Risk factors for aborted cardiac arrest and sudden cardiac death in children with the congenital long-QT syndrome.
BACKGROUND
The congenital long-QT syndrome (LQTS) is an important cause of sudden cardiac death in children without structural heart disease. However, specific risk factors for life-threatening cardiac events in children with this genetic disorder have not been identified.


RESULTS
Cox proportional-hazards regression modeling was used to identify risk factors for aborted cardiac arrest or sudden cardiac death in 3015 LQTS children from the International LQTS Registry who were followed up from 1 through 12 years of age. The cumulative probability of the combined end point was significantly higher in boys (5%) than in girls (1%; P<0.001). Risk factors for cardiac arrest or sudden cardiac death during childhood included corrected QT interval [QTc] duration > 500 ms (hazard ratio [HR]; 2.72; 95% confidence interval [CI], 1.50 to 4.92; P=0.001) and prior syncope (recent syncope [< 2 years]: HR, 6.16; 95% CI 3.41 to 11.15; P<0.001; remote syncope [> or = 2 years]: HR, 2.67; 95% CI, 1.22 to 5.85; P=0.01) in boys, whereas prior syncope was the only significant risk factor among girls (recent syncope: HR, 27.82; 95% CI, 9.72 to 79.60; P<0.001; remote syncope: HR, 12.04; 95% CI, 3.79 to 38.26; P<0.001). Beta-blocker therapy was associated with a significant 53% reduction in the risk of cardiac arrest or sudden cardiac death (P=0.01).


CONCLUSIONS
LQTS boys experience a significantly higher rate of fatal or near-fatal cardiac events than girls during childhood. A QTc duration > 500 ms and a history of prior syncope identify risk in boys, whereas prior syncope is the only significant risk factor among girls. Beta-blocker therapy is associated with a significant reduction in the risk of life-threatening cardiac events during childhood.
Goldenberg
Ilan
I
Cardiology Division of the Department of Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA. Ilan.Goldenberg@heart.rochester.edu
Moss
Arthur J
AJ
Peterson
Derick R
DR
McNitt
Scott
S
Zareba
Wojciech
W
Andrews
Mark L
ML
Robinson
Jennifer L
JL
Locati
Emanuela H
EH
Ackerman
Michael J
MJ
Benhorin
Jesaia
J
Kaufman
Elizabeth S
ES
Napolitano
Carlo
C
Priori
Silvia G
SG
Qi
Ming
M
Schwartz
Peter J
PJ
Towbin
Jeffrey A
JA
Vincent
G Michael
GM
Zhang
Li
L
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D004562:Electrocardiography; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008133:Long QT Syndrome / Q000151:congenital / Q000188:drug therapy / Q000235:genetics / Q000401:mortality*; D008297:Male; D010138:Pacemaker, Artificial; D010641:Phenotype; D012042:Registries; D012307:Risk Factors; D017678:Sex Distribution; D013575:Syncope / Q000453:epidemiology
D000319:Adrenergic beta-Antagonists