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Severe QTc prolongation under mild hypothermia treatment and incidence of arrhythmias after cardiac arrest-A prospective study in 34 survivors with continuous Holter ECG.
MedLine Citation:
PMID:  21482009     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Mild hypothermia treatment (32-34°C) in survivors after cardiac arrest (CA) is clearly recommended by the current guidelines. The effects of cooling procedure towards QT interval have not been evaluated so far outside of case series. In a prospective study 34 consecutive survivors after cardiac arrest were continuously monitored with Holter ECG over the first 48h. PATIENTS AND METHODS: A total of 34 patients were analysed and received mild therapeutic hypothermia treatment (MTH) according to the current guidelines and irrespective of the initial rhythm. At admission to hospital and in the field in case of OHCA, a 12-lead ECG was performed in all patients. RESULTS: During cooling the incidence of ventricular tachycardia was low (8.8%) and in none of the patients Torsade de pointes occurred. The QTc interval was within normal range at first patient contact with EMS in the field (440.00ms; IQR 424.25-476.75; n=17) but during hypothermia treatment the QTc interval was significantly prolonged at 33°C after 24h of cooling (564.47ms; IQR 512.41-590.00; p=0.0001; n=34) and decreased after end of hypothermia to baseline levels (476.74ms; 448.71-494.97; p=0.15). CONCLUSION: The QTc interval was found to be significantly prolonged during MTH treatment, and some severe prolongations >670ms were observed, without a higher incidence of life-threatening arrhythmias, especially no Torsade des pointes were detected. However, routine and frequent ECG recording with respect to the QTc interval should become part of any hypothermia standard operation protocol and should be recommended by official guidelines.
Authors:
Christian Storm; Dietrich Hasper; Jens Nee; Achim Joerres; Joerg C Schefold; Jan Kaufmann; Mattias Roser
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-3-15
Journal Detail:
Title:  Resuscitation     Volume:  -     ISSN:  1873-1570     ISO Abbreviation:  -     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-4-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0332173     Medline TA:  Resuscitation     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Affiliation:
Department of Nephrology and Medical Intensive Care Medicine, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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