Electrocardiographic Changes Caused by Severe Accidental Hypothermia

Darocha, Tomasz; Sobczyk, Dorota; Kosiński, Sylweriusz; Jarosz, Anna; Gałązkowski, Robert; Nycz, Krzysztof; Drwiła, Rafał

doi:10.1053/j.jvca.2015.07.019

Cited by 15 publications

(24 citation statements)

References 15 publications

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“…Risk for VF is dependent of severity of hypothermia and pose a big challenge during rewarming. Of 19 accidental hypothermia patients admitted, with core temperatures between 17 °C -29 °C, seven were in VF, while two presented with asystole [20]. In a Japanese study of 60 patients, no patients with a core temperature above 26 °C developed VF [21].…”

Section: Discussionmentioning

confidence: 97%

Resistance to ventricular fibrillation predicted by the QRS/QTc - ratio in an intact rat model of hypothermia/rewarming

Dietrichs¹,

Kondratiev²,

McGlynn

et al. 2020

Preprint

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Background Accidental hypothermia is associated with increased risk for arrhythmias, including ventricular fibrillation and cardiac arrest. Recently QRS/QTc was proposed as an ECG-marker, where decreasing QRS/QTc ratio could predict ventricular arrhythmias in such patients. If reliable it should also predict nonappearance of arrhythmias, observed in species like rat that regularly tolerate prolonged hypothermia, during sustained sinus rhythm. Methods A rat model designed for studying cardiovascular function during cooling, 4 h experimental hypothermia (15 °C core temperature) and subsequent rewarming was used, and ECG recorded throughout the experimental protocol. Results No ventricular arrhythmias occured and there was no sign of a hypothermia-induced reduction of QRS/QTc values during moderate hypothermia. The ratio steadily increased throughout the entire cooling period and remained above normothermic baseline until rewarmed. Conclusion Different from the high incidence of hypothermia-induced ventricular arrhythmias in accidental hypothermia patients, where QRS/QTc ratio is decreased in moderate hypothermia, hypothermia and rewarming of rats is not associated with increased risk for ventricular fibrillation. This resistance to lethal hypothermia-induced arrhythmias was predicted by the QRS/QTc ratio.

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Section: Discussionmentioning

confidence: 97%

Resistance to ventricular fibrillation predicted by the QRS/QTc - ratio in an intact rat model of hypothermia/rewarming

Dietrichs¹,

Kondratiev²,

McGlynn

et al. 2020

Preprint

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“…The typical ECG patterns in therapeutic hypothermia are sinus bradycardia, atrial fibrillation, prolongation of PR and QTc intervals, prolongation of QRS complex, presence of Osborn waves, atrial fibrillation, and ventricular fibrillation (6,7). These ECG changes are dependent on the core body temperature.…”

Section: Discussionmentioning

confidence: 99%

“…This leads to a decreased conduction velocity, which can cause bradycardia, heart block, and prolongation of QT interval (11). Hypothermia reduces the diastolic depolarisation rate of the sinoatrial node P cells while also decreases resting potential, as well as prolongs the action potential and refractory period (slowing repolarisation) (6,13).…”

Section: Discussionmentioning

confidence: 99%

“…Therapeutic hypothermia is strongly recommended to prevent brain damage after cardiac arrest (2). Furthermore, it causes specific electrocardiographic (ECG) changes including sinus bradycardia and prolongation of the PR interval, QRS complex, and QTc interval (6,7). In several studies, a reduction in body temperature has been associated with Osborn waves (1,6,7).…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, it causes specific electrocardiographic (ECG) changes including sinus bradycardia and prolongation of the PR interval, QRS complex, and QTc interval (6,7). In several studies, a reduction in body temperature has been associated with Osborn waves (1,6,7). The aim of this study was to evaluate ECG changes during therapeutic hypothermia and their impact on the outcome.…”

Section: Introductionmentioning

confidence: 99%

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Electrocardiographic changes during therapeutic hypothermia: observational data from a single centre

Jančauskaitė

Samalavičius

Glaveckaitė

et al. 2020

AML

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Background. Therapeutic hypothermia is recommended to reduce the risk of hypoxic brain damage and improve short-term survival after cardiac arrest. It also temporarily affects the cardiac conduction system. The aim of this study was to evaluate electrocardiographic changes during therapeutic hypothermia and their impact on the outcome. Materials and methods. This retrospective analysis involved 26 patients who underwent therapeutic hypothermia after cardiac arrest in Vilnius University Hospital Santaros Klinikos from 2011 to 2015. Results. During cooling, a significant reduction in the heart rate (p = 0.013), shortening of QRS complex duration (p = 0.041), and prolongation of the QTc interval (p < 0.001) were observed. During the cooling period, five patients had subtle Osborn waves, which disappeared after rewarming. The association between electrocardiographic changes during cooling and unfavourable neurological outcome or in-hospital mortality was non-significant. Conclusions. Therapeutic hypothermia after cardiac arrest causes reversible electrocardiographic changes that do not increase the risk of in-hospital mortality or unfavourable neurological outcomes.

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Hypothermieinduzierte EKG-Veränderungen: charakteristisch, aber nicht spezifisch

Michels

Ney

Hoffmann

et al. 2017

Med Klin Intensivmed Notfmed

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Hypothermia-induced J‑ or so-called Osborn waves can be detected under therapeutic hypothermia in approximately 20-40% of cases. The occurrence of J‑waves in the context of the targeted temperature management after cardiopulmonary resuscitation is characteristic, but not pathognomonic for hypothermia. An electrocardiographic diagnosis under hypothermia after cardiac arrest should always be done with caution due to the various hypothermia-associated electromechanical changes of the myocardium.

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Electrocardiographic Changes Caused by Severe Accidental Hypothermia

Cited by 15 publications

References 15 publications

Resistance to ventricular fibrillation predicted by the QRS/QTc - ratio in an intact rat model of hypothermia/rewarming

Resistance to ventricular fibrillation predicted by the QRS/QTc - ratio in an intact rat model of hypothermia/rewarming

Electrocardiographic changes during therapeutic hypothermia: observational data from a single centre

Hypothermieinduzierte EKG-Veränderungen: charakteristisch, aber nicht spezifisch

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