Remodeling of the 12-lead electrocardiogram in immediate survivors of sudden cardiac arrest.
Electrocardiogram
Prognosis
Resuscitation
Sudden cardiac arrest
Survival
Journal
Resuscitation
ISSN: 1873-1570
Titre abrégé: Resuscitation
Pays: Ireland
ID NLM: 0332173
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
09
04
2020
revised:
27
05
2020
accepted:
04
06
2020
pubmed:
24
6
2020
medline:
22
6
2021
entrez:
24
6
2020
Statut:
ppublish
Résumé
The ECG is a critical diagnostic tool for the management of immediate sudden cardiac arrest (SCA) survivors, but can be altered as a consequence of the SCA event. A limited number of studies report that electrical remodeling post SCA is due to prolonged myocardial repolarization, but a better understanding of this phenomenon is needed. To identify specific ECG abnormalities that follow SCA in immediate survivors. SCA survivors with a pre-arrest ECG and an ECG obtained within 48 h post-SCA were prospectively collected in the Oregon Sudden Unexpected Death Study (Portland metro region) from 2002-2015. Ventricular depolarization and repolarization measurements were compared between pre-arrest and post-arrest ECGs using paired t-tests and assessed for association with survival using unpaired t-tests and Pearson's chi-square tests. A pre-arrest ECG and post-arrest ECG were available for 297 SCA cases (67.8 ± 13.4 years; 65.3% male). From the pre- to post-arrest setting, there was a significant mean increase in QRS (21 ms, p < 0.001) and QTc (35 ms, p < 0.001) in each SCA case, while there was no significant change in the JTc (4 ms, p = 0.361). Post-arrest QRS duration was significantly shorter in cases who survived to hospital discharge compared with those who did not survive (mean QRSD 115 ± 29 ms vs 127 ± 34 ms; p = 0.006). Contrary to expectations, electrical remodeling of the ECG due to SCA occurs due to prolongation of ventricular depolarization (QRSD), and not repolarization (JTc). Prolonged QRSD may also assist with prognostication and warrants further evaluation.
Sections du résumé
BACKGROUND
The ECG is a critical diagnostic tool for the management of immediate sudden cardiac arrest (SCA) survivors, but can be altered as a consequence of the SCA event. A limited number of studies report that electrical remodeling post SCA is due to prolonged myocardial repolarization, but a better understanding of this phenomenon is needed.
AIM
To identify specific ECG abnormalities that follow SCA in immediate survivors.
METHODS
SCA survivors with a pre-arrest ECG and an ECG obtained within 48 h post-SCA were prospectively collected in the Oregon Sudden Unexpected Death Study (Portland metro region) from 2002-2015. Ventricular depolarization and repolarization measurements were compared between pre-arrest and post-arrest ECGs using paired t-tests and assessed for association with survival using unpaired t-tests and Pearson's chi-square tests.
RESULTS
A pre-arrest ECG and post-arrest ECG were available for 297 SCA cases (67.8 ± 13.4 years; 65.3% male). From the pre- to post-arrest setting, there was a significant mean increase in QRS (21 ms, p < 0.001) and QTc (35 ms, p < 0.001) in each SCA case, while there was no significant change in the JTc (4 ms, p = 0.361). Post-arrest QRS duration was significantly shorter in cases who survived to hospital discharge compared with those who did not survive (mean QRSD 115 ± 29 ms vs 127 ± 34 ms; p = 0.006).
CONCLUSIONS
Contrary to expectations, electrical remodeling of the ECG due to SCA occurs due to prolongation of ventricular depolarization (QRSD), and not repolarization (JTc). Prolonged QRSD may also assist with prognostication and warrants further evaluation.
Identifiants
pubmed: 32574652
pii: S0300-9572(20)30253-7
doi: 10.1016/j.resuscitation.2020.06.017
pmc: PMC7405431
mid: NIHMS1605837
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
169-175Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL126938
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL145675
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL147358
Pays : United States
Informations de copyright
Copyright © 2020 Elsevier B.V. All rights reserved.
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