• Elizabeth P Held, Kyndaron Reinier, Audrey Uy-Evanado, Kotoka Nakamura, Harpriya S Chugh, Jonathan Jui, and Sumeet S Chugh.
• Center for Cardiac Arrest Prevention, Cedars-Sinai Smidt Heart Institute, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd., Los Angeles, CA 90048, US.
• Resuscitation. 2020 Aug 1; 153: 169-175.

BackgroundThe ECG is a critical diagnostic tool for the management of immediate sudden cardiac arrest (SCA) survivors, but can be altered as a consequence of the SCA event. A limited number of studies report that electrical remodeling post SCA is due to prolonged myocardial repolarization, but a better understanding of this phenomenon is needed.AimTo identify specific ECG abnormalities that follow SCA in immediate survivors.MethodsSCA survivors with a pre-arrest ECG and an ECG obtained within 48 h post-SCA were prospectively collected in the Oregon Sudden Unexpected Death Study (Portland metro region) from 2002-2015. Ventricular depolarization and repolarization measurements were compared between pre-arrest and post-arrest ECGs using paired t-tests and assessed for association with survival using unpaired t-tests and Pearson's chi-square tests.ResultsA pre-arrest ECG and post-arrest ECG were available for 297 SCA cases (67.8 ± 13.4 years; 65.3% male). From the pre- to post-arrest setting, there was a significant mean increase in QRS (21 ms, p < 0.001) and QTc (35 ms, p < 0.001) in each SCA case, while there was no significant change in the JTc (4 ms, p = 0.361). Post-arrest QRS duration was significantly shorter in cases who survived to hospital discharge compared with those who did not survive (mean QRSD 115 ± 29 ms vs 127 ± 34 ms; p = 0.006).ConclusionsContrary to expectations, electrical remodeling of the ECG due to SCA occurs due to prolongation of ventricular depolarization (QRSD), and not repolarization (JTc). Prolonged QRSD may also assist with prognostication and warrants further evaluation.Copyright © 2020 Elsevier B.V. All rights reserved.

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