ECG features and proarrhythmic potentials of therapeutic hypothermia

Abstract

J waves were recorded in about 40% of the patients who received TH. They were most frequently observed in the inferior limb leads or lateral precordial leads. Life-threatening VF occurred only rarely (1.7%) during TH and were mainly observed in patients with primary arrhythmic disorder. Although a causal relationship between TH-induced J waves and VF remains unknown, administering TH to this potentially susceptible, high-risk population may require careful attention.

Osborn waves following out-of-hospital cardiac arrest—Effect of level of temperature management and risk of arrhythmia and death

“…The incidence of ventricular arrhythmia in our study (6% VF, 13%VT) is seemingly higher than the one recently reported by Lee et al [12] with only 1.7% of patients with VF. However, we report the occurrence of arrhythmia the first three days after OHCA in a cohort including a majority of patients resuscitated from a shockable rhythm.…”

“…The relatively high overall OW incidence on admission (16%) may be attributable to a low admission temperature of around 35°C [13]. Recent smaller studies have shown a OW prevalence in OHCA-patients treated with TTM at 33°C ranging from 40-60% [12,27,28], likewise, OW were more prevalent in patients with STEMI vs. non-STEMI (38.6% vs. 15.2%) [29]. These findings correlate with our data showing that patients after OHCA presenting with OW have more invasive procedures performed (PCI 49% vs. 39%, p=0.01) possibly explained by higher degree of coronary ischemia.…”

“…arrest patients have suggested a possible relation between OW and an increased risk of ventricular arrhythmia [11], while a smaller observational study has failed to confirm this association [12].…”

Hypothermia and cardiac electrophysiology: a systematic review of clinical and experimental data

“…In accidental hypothermia patients (29.4°C-33.5°C) with J-waves, only one developed ventricular tachycardia (VT) (75) and J-waves does not predict survival chance (39). A multi-centre study from South Korea observed J-waves in 41% of therapeutic hypothermia patients, while VF only occurred in 1.7% (80), which concurs with other studies (81). J-waves are more common in hypothermic STEMI (38.6%) than non-STEMI (15.2%) patients (45).…”

“…In urban accidental hypothermia, underlying conditions and substance abuse can be as important predisposing factors for cardiac arrest as core temperature (61). In therapeutic hypothermia, ventricular ectopic activity is increased (97) and non-sustained VT can occur frequently (34), but sustained ventricular arrhythmias are uncommon in most (34,35,45,62,80) but not all studies. Mirzoyev found polymorphic VT in 11.7% of therapeutic hypothermia patients.…”