title: Disease-associated QT-shortage versus quinine associated QT-prolongation: age dependent ECG-effects in Ghanaian children with severe malaria.
abstract: BACKGROUND
  While several anti-malarials are known to affect the electric conduction system of the heart, less is known on the direct effects of Plasmodium falciparum infection. Some earlier studies point to a direct impact of Plasmodium falciparum infection on the electric conduction system of the heart. The aim of this study was to analyse infection- and drug-induced effects on the electric conduction system.
  
  
  METHODS
  Children aged 12 months to 108 months with severe malaria were included in Kumasi, Ghana. In addition to basic demographic, clinical, biochemical and parasitological, biochemical data were measured data upon hospitalization (day 0) and 12-lead electrocardiograms were recorded before (day 0) and after (day 1) initiation of quinine therapy as well as after 42 (±3) days.
  
  
  RESULTS
  A total of 180 children were included. Most children were tachycardic on day 0 but heart rate declined on day 1 and during follow up. The corrected QT intervals were longest on day 1 and shortest on day 0. Comparison of QT intervals with day 42 (healthy status) after stratification for age demonstrated that in the youngest (<24 months) this was mainly due to a QT shortage on day 0 while a QT prolongation on day 1 was most pronounced in the oldest (≥48 months). Nearly one third of the participating children had measurable 4-aminoquinoline levels upon admission, but no direct effect on the corrected QT intervals could be shown.
  
  
  CONCLUSIONS
  Severe P. falciparum infection itself can provoke changes in the electrophysiology of the heart, independent of anti-malarial therapy. Especially in young - thus non immune - children the effect of acute disease associated pre-treatment QT-shortage is more pronounced than quinine associated QT-prolongation after therapy. Nevertheless, neither malaria nor anti-malarial induced effects on the electrophysiology of the heart were associated with clinically relevant arrhythmias in the present study population.
authors.forename: Louise
authors.initials: L
authors.lastname: Roggelin
authors.forename: Daniel
authors.initials: D
authors.lastname: Pelletier
authors.forename: Josephine N
authors.initials: JN
authors.lastname: Hill
authors.forename: Torsten
authors.initials: T
authors.lastname: Feldt
authors.forename: Steffi
authors.initials: S
authors.lastname: Hoffmann
authors.forename: Daniel
authors.initials: D
authors.lastname: Ansong
authors.forename: Justice
authors.initials: J
authors.lastname: Sylverken
authors.forename: Jürgen
authors.initials: J
authors.lastname: Burhenne
authors.forename: Johanna
authors.initials: J
authors.lastname: Fischer-Herr
authors.forename: Parisa
authors.initials: P
authors.lastname: Mehrfar
authors.forename: Christian
authors.initials: C
authors.lastname: Thiel
authors.forename: Gerd D
authors.initials: GD
authors.lastname: Burchard
authors.forename: Samuel B
authors.initials: SB
authors.lastname: Nguah
authors.affiliation: Section Tropical Medicine, Department of Internal Medicine, University Center Hamburg-Eppendorf, Hamburg, Germany. cramer@bni-hamburg.de.
authors.forename: Jakob P
authors.initials: JP
authors.lastname: Cramer
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000503:physiopathology; D053840:Brugada Syndrome; D000075224:Cardiac Conduction System Disease; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D005260:Female; D005869:Ghana; D006329:Heart Conduction System / Q000002:abnormalities* / Q000187:drug effects* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D011803:Quinine / Q000627:therapeutic use*
chemical_list: D000962:Antimalarials; D011803:Quinine