Department of Nephrology and Medical Intensive Care Medicine, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Resuscitation. 2011 Jul;82(7):859-62. doi: 10.1016/j.resuscitation.2011.02.043. Epub 2011 Mar 15.
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 48 h.
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.
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 (440.00 ms; IQR 424.25-476.75; n=17) but during hypothermia treatment the QTc interval was significantly prolonged at 33°C after 24h of cooling (564.47 ms; IQR 512.41-590.00; p=0.0001; n=34) and decreased after end of hypothermia to baseline levels (476.74 ms; 448.71-494.97; p=0.15).
The QTc interval was found to be significantly prolonged during MTH treatment, and some severe prolongations >670 ms 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.
目前的指南明确建议对心脏骤停（CA）后存活者进行轻度低温治疗（32-34°C）。到目前为止，除了病例系列之外，还没有评估冷却程序对 QT 间期的影响。在一项前瞻性研究中，34 名连续的心脏骤停后存活者在最初的 48 小时内通过动态心电图（Holter ECG）持续监测。
共分析了 34 例患者，并根据当前指南进行了轻度治疗性低温治疗（MTH），而与初始节律无关。在入院时和在院外 OHCA 的情况下，所有患者均进行 12 导联心电图检查。
在冷却过程中，室性心动过速的发生率较低（8.8%），并且在没有患者发生尖端扭转型室性心动过速（TdP）。在现场与 EMS 首次接触时，患者的 QTc 间期在正常范围内（440.00 ms；IQR 424.25-476.75；n=17），但在低温治疗过程中，在冷却 24 小时后 33°C 时 QTc 间期显著延长（564.47 ms；IQR 512.41-590.00；p=0.0001；n=34），并且在低温治疗结束后降至基线水平（476.74 ms；448.71-494.97；p=0.15）。
在 MTH 治疗期间发现 QTc 间期显著延长，观察到一些严重的延长>670 ms，并且没有发生危及生命的心律失常的发生率更高，特别是没有检测到尖端扭转型室性心动过速。然而，常规和频繁地记录心电图以评估 QTc 间期应成为任何低温标准操作程序的一部分，并应得到官方指南的推荐。
