소아에서 항경련제가 심전도에 미치는 영향: QTc, PR, QRS, 및 TpTe 간격에 대한 단일기관 5군 비교 분석 = Electrocardiographic effects of antiseizure medications in children: A five-group comparative analysis of QTc, PR, QRS, and TpTe in a single-center cohort

다국어 초록 (Multilingual Abstract)

Background: Antiseizure medications (ASMs) are widely used in pediatric epilepsy; however, their effects on cardiac conduction and repolarization remain insufficiently characterized. Due to their developing myocardial and autonomic systems, children are particularly vulnerable to drug-induced electrophysiological changes. This study aimed to compare key electrocardiographic (ECG) parameters across commonly prescribed pediatric ASMs.
Methods: This retrospective observational study included 515 pediatric patients (1–19 years) treated at a tertiary hospital between 2013 and 2024. Patients were categorized into four ASM monotherapy groups (lamotrigine, oxcarbazepine, levetiracetam, sodium valproate) or a healthy control group. Standardized 12-lead ECGs were analyzed for QTcB, QTcF, PR interval, QRS duration, and Tpeak–Tend (TpTe) interval. Intergroup differences were assessed using one-way ANOVA with Tukey’s HSD post-hoc testing.
Results: QTcB and QTcF differed significantly across groups (QTcB: F = 4.592, p = 0.001; QTcF: F = 2.869, p = 0.023). Lamotrigine exhibited a significantly longer QTcB than controls (mean difference = +13.97 ms, p < 0.001). QTcF was significantly prolonged in the lamotrigine group compared with the oxcarbazepine and valproate groups, but not with controls. No significant group differences were observed for PR interval, QRS duration, or TpTe. Levetiracetam, oxcarbazepine, and valproate demonstrated neutral effects on ventricular depolarization and atrioventricular conduction.
Conclusion: Most antiseizure medications have a neutral cardiac electrophysiologic profile in pediatric patients. However, lamotrigine was associated with mild QTc prolongation. Although QTc values remained below high-risk thresholds, these findings highlight the importance of targeted ECG monitoring during early lamotrigine therapy in children. Prospective studies with serial ECGs and pharmacokinetic data are needed to clarify the clinical relevance and temporal dynamics of ASM-related repolarization changes in pediatric populations.

목차 (Table of Contents)

• BACKGROUND 1
• METHODS 8
• RESULTS 12
• DISCUSSION 15
• REFERENCES 20
• TABLES AND FIGURES 27
• 국문 초록 40