Analysis Of Electrocardiogram Before And After Chemotherapy In 98 Children With Acute Leukemia

Objectives:Retrospectively analyzed the 554 electrocardiograms(ECGs)results during different chemotherapy periods in 98 children with acute leukemia.Summarized the ECG change characteristics at each chemotherapy stage and explored the relationship between chemotherapy and ECG changes.Further analyzed the risk factors causing ECG changes to evaluate the value of ECG in detecting the chemotherapy-related cardiac injuries.Methods:Inclusion and exclusion criterion: Children who were hospitalized in the pediatric department of the first affiliated hospital of Nanchang University from February 1,2014 to February 1,2018;Diagnosed with acute leukemia;Onset age of 0-18 years;Without cardiac injury drugs use before chemotherapy treatment.Children who were diagnosed with congenital heart disease,genetic metabolic diseases and acquired heart disease were excluded.Analyzed ECG changes before,during and after chemotherapy treatment,and summarized the incidence of ECG changes during different chemotherapy periods.Compared statistically children's gender,onset age,disease type,chemotherapy treatment and risk degree stratification in normal and abnormal ECG groups.In addition,further explored the correlation between the above factors and ECG abnormalities.Results:554 ECGs derived from 98 children with primary acute leukemia were included in this study,there were 332 normal electrocardiogram and 222 abnormal ecg.ECG abnormal change was mainly sinus tachycardia before chemotherapy treatment,whereas that sinus arrhythmia,T wave and ST segment changes and U wave increased after chemotherapy treatment,especially in the consolidation phase.Abnormal Q waves and left ventricular hypertrophy were rare in this study andno atrioventricular block was seen.Electrocardiogram Abnormalities in Children with Acute Leukemia at different chemotherapy stages:there was a significant difference in the abnormal rate of ECG in children with acute leukemia at different chemotherapy stages(c 2=7.734,P <0.05).ECG abnormal rate in the period of consolidation and consolidation was significantly higher than that of induced remission,and the difference was statistically significant.as well as,ECG abnormal rate in the period of induced remission was significantly higher than the period of before chemotherapy(P <0.05),indicating that abnormal changes in ECG were related to dose and course of chemotherapy.Comparison of the ECG abnormal rate in 79 Children with Acute Lymphoblastic Leukemia(ALL)and 19 children with Acute Myelogenous leukemia(AML):(1)In each period,the abnormal rate of ECG in children with AML was higher than ALL,but the difference was not statistically significant(P >0.05);(2)The difference in the ECG abnormal rate of 79 children with ALL during different chemotherapy periods was statistically significant(c2=10.305,P < 0.05),with the increase of the abnormal rate of chemotherapy progression,the difference was statistically significant(P < 0.01);(3)The ECG abnormal rate of 19 children with AML at different stages in was different,but the difference was not statistically significant(c2=0.426,P >0.05).Comparison of ECG abnormal rate during different chemotherapy periods in eachsubtype acute leukemia:(1)ECG abnormal rate of B-ALL in consolidation period was significantly higher than that of T-ALL,and the difference was statistically significant;(2)ECG abnormal rate of B-ALLand T-ALL both increased with chemotherapy progress,during the all chemotherapy period in B-ALL,there was a statistically significant difference in ECG abnormal rate,whereas the were not in T-ALL;(3)ECG abnormal rate during different chemotherapy periods in different AML subtypes was different without significance(P >0.05).ECG abnormal rate in different subtypes during each chemotherapy period was different without significance too(P > 0.05).Univariate analysis of abnormal factors affecting ECG:ECG abnormalities were correlated with gender(P <0.05),onset age(P <0.05),chemotherapy(P <0.05)and risk degree stratification(P <0.05),and was not correlated with disease type(P >0.05).Conclusions:1 ECG abnormal rate(children with acute leukemia): consolidation phase >induced remission phase > phase before chemotherapy.2 Changes of ST segment,T-wave and ST-T segments indicate the presence of chemotherapy-related cardiac injury,which need more attention.3 It is necessary that analyzing reasons and monitoring dynamically must be done once sinus tachycardia happens in children with acute leukemia.4 Among children with acute leukemia,ECG abnormalities were correlated with gender,onset age,chemotherapy and risk degree stratification-female,high-risk types of leukemia,onset age of 0-3 years and 11-18 years were risk factors.5 The occurrence rate of sinus arrhythmia was increased after chemotherapy treatment in children with acute leukemia,which clinical significance remains to be further studied.