THE INFLUENCE OF ANESTHESIA ON PROLONGATION OF QTC INTERVAL IN PATIENTS THAT UNDERWENT AN OPEN-HEART SURGERY
Abstract
Introduction: Prolongation of QTc interval may cause cardiac electrical instability resulting in polymorphic ventricular tachycardia if the “torsades de pointes” type, as well as ventricular fibrillation and sudden death. It is known that anesthetics, laryngoscopy and tracheal intubation have various influences on QTc duration.
Material and methods: Study enrolled 100 consecutive patients that underwent an open-heart surgery at a single cardiosurgical center. Standard institutional protocols for premedication, introduction and conduction of anesthesia were used. Correction of QT interval was calculated according to Bazzet’s formula. For the assessments of the influence of premedications, anesthetics, operation type and tracheal intubation and extubation on QTc interval we focused to taking ECG at the following time points: baseline, after premedication, immediate postoperatively at admission to the intensive care unit, before extubation, immediately following extubation and a final following transfer to the general ward. As cut-off value of QTc prolongation we applied values >450 ms for men and >470 ms for women.
Results: Out of 100 successive patients, 55 had postoperative prolongation of QTc. In this group, males were prevalent (81,8%) in comparison to the group with normal QTc interval (64,4%; p= 0, 049); average glycemic index was higher (7, 6 mmol/l) in comparison to the group with normal QTc interval (6, 5 mmol/l; p= 0, 021) and average value of serum potassium was higher (4, 5 mmol/l) in comparison to the group with normal QTc (4, 1 mmol/l; p= 0, 003).
Conclusion: We confirmed prolongation of QTc interval during open-heart surgery, associated with anesthesia, operative and perioperative factors related to tracheal intubation and/or extubation and the increased sympathetic activity and catocholamine release. Amiodarone therapy, as well as increased perioperative glucose and potassium levels were associated with QTc prolongation.
Key words: QTc interval, anesthesia, open-heart surgery.
References
Moric-Janiszewska E., Markiewicz-Loskot G., Loscot M., et al. Challenges of diagnosis of long-QT syndrome in children. Pacing and Clinical Electrophysiology 2007; 30:9, 1168-1170
Hedley P. L., Jorgensen P., Schlamowitz S., Wangari R., et al. The genetic basis of long QT and short QT syndromes: a mutation update. Human mutation, 2009; 30:11, 1486-1511
Jervell A., & Lange-Nielsen F. Congenital deaf mutism, functional heart disease with prolongation of the Q-T interval, and sudden death. American Heart Journal, 1957; 54:1, 59-68
Castro VM, Clements CC, Murthy SN, et al. QT interval and antidepressant use: a cross sectional study of electronic healtha records. BMJ 2013; 346:288-99
Nagele P, Sal S, Brown F, et al. Postoperative QT interval Prolongation in Patients Undergoing Noncardiac Surgery under General Anesthesia. Anesthesiology. 2012; 117:321-8
Nagele P, Brown F, Francis A, et al. Influence of nitrous oxide anesthesia, B-vitamins, and MTFHR gene polymorphisms on perioperative cardiac events: the vitamins in nitrous oxide (VINO) randomized trial. Anesthesiology 2013; 119:19-28
Owczuk R, Wujtewitz MA, Zienciuk-Krajka A, et al. The influence of anesthesia on cardiac repolarization. Minerva Anestesiol2012; 78:483-95
Michaloudis DG, Kanakoudis FS, Petrou AM, et al. The effect of midazolam or propofol followed by suxamethonium on the QT interval in humans. Eur J Anaesthesiol 1996; 13:364-8
Pickham D, Helfenbein E, Shinn JA, et al. High prevalence of corrected QT interval prolongation in acutely ill patients is associated with mortality: results of the QT in Practice (QTIP) study. Crit Care Med 2012; 40:394-9
Sheinin B, Sheinin M, Vuorien J, et al. Alfentanil obtunds the cardiovascular and sympathoadrenal responses to suxamethonium-facilitated laryngoscopy and intubation. Br J Anaesth1989; 62:385-92
Drew BJ, Ackerman MJ, Funk M, et al. Prevention of torsade de pointes in hospital settings: a scientific statement from the American Heart Association and the American College of Cardiology Foundation. Circulation 2010; 121:1047-60
Staikou C, Stamelos M, Stavrulakis E. Impact of anaesthetic drugs and adjuvants on ECG markers of torsadogenicity. Br J Anaesth 2014; 112:217-30
Sauer AJ, Newton-Cheh C. Clinical and genetic determinants of torsade de pointes risk. Circulation 2012; 125:1684-94
Pickham D, Flowers E, Drew J. et al. Hyperglicemia in associated with QTc prolongation and mortality in acutely ill. NIH Public Access J CardiovasularNurs. 2014; 29(3): 264-270.doi:10.1097/JCN.
Fiorentini A, Perciaccante A, Valente R, et al. The correlation among QTc interval, hyperglicemia and the impaired autonomic activity. AutonNeurosci. Apr 2010; 154(1-2): 94-98
Van Noord C, Sturkenboom MC, Straus SM, et al. Serum glucose and insulin are associated with QTc and RR intervals in nondiabetic elderly. Eur j Endocrinol. 2010; 162(2): 241-248.
Li X, Ren H, Zhang-Rong X, et al. Prevalence and risk factors of prolonged QTc interval among Chinese patients with type 2 diabetes. Exp Diabet Res 2012; 2012: 234084.
Sakabe K, Fukuda N, Fukuda Y et al. QT interval dispersion in type 2 diabetic and non-diabetic patients with postmyocardial infarction. NutrMetabcardiovasc Dis 2008; 18(2):121-126