Electrical injury causing ventricular arrhythmias.

Abstract

SUMMARY Dangerous or long lasting ventricular arrhythmias developed in three patients who had sustained an electrical injury in which current passed through the thorax. In all three cases there was a delay of [8][9][10][11][12] hours between the injury and the onset of symptoms. The ventricular arrhythmias were severe and long lasting. In two of the three patients, ventricular tachycardia or ventricular fibrillation or both occurred and in one patient ventricular parasystole developed. No enzymatic evidence of myocardial necrosis was found but the results of an endomyocardial biopsy carried out in two of the three patients showed focal myocardial fibrosis and increased numbers of Na, K-pumps. The two patients with ventricular tachycardia became symptom free after appropriate antiarrhythmic treatment and in the third patient ventricular parasystole disappeared spontaneously within two years.Patients sustaining electrical injury in which current passes through the thorax should be monitored electrocardiographically for at least 24 hours, and patients with unexpected arrhythmias should be questioned about previous electrical injury.A lightning strike is a recognised cause of sudden death. When the mechanism of such death was investigated in 1775 it was found that an electrical shock applied to a head stunned hen whereas another shock to the sternum resuscitated it.' In 1850 it was shown in a dog that application of a current to the exposed heart was followed by very rapid and irregular movements of the ventricles-that is, probably ventricular fibrillation. We report three cases of non-fatal electrical-injury that were followed by delayed serious ventricular arrhythmias. Endomyocardial biopsy. specimens were taken from two of the patients. Microscopy showed myocardial fibrosis.The membrane bound enzyme, the Na, KATPase or Na, K-pump, performs the transport of sodium ions out of the cell and potassium ions into the cell and is essential for the specific properties of muscle and nerve tissue such as contractility and excitability. "

Atrial fibrillation following electric shock requiring cardioversion

“…7,8 The mechanism behind electrically induced cardiac arrest is not entirely clear but patchy areas of myocardial necrosis that serve as arrhythmogenic foci, as well as increased cardiac sodium-potassium pump activity is postulated. 9 AF which is among the rare complications of electrical injury has also been documented in some case reports. 10,11 Arrowsmith et al evaluated 145 patients who suffered electrical injury in a centre over a five year period; cardiac arrest was seen only in 3% (four patients).…”

“…The possible mechanism being patchy myocardial necrosis causing alteration in the sodium-potassium pump activity of cardiac myocytes. 9 …”

Atrial fibrillation associated with high voltage electric shock in a young healthy female: a case report

“…Various disturbances in the cardiac Na-K channels have also been described. 5 Cardiac arrhythmias can occur at the time of electrical shock or later, but mostly within first day after injury. Almost all patients with AF have severe electrical burns after high voltage injuries as described in the previous reports and similar was seen in our case too.…”

Again, new, Afresh: Electric Injuries In Children

“…Amerika'da yılda yaklaşık 17.000 olgunun elektrik çarpmasına bağlı acil servislere başvurduğu bildirilmiş olup elektrik çarpmalarına bağlı morbidite ve mortalite genellikle farklı elektriksel akım tiplerine ve temas yerlerine göre değiş-mektedir. 7,8,9 Yetişkinlerde çoğunlukla iş kazası olarak ortaya çıkan elektrik çarpmaları, çocuklarda ise daha çok bir tür ev kazasıdır.10 Bu çalışma, elektrik çarpmaları ile başvuran çocukların demografik özelliklerinin belirlenmesi, mortalite ve morbiditeyi azaltmaya yönelik alınabilecek önlemlerin tartışılması için planlandı. Elektrik çarpmalarının insan vücudu üzerindeki hasar yapıcı etkisi; şiddetine, akımın yoğunluğuna, seyir ettiği yola, temas süresine ve temas ettiği dokunun direncine bağlı olarak değiş-kenlik gösterir.…”