Suppression of Electrographic Seizures Is Associated with Amelioration of QTc Interval Prolongation in Patients with Traumatic Brain Injury

Abstract

Introduction: Disorders in electroencephalography (EEG) are commonly noted in patients with traumatic brain injury (TBI) and may be associated with electrocardiographic disturbances. Electrographic seizures (ESz) are the most common features in these patients. This study aimed to explore the relationship between ESz and possible changes in QTc interval and spatial QRS-T angle both during ESz and after ESz resolution. Methods: Adult patients with TBI were studied. Surface 12-lead ECGs were recorded using a Cardiax device during ESz events and 15 min after their effective suppression using barbiturate infusion. The ESz events were diagnosed using Masimo Root or bispectral index (BIS) devices. Results: Of the 348 patients considered for possible inclusion, ESz were noted in 72, with ECG being recorded in 21. Prolonged QTc was noted during ESz but significantly ameliorated after ESz suppression (540.19 ± 60.68 ms vs. 478.67 ± 38.52 ms, p < 0.001). The spatial QRS-T angle was comparable during ESz and after treatment. Regional cerebral oximetry increased following ESz suppression (from 58.4% ± 6.2 to 60.5% ± 4.2 (p < 0.01) and from 58.2% ± 7.2 to 60.8% ± 4.8 (p < 0.05) in the left and right hemispheres, respectively). Conclusion: QTc interval prolongation occurs during ESz events in TBI patients but both it and regional cerebral oximetry are improved after suppression of seizures.

Pitfalls and possibilities of using Root SedLine for continuous assessment of EEG waveform-based metrics in intensive care research

“…The Root SedLine device has been used in various research fields to assess epileptiform discharges (You et al 2017, Dabrowski et al 2021, to assess changes linked to nociception (Bublitz et al 2023), to predict the quality of recovery after anesthesia (Bae et al 2023), to predict delirium after surgery (Xu et al 2021), to monitor the depth of sedation (Eagleman et al 2021) and sensitivity to general anesthesia (Sun and Holcman 2022), and to associate changes in electrocardiographic markers with electrographic seizures (Dabrowski et al 2021). Data from the Root SedLine device can either be exported retrospectively after closing the recording session in the form of a European data file (EDF (Kemp et al 1992)), or continuously streamed by using a serial null modem USB-to-USB cable connected to data acquisition/real time analysis software, such as ICM+® (Cambridge Enterprise Ltd©, University of Cambridge).…”