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(Circulation. 2008;117:2184-2191.)
© 2008 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Risk Factors for Aborted Cardiac Arrest and Sudden Cardiac Death in Children With the Congenital Long-QT Syndrome

Ilan Goldenberg, MD; Arthur J. Moss, MD; Derick R. Peterson, PhD; Scott McNitt, MS; Wojciech Zareba, MD, PhD; Mark L. Andrews, BBA; Jennifer L. Robinson, MS; Emanuela H. Locati, MD; Michael J. Ackerman, MD, PhD; Jesaia Benhorin, MD; Elizabeth S. Kaufman, MD; Carlo Napolitano, MD; Silvia G. Priori, MD, PhD; Ming Qi, MD; Peter J. Schwartz, MD; Jeffrey A. Towbin, MD; G. Michael Vincent, MD; Li Zhang, MD

From the Cardiology Division of the Department of Medicine (I.G., A.J.M., S.M., W.Z., M.L.A., J.L.R.), Biostatistics and Computational Biology (D.R.P.), and Pathology (M.Q.), University of Rochester Medical Center, Rochester, NY; Cardiovascular Department De Gasperis (E.H.L.), Niguarda Hospital, Milan, Italy; Departments of Medicine, Pediatrics, and Molecular Pharmacology (M.J.A.), Mayo Clinic College of Medicine, Rochester, Minn; Bikur Cholim Hospital (J.B.), University of Jerusalem, Jerusalem, Israel; Heart and Vascular Research Center (E.S.K.), MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio; Molecular Cardiology (C.N., S.G.P.), Fondazione S. Maugeri–University of Pavia, Pavia, Italy; Department of Cardiology (P.J.S.), Fondazione Policlinico S. Matteo IRCCS and University of Pavia, Pavia, Italy; Department of Pediatric Cardiology (J.A.T.), Baylor College of Medicine, Houston, Tex; and Department of Medicine (M.V., L.Z.), University of Utah School of Medicine, Salt Lake City.

Correspondence to Ilan Goldenberg, MD, Heart Research Follow-Up Program, Box 653, University of Rochester Medical Center, Rochester, NY 14642. E-mail Ilan.Goldenberg{at}heart.rochester.edu

Received March 6, 2007; accepted December 24, 2007.

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.

Methods and 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 [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). β-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. β-Blocker therapy is associated with a significant reduction in the risk of life-threatening cardiac events during childhood.

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