The pattern of Tpeak–Tend and QT interval, and J wave during therapeutic hypothermia

Kim, Sunmi; Hwang, Gyo‐Seung; Park, Jin-Sun; Shin, Jin-Ho; Kim, Gi-Woon; Yang, Hyoung‐Mo; Choi, So–Yeon; Yoon, Myeong‐Ho; Shin, Joon-Han; Tahk, Seung‐Jea

doi:10.1016/j.jelectrocard.2013.05.139

Cited by 20 publications

(24 citation statements)

References 30 publications

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“…Prolongation of QT intervals during hypothermia is a consistent finding throughout the literature. However, as prolonged QT intervals do not predict ventricular tachyarrhythmias, measuring the TpTe interval was proposed as a marker for repolarization dispersion associated with an increased incidence of ventricular tachyarrhythmias . In the present study, neither changes in TpTe intervals nor spontaneous ventricular tachyarrhythmias were observed.…”

Section: Discussioncontrasting

confidence: 62%

“…TpTe interval was manually measured from leads V4 to V6. The peak of the t‐wave was defined as the point with the highest amplitude of the T‐wave deflection, while the end was defined as the point of intersection of the descending limb's tangent and the isoelectric line . QTc was calculated using the Hodges formula (QTc = QT + 1.75 (HR‐60)) …”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Mild hypothermia (33°C) increases the inducibility of atrial fibrillation: An in vivo large animal model study

Manninger

Alogna

Zweiker

et al. 2018

Pacing Clinical Electrophis

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Section: Discussioncontrasting

confidence: 62%

Section: Methodsmentioning

confidence: 99%

Mild hypothermia (33°C) increases the inducibility of atrial fibrillation: An in vivo large animal model study

Manninger

Alogna

Zweiker

et al. 2018

Pacing Clinical Electrophis

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“…Hypothermia can lead to a prolongation of ventricular repolarization, which subsequently can cause ventricular arrhythmias [6, 8]. …”

Section: Discussionmentioning

confidence: 99%

Hypothermia induced alteration of repolarization - impact on acute and long-term outcome: a prospective cohort study

Ulmenstein

Storm

Breuer

et al. 2017

Scand J Trauma Resusc Emerg Med

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BackgroundThe effects of target temperature management (TTM) on the heart aren’t thoroughly studied yet. Several studies showed the prolongation of various ECG parameters including Tpeak-Tend-time under TTM. Our study’s goal is to evaluate the acute and long-term outcome of these prolongations.MethodsIn this study we included patients with successful resuscitation after cardiac arrest who were admitted to the Charité Virchow Klinikum Berlin or the Heart and Vascular Centre of the Ruhr University Bochum between February 2006 and July 2013 (Berlin) or May 2014 to November 2015 (Bochum). For analysis, one ECG during TTM was recorded after reaching the target temperature (33–34 °C) or in the first 6 h of TTM. If possible, another ECG was taken after TTM. The patients were being followed until February 2016.Primary endpoint was ventricular arrhythmia during TTM, secondary endpoints were death and hospitalization due to cardiovascular diseases during follow-up.ResultsOne hundred fifty-eight patients were successfully resuscitated in the study period of which 95 patients had usable data (e.g. ECGs without artifacts). During TTM significant changes for different parameters of ventricular de- and repolarization were noted: QRS (103.2 ± 23.7 vs. 95.3 ± 18.1; p = 0.003),QT (405.8 ± 76.4 vs. 373.8 ± 75.0; p = 0.01), QTc (474.9 ± 59.7 vs. 431.0 ± 56.8; p < 0.001), JT (302.8 ± 69.4 vs. 278.5 ± 75.2; p = 0.043), JTc (354.3 ± 60.2 vs. 318.7 ± 59.1; p = 0.001). 13.7% of the patients had ventricular arrhythmias during TTM, however these patients showed no difference regarding their ECG parameters in comparison to those were no ventricular arrhythmias occurred. We were able to follow 69 Patients over an average period of 35 ± 31 months. The 14 (21.5%) patients who died during the follow-up had significant prolongations of the TpTe-time in the ECGs without TTM (103.9 ± 47.2 vs. 75.8 ± 28.6; p = 0.023).ConclusionOur results show a significant prolongation of ventricular repolarization during TH. However, there was no significant difference between the ECG parameters of those who developed a ventricular arrhythmia and those who did not. The temporary prolongation of the repolarization during TTM seems to be less important for the prognosis of the patient. Whereas the prolongation of the repolarization in the basal ECG is associated with a higher mortality in our study.

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“…In recent paper by Kim et al, J waves developed in 35% of patients with therapeutic hypothermia . All J waves developed on the inferior leads II, III, aVF, and in 10% additionally in lead I, aVL, V 5 , and V 6 .…”

Section: Why Not “Early Repolarization”?mentioning

confidence: 90%

Some Controversies about Early Repolarization: The Haïssaguerre Syndrome

Kukla¹,

Jastrzębski²,

Pérez‐Riera

2015

Noninvasive Electrocardiol

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Controversy has followed the groundbreaking and cornerstone paper of Haïssaguerre et al. Much of this controversy has been due to the use of the term "early repolarization pattern" and possible waveform morphologies on the standard 12-lead ECG ( it is 10 second strip) that could predict who will manifest the malignant arrhythmogenic syndrome described by Haïssaguerre et al. The standard ECG definition of early repolarization pattern (ERP) or early repolarization variant (ERV) since then has changed its clinical meaning for a surface electrocardiographic waveform from benign to malignant. The new definition of ERP/ERV contains only J wave but ST-segment elevation is no more obligatory. In the old definition, early repolarization pattern (ERP) or early repolarization variant (ERV) 3 is a well-recognized idiopathic electrocardiographic phenomenon considered to be present when at least two adjacent precordial leads show elevation of the ST segment, with values equal or higher than 1 mm. In the new electrocardiographic ERP concept, the ST segment may or may not be elevated and can be up-sloping, horizontal or down-sloping while in the old ERP/ERV concept it must be elevated at least 1 mm in at least two adjacent leads and the variant is characterized by a diffuse elevation of the ST segment of upper concavity, ending in a positive T wave of V2 to V4 or V5 and prominent J wave and ST-segment elevation predominantly in left precordial leads. The phenomenon constitutes a normal variant; it is almost a rule in athletes (present in 89% of the cases in this universe).

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The pattern of Tpeak–Tend and QT interval, and J wave during therapeutic hypothermia

Cited by 20 publications

References 30 publications

Mild hypothermia (33°C) increases the inducibility of atrial fibrillation: An in vivo large animal model study

Mild hypothermia (33°C) increases the inducibility of atrial fibrillation: An in vivo large animal model study

Hypothermia induced alteration of repolarization - impact on acute and long-term outcome: a prospective cohort study

Some Controversies about Early Repolarization: The Haïssaguerre Syndrome

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