-lead ECG: females <15 years 409 ms (384–434) males <15 years 408 ms (383–433), females ≥15 years 426 ms (401–451), males ≥15 years 385 ms (362–408).

Conclusions

Holter measurements of mean QTc and RTPc are highly repeatable. Males ≥15 years have shorter mean repolarisation length over 24 hours than males <15 years and all females. Mean QTc Holter values were on average 15–17 ms longer than QTc from 12-lead ECGs except in females >15 years.

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Keywords : QT interval, Repolarisation, Holter monitor, Puberty, Gonadal hormones, Repeatability


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© 2019  Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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