TY  - JOUR
T1  - Comparison of Corrected QT and Tp-e/QTc Interval in Intoxication with Drugs That Cause QT Prolongation in Children
TT  - Çocuklarda QT Uzaması Yapan İlaçlarla Zehirlenmelerde Düzeltilmiş QT ve Tp-e/QTc Süreleri Karşılaştırması
AU  - Sarı Gökay, Sinem
AU  - Tutun, Buğra
JF  - Güncel Pediatri
PB  - Galenos Yayınevi
WT  - DergiPark
SN  - 1304-9054
SP  - 92
EP  - 99
VL  - 19
IS  - 1
LA  - en
AB  - Introduction: Childhood intoxications are among the most common reasons for admission to the emergency department. The aim of this study is to evaluate whetherthere is a primary marker that can determine the risk of arrhythmia by comparison of QT, QTc, QT/QTc, Tp-e/QT, Tp-e/QTc intervals in drug intoxications withprolonging QTc which can be fatal by causing arrhythmia in children.Materials and Methods: In this study, 55 patients who were admitted to Pediatric Emergency Department of Training and Research Hospital between January 2018and August 2019 within the first 6 hours due to intoxication with QTc prolongation and followed up in our pediatric emergency department were retrospectivelyreviewed. In patients hospital records, age, sex, medication, time of application, clinical and physical examination findings, vital signs, treatments and results,laboratory findings, electrocardiogram findings at the time of admission hospital and in the 6. hour control, QT, QTc, Tp-e, Tp-e/QT and Tp-e/QTc times wererecorded.Results: The median age of the patients in study was 155±77.2 months. The number of female patients was 33 (60%) and the number of male patients was 22. Therewas a statistically significant difference between leukocyte count, hemoglobin,platelet,bun, creatinine, SGPT and calcium values at the time of admission andcontrol at the 6th hour. There was no statistically significant difference between CK-MB and troponin levels. Also, there was no statistically significant differencebetween QT, QTc, QT/QTc, Tp-e/QT and Tp-e/QTc intervals. But there was a statistically significant difference between Tp-e/QTc ratio and gender.Conclusions: Although QTc interval continues to be used to determine the risk of arrhythmia in children with drugs prolonging QTc, it may be significant tocompare Tp-e and Tp-e/QTc ratio. However, studies involving a larger number of patients are needed to determine whether Tp-e interval and Tp-e/QTc ratio are apriority marker.
KW  - Children
KW  - Tp-e/QTc ratio
KW  - intoxication
KW  - 
N2  - Giriş: Çocukluk çağı zehirlenmeleri sık görülen acile başvuru nedenleriarasındadır. Bu çalışmada amacımız aritmiye neden olarak ölümcül olabilecekQTc uzaması yapan ilaçlarla zehirlenmelerde QT, QTc, QT/QTc, Tp-e/QT, Tp-e/QTc oranlarını karşılaştırarak çocuklarda aritmi riskini belirleyebilecek önceliklibir belirteç olup olmadığını değerlendirmektir.Gereç ve Yöntem: Çalışmamızda Ocak 2018 ve Ağustos 2019 tarihleri arasındaEğitim ve Araştırma Hastanesi Çocuk Acil servisine QTc uzaması yapan ilaçlarlazehirlenme nedeniyle ilk 6 saat içerisinde başvuran ve çocuk acilimizde takipedilen 55 hastanın dosyası retrospektif olarak incelenmiştir. Hasta dosyalarındanyaş, cinsiyet, aldığı ilaç, müracaat süresi, klinik bulgu ve fizik muayene bulgusu,vital bulgular, yapılan tedavi ve sonuçları laboratuarbulguları ve başvuru anı ve kontrol bakılan 6. saat EKG (elektrokardiyogram) bulguları, QT, QTc, Tp-e, Tp-e/QT ve Tp-e/QTcsüreleri kaydedilmiştir.Bulgular: Çalışmaya alınan hastaların yaş ortancası 155±77,2 ay idi. Kız hasta sayısı 33(%60), erkek hasta sayısı 22 (%40) idi.Çalışmamızda hastaların başvuru anı ve 6. saatte bakılan lökosit sayısı, hemoglobin, platelet, bun, kreatinin, SGPT ve kalsiyumdeğerleri arasında istatistiksel olarak anlamlı farklılık saptandı (p0,05).EKG’lerinde QT, QTc, QT/QTc, Tp-e/QT ve Tp-e/QTc süreleri arasında istatistiksel olarak anlamlı farksaptanmadı (p>0,05). Tp-e/QTc süreleri ve cinsiyet arasında istatistiksel olarak anlamlı bir farklılık mevcuttu (p
CR  - 1. Mowry JB, Spyker DA, Brooks DE, McMillan N, Schauben JL. 2014 Annual Report of theAmericanAssociation of Poison Control Centers’ NationalPoison Data System (NPDS): 32nd Annual Report. ClinicalToxicol (Phila). 2015;53:962-1147.
CR  - 2. Akgül F, Er A, Çelik FÇ, Çağlar A et al. Retrospective Analysis of Childhood Poisoning. J Pediatr Emerg Intensive Care Med. 2016;3:91-6.
CR  - 3. Li EC, Esterly JS, Pohl S, Scott SD, McBride BF. Druginduced QT interval prolongation: considerations for clinicians. Pharmacotherapy. 2010;30(7):684-701.
CR  - 4. CredibleMeds QT drugs list website sponsored by Science Foundation of the University of Arizona.Available at http:// crediblemeds.org/.
CR  - 5. Zhao X, Xie Z, Chu Y et al. Association between Tp-e/QT ratio and prognosis in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Clin. Cardiol.2012; 35: 559-64.
CR  - 6. Smetana P, Schmidt A, Zabel M, Hnatkova K et al. Assessment of repolarization heterogeneity for prediction of mortality in cardiovascular disease: peak to the end of the T wave interval and nondipolar repolarization components. J. Electrocardiol.2011;44: 301-8.
CR  - 7. Antzelevitch C, Sicouri S, Di Diego JM et al.Does Tpeak-Tend provide an index of transmural dispersion of repolarization? Heart Rhythm.2007;4: 1114-16.
CR  - 8. Pater C. Methodological considerations in the design of trials for safety assessment of new drugs and chemical entities. Curr Control Trials Cardiovasc Med. 2005;6(1):1.
CR  - 9. Cavero I, Mestre M, Guillon JM, Crumb W. Drugs that prolong QT interval as an unwanted effect: assessing their likelihood of inducing hazardous cardiac dysrhythmias. Expert Opin Pharmacother. 2000;1(5):947-73.
CR  - 10. Yıldız SS, Sutaşır MN, Sığırcı S, Topçu H, Gürdal A, Keskin K, Kılıçkesmez KO. Acute effects of synthetic cannabinoids on ventricular repolarization parameters. Turk Kardiyol Dern Ars. 2019;47(5):384-90.
CR  - 11. Gupta P, Patel C, Patel H, Narayanaswamy S, Malhotra B, Green JT, et al. T(p-e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol.2008;41:567-74.
CR  - 12. Okayasu H, Ozeki Y, Fujii K, Takano Y, Shinozaki T, Ohrui M, Shimoda K. Investigation of the Proarrhythmic Effects of Antidepressants according to QT Interval, QT Dispersion and T Wave Peak-to-End Interval in the Clinical Setting. Psychiatry Investig. 2019;16(2):159-66.
CR  - 13. Sicouri S, Antzelevitch C. Sudden cardiac death secondary to antidepressant and antipsychotic drugs. Expert Opin Drug Saf.2008;7:181-94.
CR  - 14. Beach SR, Kostis WJ, Celano CM, Januzzi JL, Ruskin JN, Noseworthy PA, et al. Meta-analysis of selective serotonin reuptake inhibitor-associated QTc prolongation. J Clin Psychiatry. 2014;75:441-9.
CR  - 15. Feldman AE, Gidal BE. Qtc prolongation by antiepileptic drugs and the risk of torsade de pointes in patients with epilepsy. Epilepsy Behav. 2013;26(3):421-6.
CR  - 16. Kwon S, Lee S, Hyun M, Choe BH, Kim Y, Park W, Cho Y. The potential for QT prolongation by antiepileptic drugs in children. Pediatr Neurol. 2004;30(2):99-101.
CR  - 17. Lee JH, Park YH, Kim JT, Kim CS, Kim HS. The effect of sevoflurane and ondansetron on QT interval and transmural dispersion of repolarization in children Paediatr Anaesth. 2014;24(4):421-5.
CR  - 18. Kim HS, Kim JT, Kim CS, Kim SD, Kim K, Yum MKEffects of sevoflurane on QT parameters in children with congenital sensorineural hearing loss. Anaesthesia. 2009;64(1):3-8. doi: 10.1111/j.1365-2044.2008.05678.x.
CR  - 19. Mehta D, Sanatani S, Whyte SD. The effects of droperidol and ondansetron on dispersion of myocardial repolarization in children. Paediatr Anaesth. 2010;20(10):905-12.
CR  - 20. ICH E14 guideline:The clinical evaluation of QT/QTC interval prolongation and proarrhythmic potential for nonantiarrhythmic drugs. Questions and answers (R2). 2014 http://www.raps.org/regulatoryDetail.aspx?id= 6753.
CR  - 21. Benatar A, Feenstra A. QT correction methods in infants and children: effects of age and genderAnn Noninvasive Electrocardiol. 2015;20(2):119-25.
UR  - http://dergipark.org.tr/tr/pub/pediatri/issue//912119
L1  - http://dergipark.org.tr/tr/download/article-file/1693866
ER  -