Problems with Bazett QTc correction in paediatric screening of
prolonged QTc interval

J 2020

Problems with Bazett QTc correction in paediatric screening of prolonged QTc interval

ANDRŠOVÁ, Irena, Katerina HNATKOVA, Kateřina HELÁNOVÁ, Martina ŠIŠÁKOVÁ, Tomáš NOVOTNÝ et. al.

Basic information

Original name

Problems with Bazett QTc correction in paediatric screening of prolonged QTc interval

Authors

ANDRŠOVÁ, Irena (203 Czech Republic, belonging to the institution), Katerina HNATKOVA (203 Czech Republic), Kateřina HELÁNOVÁ (203 Czech Republic, belonging to the institution), Martina ŠIŠÁKOVÁ (203 Czech Republic, belonging to the institution), Tomáš NOVOTNÝ (203 Czech Republic, belonging to the institution), Petr KALA (203 Czech Republic, belonging to the institution) and Marek MALÍK (203 Czech Republic, guarantor)

Edition

BMC Pediatrics, LONDON, BMC, 2020, 1471-2431

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30209 Paediatrics

Country of publisher

United Kingdom of Great Britain and Northern Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 2.125

RIV identification code

RIV/00216224:14110/20:00117690

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1186/s12887-020-02460-8

UT WoS

000599854700002

Keywords in English

Long QT screening; QTc prolongation in children; Bazett correction; Fridericia correction; Framingham correction

Abstract

V originále

BackgroundBazett formula is frequently used in paediatric screening for the long QT syndrome (LQTS) and proposals exist that using standing rather than supine electrocardiograms (ECG) improves the sensitivity of LQTS diagnosis. Nevertheless, compared to adults, children have higher heart rates (especially during postural provocations) and Bazett correction is also known to lead to artificially prolonged QTc values at increased heart rates. This study assessed the incidence of erroneously increased QTc values in normal children without QT abnormalities.MethodsContinuous 12-lead ECGs were recorded in 332 healthy children (166 girls) aged 10.72.6years while they performed postural manoeuvring consisting of episodes (in the following order) of supine, sitting, standing, supine, standing, sitting, and supine positions, each lasting 10min. Detailed analyses of QT/RR profiles confirmed the absence of prolonged individually corrected QTc interval in each child. Heart rate and QT intervals were measured in 10-s ECG segments and in each segment, QTc intervals were obtained using Bazett, Fridericia, and Framingham formulas. In each child, the heart rates and QTc values obtained during supine, sitting and standing positions were averaged. QTc durations by the three formulas were classified to <440ms, 440-460ms, 460-480ms, and>480ms.ResultsAt supine position, averaged heart rate was 77.5 +/- 10.5 beat per minute (bpm) and Bazett, Fridericia and Framingham QTc intervals were 425.3 +/- 15.8, 407.8 +/- 13.9, and 408.2 +/- 13.1ms, respectively. At sitting and standing, averaged heart rate increased to 90.9 +/- 10.1 and 100.9 +/- 10.5bpm, respectively. While Fridericia and Framingham formulas showed only minimal QTc changes, Bazett correction led to QTc increases to 435 +/- 15.1 and 444.9 +/- 15.9ms at sitting and standing, respectively. At sitting, Bazett correction identified 51, 4, and 0 children as having the QTc intervals 440-460, 460-480, and>480ms, respectively. At sitting, these numbers increased to 118, 11, and 1, while on standing these numbers were 151, 45, and 5, respectively. Irrespective of the postural position, Fridericia and Framingham formulas identified only a small number (<7) of children with QT interval between 440 and 460ms and no children with longer QTc.Conclusion During screening for LQTS in children, the use of Bazett formula leads to a high number of false positive cases especially if the heart rates are increased (e.g. by postural manoeuvring). The use of Fridericia formula can be recommended to replace the Bazett correction not only for adult but also for paediatric ECGs.

Citovat

ANDRŠOVÁ, Irena, Katerina HNATKOVA, Kateřina HELÁNOVÁ, Martina ŠIŠÁKOVÁ, Tomáš NOVOTNÝ, Petr KALA and Marek MALÍK. Problems with Bazett QTc correction in paediatric screening of prolonged QTc interval. BMC Pediatrics. LONDON: BMC, 2020, vol. 20, No 1, p. 1-10. ISSN 1471-2431. Available from: https://dx.doi.org/10.1186/s12887-020-02460-8.

@article{1725797,
   author = {Andršová, Irena and Hnatkova, Katerina and Helánová, Kateřina and Šišáková, Martina and Novotný, Tomáš and Kala, Petr and Malík, Marek},
   article_location = {LONDON},
   article_number = {1},
   doi = {http://dx.doi.org/10.1186/s12887-020-02460-8},
   keywords = {Long QT screening; QTc prolongation in children; Bazett correction; Fridericia correction; Framingham correction},
   language = {eng},
   issn = {1471-2431},
   journal = {BMC Pediatrics},
   title = {Problems with Bazett QTc correction in paediatric screening of prolonged QTc interval},
   url = {https://bmcpediatr.biomedcentral.com/track/pdf/10.1186/s12887-020-02460-8.pdf},
   volume = {20},
   year = {2020}
}

TY  - JOUR
ID  - 1725797
AU  - Andršová, Irena - Hnatkova, Katerina - Helánová, Kateřina - Šišáková, Martina - Novotný, Tomáš - Kala, Petr - Malík, Marek
PY  - 2020
TI  - Problems with Bazett QTc correction in paediatric screening of prolonged QTc interval
JF  - BMC Pediatrics
VL  - 20
IS  - 1
SP  - 1-10
EP  - 1-10
PB  - BMC
SN  - 14712431
KW  - Long QT screening
KW  - QTc prolongation in children
KW  - Bazett correction
KW  - Fridericia correction
KW  - Framingham correction
UR  - https://bmcpediatr.biomedcentral.com/track/pdf/10.1186/s12887-020-02460-8.pdf
L2  - https://bmcpediatr.biomedcentral.com/track/pdf/10.1186/s12887-020-02460-8.pdf
N2  - BackgroundBazett formula is frequently used in paediatric screening for the long QT syndrome (LQTS) and proposals exist that using standing rather than supine electrocardiograms (ECG) improves the sensitivity of LQTS diagnosis. Nevertheless, compared to adults, children have higher heart rates (especially during postural provocations) and Bazett correction is also known to lead to artificially prolonged QTc values at increased heart rates. This study assessed the incidence of erroneously increased QTc values in normal children without QT abnormalities.MethodsContinuous 12-lead ECGs were recorded in 332 healthy children (166 girls) aged 10.72.6years while they performed postural manoeuvring consisting of episodes (in the following order) of supine, sitting, standing, supine, standing, sitting, and supine positions, each lasting 10min. Detailed analyses of QT/RR profiles confirmed the absence of prolonged individually corrected QTc interval in each child. Heart rate and QT intervals were measured in 10-s ECG segments and in each segment, QTc intervals were obtained using Bazett, Fridericia, and Framingham formulas. In each child, the heart rates and QTc values obtained during supine, sitting and standing positions were averaged. QTc durations by the three formulas were classified to <440ms, 440-460ms, 460-480ms, and>480ms.ResultsAt supine position, averaged heart rate was 77.5 +/- 10.5 beat per minute (bpm) and Bazett, Fridericia and Framingham QTc intervals were 425.3 +/- 15.8, 407.8 +/- 13.9, and 408.2 +/- 13.1ms, respectively. At sitting and standing, averaged heart rate increased to 90.9 +/- 10.1 and 100.9 +/- 10.5bpm, respectively. While Fridericia and Framingham formulas showed only minimal QTc changes, Bazett correction led to QTc increases to 435 +/- 15.1 and 444.9 +/- 15.9ms at sitting and standing, respectively. At sitting, Bazett correction identified 51, 4, and 0 children as having the QTc intervals 440-460, 460-480, and>480ms, respectively. At sitting, these numbers increased to 118, 11, and 1, while on standing these numbers were 151, 45, and 5, respectively. Irrespective of the postural position, Fridericia and Framingham formulas identified only a small number (<7) of children with QT interval between 440 and 460ms and no children with longer QTc.Conclusion During screening for LQTS in children, the use of Bazett formula leads to a high number of false positive cases especially if the heart rates are increased (e.g. by postural manoeuvring). The use of Fridericia formula can be recommended to replace the Bazett correction not only for adult but also for paediatric ECGs.
ER  -

ANDRŠOVÁ, Irena, Katerina HNATKOVA, Kateřina HELÁNOVÁ, Martina ŠIŠÁKOVÁ, Tomáš NOVOTNÝ, Petr KALA and Marek MALÍK. Problems with Bazett QTc correction in paediatric screening of prolonged QTc interval. \textit{BMC Pediatrics}. LONDON: BMC, 2020, vol.~20, No~1, p.~1-10. ISSN~1471-2431. Available from: https://dx.doi.org/10.1186/s12887-020-02460-8.

Detailed Information on Publication Record