Department of Cardiology, Rambam Medical Center, Haifa, Israel; Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Israel.
Department of Cardiology, Rambam Medical Center, Haifa, Israel; Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Israel.
J Crit Care. 2018 Aug;46:151-156. doi: 10.1016/j.jcrc.2018.03.014.
We aimed to investigate the factors that modulate the extent of QTc prolongation and potential arrhythmogenic consequences during mild therapeutic hypothermia (MTH).
We studied 205 patients after out-of-hospital cardiac arrest (131 underwent MTH). QTc was measured at baseline, 3h, 6h, 12h, 24h (end of hypothermia), 48h and 72h, and ventricular arrhythmias quantified.
During MTH, the QTc interval increased progressively peaking at 12h (mean increase 42ms, 95% CI 30-55). There was a strong gender effect (P<0.001) and a significant gender-by-MTH interaction (P=0.004). At 12h, the QTc interval was markedly longer in women as compared with men (mean difference 50ms [95% CI 27-73]. Anoxic brain injury (P=0.002) was also positively associated with QTc prolongation. The risk for ventricular arrhythmic events was not higher with MTH compared with no hypothermia (incidence rate ratio 0.57, 95% CI 0.32-1.02, P=0.06). However, typical cases of Torsade de pointes occurred in association with AV block and LQT2.
QTc prolongation during MTH is strongly affected by female gender and moderately by concomitant anoxic brain injury. Although the overall risk for ventricular arrhythmias is not greater with MTH, Torsade de pointes may develop when other contributing factors coexist.
我们旨在研究调节轻度治疗性低温（MTH）期间 QTc 延长程度和潜在致心律失常后果的因素。
我们研究了 205 例院外心脏骤停后患者（131 例接受 MTH）。在基线、3 小时、6 小时、12 小时、24 小时（低温结束）、48 小时和 72 小时测量 QTc，并量化室性心律失常。
在 MTH 期间，QTc 间期逐渐延长，在 12 小时达到峰值（平均增加 42ms，95%CI 30-55）。存在强烈的性别效应（P<0.001）和显著的性别-MTH 相互作用（P=0.004）。在 12 小时时，女性的 QTc 间期明显长于男性（平均差异 50ms [95%CI 27-73]）。缺氧性脑损伤（P=0.002）也与 QTc 延长呈正相关。与无低温相比，MTH 发生室性心律失常事件的风险并没有更高（发生率比 0.57，95%CI 0.32-1.02，P=0.06）。然而，尖端扭转型室性心动过速的典型病例与 AV 阻滞和 LQT2 相关。
MTH 期间的 QTc 延长受女性性别和伴发缺氧性脑损伤的强烈影响。尽管 MTH 的总体室性心律失常风险没有增加，但当其他促成因素共存时，尖端扭转型室性心动过速可能会发生。
