Nahshoni Eitan, Spitzer Sara, Berant Michael, Shoval Gal, Zalsman Gil, Weizman Abraham
Geha Mental Health Center, Liaison Service, Rabin Medical Center, Petach Tikva, Israel.
J Child Adolesc Psychopharmacol. 2007 Apr;17(2):187-94. doi: 10.1089/cap.2007.0061.
QT dispersion (QTd) is a measure of interlead variations of the surface 12-lead electrocardiogram (ECG). Increased QTd, found in various cardiac diseases, reflects cardiac instability and risk for lethal cardiac arrhythmias. Research suggests a link between psychotropic treatment, ECG abnormalities (QT prolongation), and increased sudden cardiac mortality rates. Reports of sudden death in children treated with psychotropic drugs have raised concerns about cardiovascular monitoring and risk stratification. QTd analysis has not been investigated in very young children treated with antipsychotic drugs. In the present retrospective chart review study, we calculated QT interval, QTd, and their rate-corrected values in very young children treated with antipsychotics.
The charts of 12 children (ages 5.8 +/- 0.98 yr; 4 girls, 8 boys) were examined before initiation of antipsychotic treatment [risperidone (n = 7), clotinapine (n = 1), and propericiazine (n = 4)] and during the maintenance period after achieving a positive clinical response. Three children were concomitantly maintained on methylphenidate. QT interval, QTd, and their rate-corrected values were calculated.
QT interval, QTd, and their rate-corrected values were all within normal values both before and after successful drug treatment.
This preliminary, naturalistic, small-scale study suggests that antipsychotic treatment, with or without methylphenidate, in very young children is not commonly associated with significant alterations of QT interval and dispersion, suggesting the relative safety of these agents in this unique age group.
QT离散度（QTd）是体表12导联心电图（ECG）导联间变异的一种测量指标。在各种心脏疾病中发现的QTd增加反映了心脏不稳定以及发生致命性心律失常的风险。研究表明精神药物治疗、心电图异常（QT延长）与心脏性猝死率增加之间存在关联。使用精神药物治疗的儿童发生猝死的报告引发了对心血管监测和风险分层的关注。尚未对使用抗精神病药物治疗的幼儿进行QTd分析。在本项回顾性图表审查研究中，我们计算了使用抗精神病药物治疗的幼儿的QT间期、QTd及其心率校正值。
检查了12名儿童（年龄5.8±0.98岁；4名女孩，8名男孩）在开始抗精神病药物治疗前[利培酮（n = 7）、氯氮平（n = 1）和丙咪嗪（n = 4）]以及在取得阳性临床反应后的维持期的病历。3名儿童同时维持使用哌甲酯。计算QT间期、QTd及其心率校正值。
成功药物治疗前后，QT间期、QTd及其心率校正值均在正常范围内。
这项初步的、自然主义的小规模研究表明，在幼儿中使用抗精神病药物治疗，无论是否联合哌甲酯，通常都不会显著改变QT间期和离散度，提示这些药物在这个特殊年龄组中的相对安全性。
