Disease-associated QT-shortage versus quinine associated QT-Prolongation: age dependent ECG-effects in Ghanaian children with severe malaria
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Disease-associated QT-shortage versus quinine associated QT-Prolongation: age dependent ECG-effects in Ghanaian children with severe malaria. / Roggelin, Louise; Pelletier, Daniel; Hill, Josephine N; Feldt, Torsten; Hoffmann, Steffi; Ansong, Daniel; Sylverken, Justice; Burhenne, Jürgen; Fischer-Herr, Johanna; Mehrfar, Parisa; Thiel, Christian; Burchard, Gerd D; Nguah, Samuel B; Cramer, Jakob P.
in: MALARIA J, Jahrgang 13, 01.01.2014, S. 219.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Disease-associated QT-shortage versus quinine associated QT-Prolongation: age dependent ECG-effects in Ghanaian children with severe malaria
AU - Roggelin, Louise
AU - Pelletier, Daniel
AU - Hill, Josephine N
AU - Feldt, Torsten
AU - Hoffmann, Steffi
AU - Ansong, Daniel
AU - Sylverken, Justice
AU - Burhenne, Jürgen
AU - Fischer-Herr, Johanna
AU - Mehrfar, Parisa
AU - Thiel, Christian
AU - Burchard, Gerd D
AU - Nguah, Samuel B
AU - Cramer, Jakob P
PY - 2014/1/1
Y1 - 2014/1/1
N2 - 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.CONCLUSION: 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.
AB - 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.CONCLUSION: 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.
KW - Antimalarials
KW - Arrhythmias, Cardiac
KW - Child
KW - Child, Preschool
KW - Electrocardiography
KW - Female
KW - Ghana
KW - Heart Conduction System
KW - Humans
KW - Infant
KW - Malaria, Falciparum
KW - Male
KW - Quinine
U2 - 10.1186/1475-2875-13-219
DO - 10.1186/1475-2875-13-219
M3 - SCORING: Journal article
C2 - 24902591
VL - 13
SP - 219
JO - MALARIA J
JF - MALARIA J
SN - 1475-2875
ER -
