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      An evaluation of ECG leads used to assess QT prolongation.

      Radiology
      Adolescent, Adult, Aged, Aged, 80 and over, Electrocardiography, Female, Heart Rate, drug effects, Humans, Japan, epidemiology, Long QT Syndrome, chemically induced, physiopathology, Male, Middle Aged, Observer Variation, Prevalence, Psychotropic Drugs, adverse effects, Reproducibility of Results, Sensitivity and Specificity

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          Abstract

          The aim of the present study is to elucidate the optimal lead to be selected for the evaluation of drug-induced QT prolongation. We assessed the validity of each electrocardiography (ECG) lead for the evaluation of QT intervals in 688 patients receiving psychotropic drugs. Abnormal QTc prolongation was observed in 96 (14%) patients using the longest ECG lead. Prevalence of QTc prolongation was larger when using leads I, III, aVR, aVL, aVF, V1, and V6 (> 18%), and smaller when using lead V2 (10%). In the remaining 4 ECG leads, the overall accuracy to predict QTc prolongation was higher when using lead V3 (94%) compared with lead II (89%) or lead V5 (90%). Sensitivity to predict QTc prolongation was higher when using lead V4 (81%) compared with lead II (66%) or lead V2 (63%). When a single lead was used for the evaluation of QT prolongation, the results were not always similar to those using the lead which demonstrated the longest QT interval, and if only one lead is to be chosen, lead V3 or V4 should be selected. Copyright 2006 S. Karger AG, Basel.

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          Most cited references11

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          Prolongation of the QT interval and the sudden infant death syndrome.

          The sudden infant death syndrome (SIDS) is multifactorial in origin, but its causes remain unknown. We previously proposed that prolongation of the QT interval on the electrocardiogram, possibly resulting from a developmental abnormality in cardiac sympathetic innervation, may increase the risk of life-threatening ventricular arrhythmias and contribute to this devastating disorder. We prospectively tested this hypothesis. Between 1976 and 1994, we recorded electrocardiograms on the third or fourth day of life in 34,442 newborns and followed them prospectively for one year. The QT interval was analyzed with and without correction for the heart rate. One-year follow-up data were available for 33,034 of the infants. There were 34 deaths, of which 24 were due to SIDS. The infants who died of SIDS had a longer corrected QT interval (QTc) than did the survivors (mean [+/-SD], 435+/-45 vs. 400+/-20 msec, P<0.01) and the infants who died from causes other than SIDS (393+/-24 msec, P<0.05). Moreover, 12 of the 24 SIDS victims but none of the other infants had a prolonged QTc (defined as a QTc greater than 440 msec). When the absolute QT interval was determined for similar cardiac-cycle lengths, it was found that 12 of the 24 infants who died of SIDS had a QT value exceeding the 97.5th percentile for the study group as a whole. The odds ratio for SIDS in infants with a prolonged QTc was 41.3 (95 percent confidence interval, 17.3 to 98.4). Prolongation of the QT interval in the first week of life is strongly associated with SIDS. Neonatal electrocardiographic screening may permit the early identification of a substantial percentage of infants at risk for SIDS, and the institution of preventive measures may therefore be possible.
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            The prognostic value of the QT interval and QT interval dispersion in all-cause and cardiac mortality and morbidity in a population of Danish citizens.

            To evaluate the prognostic value of the QT interval and QT interval dispersion in total and in cardiovascular mortality, as well as in cardiac morbidity, in a general population. The QT interval was measured in all leads from a standard 12-lead ECG in a random sample of 1658 women and 1797 men aged 30-60 years. QT interval dispersion was calculated from the maximal difference between QT intervals in any two leads. All cause mortality over 13 years, and cardiovascular mortality as well as cardiac morbidity over 11 years, were the main outcome parameters. Subjects with a prolonged QT interval (430 ms or more) or prolonged QT interval dispersion (80 ms or more) were at higher risk of cardiovascular death and cardiac morbidity than subjects whose QT interval was less than 360 ms, or whose QT interval dispersion was less than 30 ms. Cardiovascular death relative risk ratios, adjusted for age, gender, myocardial infarct, angina pectoris, diabetes mellitus, arterial hypertension, smoking habits, serum cholesterol level, and heart rate were 2.9 for the QT interval (95% confidence interval 1.1-7.8) and 4.4 for QT interval dispersion (95% confidence interval 1.0-19-1). Fatal and non-fatal cardiac morbidity relative risk ratios were similar, at 2.7 (95% confidence interval 1.4-5.5) for the QT interval and 2.2 (95% confidence interval 1.1-4.0) for QT interval dispersion. Prolongation of the QT interval and QT interval dispersion independently affected the prognosis of cardiovascular mortality and cardiac fatal and non-fatal morbidity in a general population over 11 years.
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              QTc-interval abnormalities and psychotropic drug therapy in psychiatric patients

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