• ThomsenJakob HartvigJHDepartment of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark. Electronic address: jakob@jht.dk., Christian Hassager, David Erlinge, Niklas Nielsen, Matias Greve Lindholm, John Bro-Jeppesen, Johannes Grand, Steen Pehrson, Claus Graff, Lars V Køber, and Jesper Kjaergaard.
• Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark. Electronic address: jakob@jht.dk.
• Resuscitation. 2021 Sep 1; 166: 74-82.

BackgroundTargeted 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.ObjectiveTo 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.MethodsAn 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.ResultsThe 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).ConclusionsTTM 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 RegistrationThe TTM-trial is registered and accessible at ClinicalTrials.gov (Identifier: NCT01020916).Copyright © 2021 Elsevier B.V. All rights reserved.

22 keywords...

hide…