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QTc Prolongation during Therapeutic Hypothermia: Does it deserve attention?

QTc Prolongation during Therapeutic Hypothermia: Does it deserve attention?. Umashankar Lakshmanadoss MD, Saadia Sherazi MD, Lohith Reddy MD, Carlos Palacio MD, Vijay Das MD, Abrar H Shah MD, Mehmet Aktas MD, James P Daubert MD. Background.

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QTc Prolongation during Therapeutic Hypothermia: Does it deserve attention?

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  1. QTc Prolongation during Therapeutic Hypothermia: Does it deserve attention? UmashankarLakshmanadoss MD, SaadiaSherazi MD, Lohith Reddy MD, Carlos Palacio MD, Vijay Das MD, Abrar H Shah MD, Mehmet Aktas MD, James P Daubert MD

  2. Background • Therapeutic hypothermia (TH) has become a standard of care for management of patients following sudden cardiac arrest (SCA). Hypothermia is associated with prolongation of QTc interval which could lead to further cardiac arrhythmia. We aimed to describe the effects of TH on QTc prolongation and arrhythmic events in patients undergoing TH following SCA.

  3. Methods • In this retrospective study we reviewed all patients who had undergone TH protocol following both out of hospital and in hospital SCA from June 2006 to December 2009. Baseline characteristics of these patients were collected. Serial 12 lead electrocardiograms were done, before and during TH and QTc were calculated manually, using Bazett’s formula. Data of the patients who had ventricular tachycardia (VT) during the hypothermia and warming phase was collected.

  4. Results • We identified 31 patients who underwent TH protocol. There was a significant prolongation of QTc from baseline (QTc1) of 473 msec to 532 msec during cooling phase (QTc2) (p=0.007). The QTc reverted back to the baseline once the body temperature reached more than 36ºC (p=0.98). The mean QTc2 of the patients who survived (13 patients) was 522 + 87 msecvs 541 + 76 msec among those who did not survive (p=0.5). 2 patients had Torsades de Pointes during the cooling phase, which terminated spontaneously. Two patients had monomorphic nonsustained VT: one during the cooling and the other during the warming phase. These arrhythmic events did not contribute to any death or refibrillation.

  5. Conclusions • Until there is more data inferring that QTc prolongation during TH leads to further ventricular arrhythmias, we must not halt the use of TH for neurologic benefits driven from using the protocol.

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