Beyond the obvious in childhood obesity: exploring cardiac electrophysiological balance index and subclinical risk

BACKGROUND: Childhood obesity is associated with adverse cardiovascular outcomes, including increased risk of arrhythmias and subclinical myocardial dysfunction. However, its impact on cardiac electrophysiological balance remains underexplored. The index of cardiac electrophysiological balance, calculated as QT/QRS ratio and corrected form of index of cardiac electrophysiological balance, emerged as novel electrocardiographic markers of ventricular arrhythmia risk. Although these parameters have been investigated in adult populations, data in obese children are lacking. This study aimed to evaluate the effects of obesity on index of cardiac electrophysiological balance and corrected form of index of cardiac electrophysiological balance in children and explore their associations with metabolic and anthropometric measures. METHODS: This retrospective cross-sectional study included 50 obese, 23 healthy children aged 10-18 years. Demographic, metabolic, electrocardiographic, and echocardiographic data were retrieved from hospital records. Index of cardiac electrophysiological balance, corrected form of index of cardiac electrophysiological balance, and repolarisation indices (QTc dispersion, Tp-e dispersion, and P-wave dispersion) were manually measured from 12-lead electrocardiograms. Associations with metabolic and anthropometric parameters were analysed using linear regression. RESULTS: < 0.001). QTc, Tp-e, and P-wave dispersions were also increased, indicating greater electrical heterogeneity. Index of cardiac electrophysiological balance showed negative correlations with LDL and total cholesterol levels. Tp-e duration and Tp-e/QTc ratio were inversely associated with hip circumference z-scores, possibly reflecting protective effects of gluteofemoral fat distribution. CONCLUSION: Childhood obesity may disrupt cardiac electrophysiological balance and repolarisation, even in the absence of overt cardiovascular disease. Index of cardiac electrophysiological balance and corrected form of index of cardiac electrophysiological balance could serve as early markers of arrhythmia risk. Prospective studies are needed to validate their prognostic significance.