Background The sudden infant death syndrome (SIDS) is multifactorialin origin, but its causes remain unknown. We previously proposedthat prolongation of the QT interval on the electrocardiogram,possibly resulting from a developmental abnormality in cardiacsympathetic innervation, may increase the risk of life-threateningventricular arrhythmias and contribute to this devastating disorder.We prospectively tested this hypothesis.
Methods Between 1976 and 1994, we recorded electrocardiogramson the third or fourth day of life in 34,442 newborns and followedthem prospectively for one year. The QT interval was analyzedwith and without correction for the heart rate.
Results One-year follow-up data were available for 33,034 ofthe infants. There were 34 deaths, of which 24 were due to SIDS.The infants who died of SIDS had a longer corrected QT interval(QTc) than did the survivors (mean [±SD], 435±45vs. 400±20 msec, P<0.01) and the infants who diedfrom causes other than SIDS (393±24 msec, P<0.05).Moreover, 12 of the 24 SIDS victims but none of the other infantshad a prolonged QTc (defined as a QTc greater than 440 msec).When the absolute QT interval was determined for similar cardiac-cyclelengths, it was found that 12 of the 24 infants who died ofSIDS had a QT value exceeding the 97.5th percentile for thestudy group as a whole. The odds ratio for SIDS in infants witha prolonged QTc was 41.3 (95 percent confidence interval, 17.3to 98.4).
Conclusions Prolongation of the QT interval in the first weekof life is strongly associated with SIDS. Neonatal electrocardiographicscreening may permit the early identification of a substantialpercentage of infants at risk for SIDS, and the institutionof preventive measures may therefore be possible.
Source Information
From the Department of Cardiology, Policlinico San Matteo Istituto di Ricovero e Cura a Carattene Scientifico and the University of Pavia, Pavia (P.J.S.); Centro di Fisiologia Clinica e Ipertensione, University of Milan and Ospedale Maggiore Istituto di Ricovero e Cura a Carattene Scientifico, Milan (M.S.-B., A.S., F.G.); the Cardiology Department A. De Gasperis, Ospedale Niguarda Ca' Granda, Milan (P.A.); the Pediatrics Institute, University of Ferrara, Ferrara (G.B.); Ospedale Galmarini, Tradate (R.G.); the Department of Pediatrics, University of Pavia, Pavia (E.D.M.); the Department of Experimental and Clinical Cardiology G. Salvatore–Catanzaro, University of Reggio Calabria, Catanzaro (F.P.); and Ospedale Regina Elena, Milan (D.R., P.S.) — all in Italy.
Address reprint requests to Dr. Schwartz at the Department of Cardiology, Policlinico San Matteo IRCCS, Piazzale Golgi, 2, Pavia 27100, Italy.
Prolongation of the QT Interval and the Sudden Infant Death Syndrome
Guntheroth W. G., Spiers P. S., Dancey D. R., Redelmeier D. A., Rosenthal E., Scholz T. D., Yoldi A., Sena F., Gutierrez L., Schwartz P. J., Stramba-Badiale M., Friedman R. A., Towbin J. A.
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N Engl J Med 1998;
339:1161-1163, Oct 15, 1998.
Correspondence
Prolongation of the QT Interval and SIDS
Beinder E., Grancay T., Hofbeck M., Skinner J., Phoon C. K., Schwartz P. J., Priori S. G., Stramba-Badiale M.
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N Engl J Med 2000;
343:1896-1897, Dec 21, 2000.
Correspondence
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