Key result
Low-dose ACTH treatment in infants with infantile spasms significantly increased the Tp-Te/QTc ratio from 0.168 to 0.247 (p<0.001), indicating an increased risk of arrhythmia.
Why the study?
ACTH is the most effective treatment for infantile spasms, but it was hypothesized that it might carry cardiac adverse effects.
Does ACTH treatment cause subclinical damage to the heart muscle and increase arrhythmia risk in patients with infantile spasms?
Observational (n=48)
Single-blind
No
Does ACTH treatment cause subclinical damage to the heart muscle and increase arrhythmia risk in patients with infantile spasms?
Low-dose, short-duration ACTH treatment for infantile spasms may cause subclinical myocardial damage and increase arrhythmia risk, suggesting a need for electrocardiographic and echocardiographic monitoring.
Answers are grounded in this paper and cite their sources.
May warrant ECG monitoring during ACTH for infantile spasms; leaves open true arrhythmia risk pending prospective confirmation.
Objective Infantile spasms (ISs) are a group of epileptic disorders, which represents the most frequent type of epilepsy in the first year of life. The most effective treatment for IS is adrenocorticotropic hormone (ACTH). We hypothesized that ACTH treatment might have cardiac adverse effects. This study aimed to evaluate the effects of ACTH treatment on the heart muscle and/or arrhythmia risk in patients with IS. Methods Twenty-four patients with IS and 24 healthy children (control group) participated in the study. Electroencephalography (EEG), electrocardiography (ECG), and transthoracic echocardiography were studied during treatment, and evaluations were made at 0-2-4 and 6th months of the treatment. Results None of the patients had significant tachycardia or bradycardia when compared with the healthy group, or during treatment. On the other hand, values of the PR, QRS, QT, tp/te, tpte/QT, and tpte/QTc values were significantly increased compared with either pretreatment values or each other, which indicated an increased arrhythmia risk in the patient group. In transthoracic echocardiographic examinations, we observed diminished diastolic dysfunctions, either with pulse wave or TDI Doppler. We found a significant difference between the groups in terms of longitudinal strain parameters. Conclusion Although we use low-dose and short-duration ACTH treatment in patients with IS, it may cause subclinical damage to the heart muscle and an increased risk of arrhythmia.
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Çevik et al. (2022) conducted an observational in Infantile spasms (n=48). ACTH vs. Pretreatment baseline and healthy controls was evaluated on Tp-Te/QTc ratio at 6 months compared to pretreatment (p=<0.001). Low-dose ACTH treatment in infants with infantile spasms significantly increased the Tp-Te/QTc ratio from 0.168 to 0.247 (p<0.001), indicating an increased risk of arrhythmia.
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