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Disease-associated QT-shortage versus quinine associated QT-prolongation: age dependent ECG-effects in Ghanaian children with severe malaria

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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4067506/
https://www.ncbi.nlm.nih.gov/pubmed/24902591
http://dx.doi.org/10.1186/1475-2875-13-219
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author 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
author_facet 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
author_sort Roggelin, Louise
collection PubMed
description 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.
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spelling pubmed-40675062014-06-25 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 Malar J Research 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. BioMed Central 2014-06-05 /pmc/articles/PMC4067506/ /pubmed/24902591 http://dx.doi.org/10.1186/1475-2875-13-219 Text en Copyright © 2014 Roggelin et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
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
Disease-associated QT-shortage versus quinine associated QT-prolongation: age dependent ECG-effects in Ghanaian children with severe malaria
title Disease-associated QT-shortage versus quinine associated QT-prolongation: age dependent ECG-effects in Ghanaian children with severe malaria
title_full Disease-associated QT-shortage versus quinine associated QT-prolongation: age dependent ECG-effects in Ghanaian children with severe malaria
title_fullStr Disease-associated QT-shortage versus quinine associated QT-prolongation: age dependent ECG-effects in Ghanaian children with severe malaria
title_full_unstemmed Disease-associated QT-shortage versus quinine associated QT-prolongation: age dependent ECG-effects in Ghanaian children with severe malaria
title_short Disease-associated QT-shortage versus quinine associated QT-prolongation: age dependent ECG-effects in Ghanaian children with severe malaria
title_sort disease-associated qt-shortage versus quinine associated qt-prolongation: age dependent ecg-effects in ghanaian children with severe malaria
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4067506/
https://www.ncbi.nlm.nih.gov/pubmed/24902591
http://dx.doi.org/10.1186/1475-2875-13-219
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