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Arrhythmias and sudden death
Original article
ECG features and proarrhythmic potentials of therapeutic hypothermia
  1. Woo Seok Lee1,
  2. Gi-Byoung Nam1,
  3. Sung-Hwan Kim2,
  4. Jin Hee Choi1,
  5. Uk Jo1,
  6. Won Young Kim3,
  7. Yong-Seog Oh2,
  8. Kyu Nam Park4,
  9. Guang-Won Seo5,
  10. Ki-Hun Kim5,
  11. Eun-Sun Jin6,
  12. Kyoung-Suk Rhee7,
  13. Laeyoung Jung7,
  14. Ki-Won Hwang8,
  15. Yoo Ri Kim9,
  16. Chang Hee Kwon10,
  17. Jun Kim1,
  18. Kee-Joon Choi1,
  19. You-Ho Kim1
  1. 1Department of Internal Medicine, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  2. 2Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea
  3. 3Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  4. 4Department of Emergency Medicine, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea
  5. 5Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
  6. 6Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
  7. 7Division of Cardiology, Chonbuk National University Hospital, Chonbuk National University, Jeonju, Korea
  8. 8Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Busan, Korea
  9. 9Division of Cardiology, Department of Internal Medicine, College of Medicine, Incheon St Mary's Hospital, The Catholic University of Korea, Seoul, Korea
  10. 10Division of Cardiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
  1. Correspondence to Dr Gi-Byoung Nam, Department of Internal Medicine, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 88 Olimpic-ro 43 gil, Songpa-gu, Seoul 05505, Korea; gbnam{at}amc.seoul.kr Sung-Hwan Kim, Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea; sunghwan{at}catholic.ac.kr

Abstract

Objective Hypothermia can induce ECG J waves. Recent studies suggest that J waves may be associated with ventricular fibrillation (VF) in patients with structurally normal hearts. However, little is known about the ECG features, clinical significance or arrhythmogenic potentials of therapeutic hypothermia (TH)-induced J waves.

Methods We analysed ECGs from 240 patients who underwent TH at six major university hospitals in Korea between August 2010 and December 2013. The prevalence, amplitudes and distributions of the J waves and the development of malignant arrhythmia were analysed.

Results The average patient body temperature was 33.5±1.0°C during TH. J waves were observed in 98 patients (40.8%). They were newly developed in 91 cases, and pre-existing J waves were augmented in seven patients. J waves during TH were primarily observed in leads II, III, aVF and V4–6. The average amplitude of the J waves was 0.239±0.152 mV. There were four VF events during TH. These events occurred in three patients who were finally diagnosed with Brugada syndrome, idiopathic VF or early repolarisation syndrome, respectively, and in one patient with non-cardiac aetiology (asphyxia).

Conclusions J waves were recorded in about 40% of the patients who received TH. They were most frequently observed in the inferior limb leads or lateral precordial leads. Life-threatening VF occurred only rarely (1.7%) during TH and were mainly observed in patients with primary arrhythmic disorder. Although a causal relationship between TH-induced J waves and VF remains unknown, administering TH to this potentially susceptible, high-risk population may require careful attention.

https://doi.org/10.1136/heartjnl-2015-308821

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