Evaluation of Ventricular Repolarization Parameters in Patients Admitted to Emergency Department with Electrical Injury

Objective: Prolonged T-peak to T-end (Tp-e), a ventricular repolarization parameter, has been related with ventricular arrhythmias (VAs). Novel electrocardiogram (ECG) parameters of ventricular repolarization have received considerable attention recently. In this study, we sought to investigate ventricular repolarization indexes such as the Tp-e and corrected Tp-e (Tp-ec) intervals, Tp-e/QT, Tp-e/QTc, and Tp-ec/QT ratios in patients with electrical injuries (EIs). Methods: Thirty-six patients diagnosed with EIs and 35 age- and sex-matched healthy control patients were included. Admission ECGs of the EI patients were compared with those of the healthy controls. QT and QTc intervals were measured, and the Tp-e and Tp-ec intervals, Tp-e/QT, Tp-ec/QT, and Tp-e/QTc ratios were then calculated from a 12-lead surface ECG. Results: The QT, Tp-e, Tp-e/QT, Tp-e/QTc, Tp-ec/QT were not significantly different between the control group and the EI group (p > 0.05). However, the mean QTc interval was significantly higher in the EI group compared to the control group (412.81 ± 25.46 vs 396.31 ± 26.47 ms; p:0.009). Furthermore, the Tp-ec and Tp-ec/QT of the EI subgroup with elevated troponin levels significantly differed from those of the EI patients with normal troponin levels (p:0.033 and p:0.016, respectively). Conclusions: This retrospective study indicated that patients with EIs tend to have a prolonged QTc interval. Additionally, Tp-ec and Tp-ec/QT, which reportedly designate the tendency for VAs, were significantly higher in the EI patients with elevated troponin I levels than the EI patients with normal troponin levels, suggesting that patients with myocardial injury may be prone to VAs.

Electrocardiogram, Electrical Injuries, Repolarization Parameters, QTc

[1] Smith MA, Muehlberger T, Dellon AL. Peripheral nerve compression as-sociated with low-voltage electrical injury without associated significant cutaneous burn. Plast Reconstr Surg. 2002;109:137-144.

[2] Clark AT, Wolf S. Electrical Injury. JAMA. 2017;318:1198.

[3] Rai J, Jeschke MG, Barrow RE, et al. Electrical injuries: a 30-year review. J Trauma. 1999;46:933–936.

[4] Karadaş S, Gönüllü H, Öncü MR, et al. The effects on complications and myopathy of different voltages in electrical injuries. Turk J Trauma Emerg Surg. 2011;17:349–353.

[5] Cowan JC, Hilton CJ, Griffiths CJ, et al. Sequence of epicardial repolarization and configuration of the T wave. Br Heart J. 1988;60:424–433.

[6] Opthof T, Coronel R, Wilms-Schopman FJ, et al. Dispersion of repolarization in canine ventricle and the electrocardiographic T wave: Tp-e interval does not reflect transmural dispersion. Heart Rhythm. 2007;4:341–348.

[7] Tanriverdi Z, Besli F, Gungoren F. The evaluation of Tp-e interval after transcatheter aortic valve implantation. J Electrocardiol. 2018;51:573. Yılmaz Coskun F, Elboga G, [6] [6] [8] Altunbas G, et al. Evaluation of ventricular repolarization features with Tp-e, Tp-e/QTc, JTc and JTd during electroconvulsive therapy. J Electrocardiol. 2018;51:440–442.

[9] Opthof T, Coronel R, Janse MJ. Is there a significant transmural gradient in repolarization time in the intact heart?: repolarization gradients in the intact heart. Circ Arrhythm Electrophysiol. 2009;2:89–96.

[10] Panikkath R, Reinier K, Uy-Evanado A, et al. Prolonged Tpeak-to-tend interval on the resting ECG is associated with increased risk of sudden cardiac death. Circ Arrhythm Electrophysiol. 2011;4:441–447.

[11] Rautaharju PM, Surawicz B, Gettes LS, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part IV: the ST segment, T and U waves, and the QT interval: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. JACC. 2009:53;982–991.

[12] Antzelevitch C, Sicouri S, Di Diego JM, et al. Does Tpeak-Tend provide an index of transmural dispersion of repolarization? Heart Rhythm. 2007;4:1114–1116.

[13] Tatlisu MA, Ozcan KS, Gungor B, et al. Can the T-peak to T-end interval be a predictor of mortality in patients with ST-elevation myocardial infarction? Coron Artery Dis. 2014;25:399–404.

[14] Porthan K, Viitasalo M, Toivonen L, et al. Predictive value of electrocardiographic T-wave morphology parameters and T-wave peak to

T- wave end interval for sudden cardiac death in the general population. Circ Arrhythm Electrophysiol. 2013;6:690–696.

[15] Rosenthal TM, Masvidal D, Abi Samra FM, et al. Optimal method of measuring the T-peak to T-end interval for risk stratification in primary prevention. Europace. 2018;20:698-705.

[16] Postema PG and Wilde AA. The Measurement of the QT Interval. Current Cardiology Reviews. 2014;10:287-294.

[17] Nursal TZ, Yildirim S, Tarim A, et al. Burns in southern Turkey: electrical burns remain a major problem. J Burn Care Rehabil. 2003;24:309–314.

[18] Fineschi V, Karch SB, D’Errico S, et al. Cardiacpathology in death from electrocution. Int J Legal Med. 2006;120:79–82.

[19] Searle J, Slagman A, Maaß W, et al. Cardiac monitoring in patients with electrical injuries. An analysis of 268 patients at the Charité Hospital. Dtsch Arztebl Int.

2013;110:847-853.

[20] Kors JA, Ritsema van Eck HJ, van Herpen G. The meaning of the Tp-Te interval and its diagnostic value. J Electrocardiol. 2008;41:575–580.

[21] Gupta P, Patel C, Patel H, et al. T(p-e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol. 2008;41:567–574.

[22] Castro Hevia J, Antzelevitch C, Tornes Barzaga F, et al. Tpeak-tend and Tpeak-to end dispersion as risk factors for ventricular tachycar-dia/ventricular fibrillation in patients with the Brugada syndrome. J Am Coll Cardiol. 2006;47:1828–1834.

[23] Zhao X, Xie Z, Chu Y, et al. Association between Tp-e/QT ratio and prognosis in patients undergoing primary percutaneous coronary inter-vention for ST-segment elevation myocardial infarction. Clin Cardiol. 2012;35:559–564.

[24] Hetland M, Haugaa KH, Sarvari SI, et al. A novel ECG- index for prediction of ventricular arrhythmias in patients after myocardial infarction. Ann Noninvasive Electrocardiol. 2014;19:330–337.

[25] Karaman K, Altunkaş F, Cetin M, et al. New markers for ventricular repolarization in coronary slow flow: Tp-e interval, Tp-e/QT ratio, and Tp-e/ QTc ratio. Ann Noninvasive Electrocardiol. 2014;20:338-344.

[26] Karataş MB, Onuk T, Güngör B, et al. Assessment of Electrocardio-graphic Parameters in Patients With Electrocution Injury. J electrocardiol. 2015;48:809-814.

[27] Jae Hyuk Choi, Donghoon Han, Si-Hyuck Kang, et al. Retrospective study of prognosis and relating factors of cardiac complications associated with electrical injuries at a single centre in Korea. BMJ. 2019;9:e028741.

[28] Pawlik AM, Lampart A, Stephan FP, et al. Outcomes of electrical injuries in the emergency department: a 10-year retrospective study. Eur J Emerg Med. 2016;23:448–454.