P波和QT间期离散度对先天性心脏病伴肺动脉高压患儿心律失常发生的预测价值

Objectives:

To evaluate P-wave dispersion (PWD) and QT dispersion (QTd) in children with congenital heart disease and pulmonary arterial hypertension (PAH-CHD) and to investigate the predictive value of both PWD and QTd for prediction of arrhythmias in such children.

Materials and methods:

We included 40 children with PAH-CHD as Group I. Forty other children with CHD and no PAH were included as Group II. Forty healthy children of matched age and sex served as a Control group. Electrocardiography was performed to determine PWD and QTd. Furthermore, 24-hour Holter monitoring was performed to detect the presence of arrhythmias. Echocardiographic evaluation was also performed.

Results:

QTd and PWD were significantly higher in Group I than in Group II and Control group. A significant positive correlation was present between both QTd and PWD and mean pulmonary artery pressure, right ventricular diameter, pulmonary vascular resistance (PVR), and PVR to systemic vascular resistance ratio. QTd showed 93% sensitivity, 80% specificity, and 85% accuracy for prediction of occurrence of arrhythmias in patients with PAH-CHD at a cutoff point of 61 ms, whereas PWD showed 87% sensitivity, 80% specificity, and 85% accuracy for prediction of arrhythmias at a cutoff point of 32.5 ms in such patients. Logistic regression analysis showed that both QTd and PWD were good predictors for the occurrence of arrhythmias in children with PAH-CHD (p = 0.003 and p = 0.01, respectively).

Conclusions:

PWD and QTd were good predictors for the occurrence of various arrhythmias in children with PAH-CHD.