Osborn Wave Is Related to Ventricular Fibrillation and Tachycardia in Hypothermic Patients

Abstract

Background: The Osborn wave (OW) is often observed in hypothermic patients; however, whether OW in hypothermic patients is related to the development of fatal ventricular arrhythmia, including ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT), remains undetermined. This study aimed to estimate the association between OW and the incidence of fatal ventricular arrhythmias. Methods and Results: This retrospective study used the Japanese Accidental Hypothermia Network registry database and included 572 hypothermic patients. Patients were divided into the OW group (those with OW) and non-OW group (those without OW). The relationship between the development of fatal arrhythmias and presence of OW was assessed using the chi-squared test. All patients who developed VF/VT (n=10) had OW on electrocardiogram upon hospital arrival. The presence of OW had a sensitivity of 100%, specificity of 47.8%, positive predictive value of 4.0%, and negative predictive value of 100% for VF/VT development. The in-hospital mortality rate was 22.3% in the OW group and 21.2% in the non-OW group (P=0.781). Conclusions: OW was observed in all hypothermic patients with VF/VT. The occurrence of ventricular arrhythmias is highly unlikely in the absence of OW on the electrocardiogram. Although the presence of OW might be used to predict these fatal arrhythmias in hypothermic patients, there was no association between the presence of OW and in-hospital mortality.

Accidental Hypothermia-Induced J Wave Coupled With Giant R Wave Augmented by Premature Atrial Contraction: A Case Report

“…Hypothermia is an important trigger of ventricular tachyarrhythmias, particularly ERS but not BrS. Thus, in patients with J waves mainly due to delayed conduction, and even in patients without J waves, other factors such as QT interval on ECG and serum potassium level should be carefully monitored and corrected [ 6 , 7 ]. Isoproterenol, a β-adrenergic agonist capable of augmenting I Ca,L , reduces the amplitude of the J wave and prevents arrhythmogenesis associated with JWS by opposing the increased outward current forces [ 6 ].…”

“…Arrhythmias associated with JWS, hypothermia, and the acute phase of ST-segment elevation myocardial infarction are mechanistically linked to abnormalities in the manifestation of I to -mediated J waves [ 3 ]. On the other hand, ventricular tachyarrhythmias during hypothermia, which occur only in cases with J waves, do not increase mortality; however, once VF has occurred, it is often fatal [ 7 ]. The incidence of VF is unexpectedly low in hypothermic patients with J waves, varying from 0% to 2% [ 5 ].…”

Ventricular fibrillation/ventricular tachycardia within 72 h of VA‐ECMO: incidence, outcomes, risk factors, and management

“…Incidentally, previous studies have suggested that hypothermia can reduce cardiovascular stability, prolong the QT interval, and induce VF/VT. 17,18 Defibrillation plays a key role in the treatment of VF/VT, aiming to restore a 'normal' cardiac rhythm and provide car- 528 diac output to some extent, although there is no consensus on the need of defibrillation in patients on VA-ECMO. Defibrillation may any increase myocardial injury during VA-ECMO treatment.…”

“…(iii) In the present study, all ECPR patients were treated with mild hypothermia, with a body temperature between 33°C and 35°C, while RCS patients only needed fever control and generally maintained a body temperature < 37°C. Incidentally, previous studies have suggested that hypothermia can reduce cardiovascular stability, prolong the QT interval, and induce VF/VT 17,18 …”

“…Incidentally, previous studies have suggested that hypothermia can reduce cardiovascular stability, prolong the QT interval, and induce VF/VT. 17 , 18 …”