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QT dispersion after beta-blocker therapy (carvedilol or metoprolol) in children with heart failure

      Sudden death accounts for almost half of the high mortality in adult patients with heart failure and is assumed to be associated with ventricular arrhythmias. Beta-blocking agents result in improved ventricular function and reduce the risk of death in these patients
      • Packer M.
      • Bristow M.R.
      • Cohn J.N.
      • Colucci W.S.
      • Fowler M.B.
      • Gilbert E.M.
      • Shusterman N.H.
      The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. U.S. Carvedilol Heart Failure Study Group.
      ,
      • Bristow M.R.
      • Gilbert E.M.
      • Abrahma W.T.
      • Adams K.F.
      • Fowler M.B.
      • Hershberger R.E.
      • Kubo S.H.
      • Narahara K.A.
      • Ingersoll H.
      • Krueger S.
      • Young S.
      • Shusterman N.
      Carvedilol produces dose-related improvements in left ventricular function and survival in subjects with chronic heart failure. MOCHA Investigators.
      and decrease QT and QT dispersion in adults with heart failure. This may account for the decrease in mortality.
      • Bonnar C.E.
      • Davie A.P.
      • Caruana L.
      • Fenn L.
      • Ogston S.A.
      • McMurray J.J.
      • Struthers A.D.
      QT dispersion in patients with chronic heart failure beta blockers are associated with a reduction in QT dispersion.
      QT dispersion has been proposed as a measure of ventricular recovery and may provide indirect evidence of the inhomogeneity of ventricular repolarization. Studies have demonstrated a correlation between inhomogeneous myocardial repolarization and ventricular arrhythmias.
      • Vassallo J.A.
      • Cassidy D.M.
      • Kindwall K.E.
      • Marchlinski F.E.
      • Josephson M.E.
      Nonuniform recovery of excitability in the left ventricle.
      Thus, QT dispersion has been proposed as a means to identify patients with heart failure at risk of sudden death.
      • Fu G.S.
      • Meissner A.
      • Simon R.
      Repolarization dispersion and sudden cardiac death in patients with impaired left ventricular function.
      QT dispersion is increased in adults with chronic heart failure compared with controls,
      • Bonnar C.E.
      • Davie A.P.
      • Caruana L.
      • Fenn L.
      • Ogston S.A.
      • McMurray J.J.
      • Struthers A.D.
      QT dispersion in patients with chronic heart failure beta blockers are associated with a reduction in QT dispersion.
      and is reduced with β-blocking agents. A similar decrease has not been explored in pediatric patients with heart failure. This study examines QT dispersion in pediatric patients with heart failure and the effect of β-blocker therapy.
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