Intraoperative QTc interval interpretation: effects of anaesthesia, ECG, correction formulae, sex, and current limits; a prospective observational study

  • Background Severe QT interval prolongation requires monitoring QTc intervals during anaesthesia with recommended therapeutic interventions at a threshold of 500 ms. The need for 12-lead ECG and lack of standardisation limit such monitoring. We determined whether automated continuous intraoperative QTc monitoring with 5-lead ECG measures QTc intervals comparable to 12-lead ECG and whether the interpretation of QTc intervals depends on the correction formulae and the patient's sex. We compared intraoperative QTc times to QTc times from resting ECGs of a population from the same region, to substantiate the hypothesis that patients under general anaesthesia may need specific treatment thresholds. Methods In this prospective observational study, intraoperative QT/QTc intervals were automatically recorded using 12 and 5-lead ECG in 100 patients (44% males). QTc values were analysed for sex and formula-specific aspects after correction for heart rate according to Bazett, Fridericia,Background Severe QT interval prolongation requires monitoring QTc intervals during anaesthesia with recommended therapeutic interventions at a threshold of 500 ms. The need for 12-lead ECG and lack of standardisation limit such monitoring. We determined whether automated continuous intraoperative QTc monitoring with 5-lead ECG measures QTc intervals comparable to 12-lead ECG and whether the interpretation of QTc intervals depends on the correction formulae and the patient's sex. We compared intraoperative QTc times to QTc times from resting ECGs of a population from the same region, to substantiate the hypothesis that patients under general anaesthesia may need specific treatment thresholds. Methods In this prospective observational study, intraoperative QT/QTc intervals were automatically recorded using 12 and 5-lead ECG in 100 patients (44% males). QTc values were analysed for sex and formula-specific aspects after correction for heart rate according to Bazett, Fridericia, Hodges, Framingham, Charbit and QTcRAS, and compared to a regional community-based cohort. The level of significance was set to α = 0.05. Results QT interval duration was not significantly different between 12-lead and 5-lead ECG (difference − 0.09 ms ± 8.5 ms, p = 0.793). The QTc interval duration significantly differed between the correction formulae (p < 0.001) and between sexes (p < 0.001). Mean intraoperative QTc duration was higher than in resting ECGs from a large community-based population with the same regional background (438 vs. 417 ms). The incidence of prolonged values >500 ms significantly depended on the correction formula (p < 0.001) and was up to tenfold higher in women versus men. Conclusion Intraoperative QTc interval measurement using a 5-lead ECG is valid. Correction formulae and gender influence the intraoperative QTc interval duration and the incidence of pathologically prolonged values according to current limits. The consideration and definition of sex-specific normal limits for QTc times under general anaesthesia, therefore, warrant further investigation.show moreshow less

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Metadaten
Author:Thomas KrönauerORCiD, Lorenz L. Mihatsch, Patrick Friederich
URN:urn:nbn:de:bvb:384-opus4-1156685
Frontdoor URLhttps://opus.bibliothek.uni-augsburg.de/opus4/115668
ISSN:0001-5172OPAC
ISSN:1399-6576OPAC
Parent Title (English):Acta Anaesthesiologica Scandinavica
Publisher:Wiley
Type:Article
Language:English
Year of first Publication:2024
Publishing Institution:Universität Augsburg
Release Date:2024/10/07
Volume:68
Issue:10
First Page:1369
Last Page:1378
DOI:https://doi.org/10.1111/aas.14515
Institutes:Medizinische Fakultät
Medizinische Fakultät / Universitätsklinikum
Medizinische Fakultät / Lehrstuhl für Anästhesiologie und Operative Intensivmedizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):CC-BY 4.0: Creative Commons: Namensnennung (mit Print on Demand)