Decompressive Craniectomy Improves QTc Interval in Traumatic Brain Injury Patients

International Journal of Environmental Research and Public Health

Katarzyna Kotfis¹  Chiara Robba²  Rafael Badenes³  Wojciech Dabrowski⁴  Dorota Siwicka-Gieroba⁴  ToddT. Schlegel⁵  Andrzej Jaroszynski⁶ 

[1] Department Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland;Department of Anaesthesia and Intensive Care, Policlinico San Martino, 1100 Genova, Italy;Department of Anaesthesiology and Intensive Care, Hospital Clìnico Universitario de Valencia, University of Valencia, 46010 Valencia, Spain;Department of Anaesthesiology and Intensive Care, Medical University of Lublin, 20-954 Lublin, Poland;Department of Molecular Medicine and Surgery, Karolinska Institute, SE-171 76 Stockholm, Sweden;Department of Nephrology, Collegium Medicum, Jan Kochanowski University of Kielce, 25-736 Kielce, Poland;

关键词: traumatic brain injury;    cardiac disorders;    electrocardiography;    cardiac arrhythmias;    the index of cardio-electrophysiological balance;   

DOI  :  10.3390/ijerph17228653

来源: DOAJ

【 摘 要 】

Background: Traumatic brain injury (TBI) is commonly associated with cardiac dysfunction, which may be reflected by abnormal electrocardiograms (ECG) and/or contractility. TBI-related cardiac disorders depend on the type of cerebral injury, the region of brain damage and the severity of the intracranial hypertension. Decompressive craniectomy (DC) is commonly used to reduce intra-cranial hypertension (ICH). Although DC decreases ICH rapidly, its effect on ECG has not been systematically studied. The aim of this study was to analyze the changes in ECG in patients undergoing DC. Methods: Adult patients without previously known cardiac diseases treated for isolated TBI with DC were studied. ECG variables, such as: spatial QRS-T angle (spQRS-T), corrected QT interval (QTc), QRS and T axes (QRS_ax and T_ax, respectively), STJ segment and the index of cardio-electrophysiological balance (iCEB) were analyzed before DC and at 12–24 h after DC. Changes in ECG were analyzed according to the occurrence of cardiac arrhythmias and 28-day mortality. Results: 48 patients (17 female and 31 male) aged 18–64 were studied. Intra-cranial pressure correlated with QTc before DC (p < 0.01, r = 0.49). DC reduced spQRS-T (p < 0.001) and QTc interval (p < 0.01), increased Tax (p < 0.01) and changed STJ in a majority of leads but did not affect QRS_ax and iCEB. The iCEB was relatively increased before DC in patients who eventually experienced cardiac arrhythmias after DC (p < 0.05). Higher post-DC iCEB was also noted in non-survivors (p < 0.05), although iCEB values were notably heart rate-dependent. Conclusions: ICP positively correlates with QTc interval in patients with isolated TBI, and DC for relief of ICH reduces QTc and spQRS-T. However, DC might also increase risk for life-threatening cardiac arrhythmias, especially in ICH patients with notably prolonged QTc before and increased iCEB after DC.

【 授权许可】

Unknown