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Repolarization and ventricular arrhythmia during targeted temperature management post cardiac arrest

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BACKGROUND: Targeted temperature management (TTM) following out-of-hospital cardiac arrest (OHCA) prolongs the QT-interval but our knowledge of different temperatures and risk of arrhythmia is incomplete.

OBJECTIVE: To assess whether the QTc, QT-peak (QTp) and T-peak to T-end interval (TpTe) may be useful markers of ventricular arrhythmia in contemporary post cardiac arrest treatment.

METHODS: An ECG-substudy of the TTM-trial (TTM at 33 °C vs. 36 °C) with serial ECGs from 680 (94%) patients. Bazett's (B) and Fridericia's (F) formula were used for heart rate correction of the QT, QTp and TpTe. Ventricular arrhythmia (VT/VF) were registered during the first three days of post cardiac arrest care.

RESULTS: The QT, QTc and QTp intervals were prolonged more at 33 °C compared to 36 °C and restored to similar and lower levels after rewarming. The TpTe-interval remained between 92-100 ms throughout TTM in both groups. The QTc intervals were associated with ventricular arrhythmia, but not after adjustment for cardiac arrest characteristics. The QTp-interval was not associated with risk of ventricular arrhythmia. Heart rate corrected TpTe-intervals were associated with higher risk of arrhythmia (Odds ratio (OR): TpTe(B): 1.12 (1.02-1.23, p = 0.01 TpTe(F): 1.12 (1.02-1.23, p = 0.02) per 20 ms). Further a prolonged TpTe-interval ≥ 90 ms was consistently associated with higher risk (ORadjusted: TpTe(B): 2.05 (1.25-3.37), p < 0.01, TpTe(F): 2.14 (1.32-3.49), p < 0.01).

CONCLUSIONS: TTM prolongs the QT-interval by prolongation of the QTp-interval without association to increased risk. The TpTe-interval is not significantly affected by core temperature, but heart rate corrected TpTe intervals are robustly associated with risk of ventricular arrhythmia.

TRIAL REGISTRATION: The TTM-trial is registered and accessible at ClinicalTrials.gov (Identifier: NCT01020916).

OriginalsprogEngelsk
TidsskriftResuscitation
Vol/bind166
Sider (fra-til)74-82
Antal sider9
ISSN0300-9572
DOI
StatusUdgivet - sep. 2021

Bibliografisk note

Funding Information:
The Danish Heart Foundation (Grant no: 13-04-R94-A4460-22756 and 14-R97-A5142-22831 ) has supported this study with 18 months of salary in JHT́s Ph.D. project. The TTM-trial was funded by independent research grants from non-profit or governmental agencies: Swedish Heart Lung Foundation ; Arbetsmarknadens försäkringsaktiebolag (AFA)-insurance Foundation; The Swedish Research Council ; Regional research support, Region Skåne; Governmental funding of clinical research within the Swedish NHS (National Health Services); Thelma Zoega Foundation ; Krapperup Foundation ; Thure Carlsson Foundation ; Hans-Gabriel and Alice Trolle-Wachtmeister Foundation for Medical Research; Skåne University Hospital, Sweden; TrygFonden, Denmark, and the European Clinical Research Infrastructures Network.

Funding Information:
The Danish Heart Foundation (Grant no: 13-04-R94-A4460-22756 and 14-R97-A5142-22831) has supported this study with 18 months of salary in JHT?s Ph.D. project. The TTM-trial was funded by independent research grants from non-profit or governmental agencies: Swedish Heart Lung Foundation; Arbetsmarknadens f?rs?kringsaktiebolag (AFA)-insurance Foundation; The Swedish Research Council; Regional research support, Region Sk?ne; Governmental funding of clinical research within the Swedish NHS (National Health Services); Thelma Zoega Foundation; Krapperup Foundation; Thure Carlsson Foundation; Hans-Gabriel and Alice Trolle-Wachtmeister Foundation for Medical Research; Sk?ne University Hospital, Sweden; TrygFonden, Denmark, and the European Clinical Research Infrastructures Network.

Publisher Copyright:
© 2021 Elsevier B.V.

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

ID: 67650858