Evaluation of Tp-e / QTc ratio in determining the risk of arrhythmia in electric shocks in children

Year 2021, Volume: 11 Issue: 2, 232 - 236, 25.03.2021

Sinem Sarı Gökay , Şener Çınıçev

https://doi.org/10.16899/jcm.865000

Abstract

INTRODUCTION: Patients who have electrical accidents can apply to hospital with clinical signs ranging from simple skin burns to serious organ injuries. Our aim in this study is to evaluate whether QT, QTc interval and QT/QTc, Tp-e/QT, Tp-e/QTc ratios can be a marker for determine the risk of arrhythmias in children in cases of electric shock injuries that can be fatal.

MATERIAL & METHOD: In our study, 36 patients who were admitted to pediatric emergency with an electric shock between July 2018 and September 2019 and followed up in our clinic were included. As a control group, 25 healthy patients were included in the study. The files of the patients were examined retrospectively ECG (electrocardiogram) findings in leads DII and V5 were recorded.
RESULTS: Thirty-six (41%) patients who were admitted to our study due to electrical shock and followed up in our pediatric emergency were included. Sinus tachycardia was observed in two patients and no arrhythmias were detected in others. There was no statistically significant difference between the two groups between QT, QTc interval and QT/QTc, Tp-e/QT and Tp-e/QTc ratios measured in DII and V5 leads on ECG (p> 0.05). There was no statistically significant difference between ECG findings by gender(p> 0.05).

CONCLUSION: Electric shock can cause life-threatening situations by causing fatal arrhythmia. Although ECG findings are used to determine cardiac arrhythmia, it should be shown whether QT, QTc interval and Tp-e/QT, Tp-e/QTc ratios are significant arrhythmogenic markers by prospective studies in more specific age groups.

Keywords

Tp-e/QTc, electrical injury, children

ÇOCUK ACİLE BAŞVURAN ELEKTRİK ÇARPMALARINDA ARİTMİ RİSKİNİ BELİRLEMEDE Tp-e/QTc SÜRESİ

Abstract

Amaç: Elektrik kazaları basit cilt yanıklarından ciddi organ yaralanmalarına kadar değişen klinik bulgu ile gelebilmektedir. Elektrik çarpmaları sonrasında hayati tehdit eden kardiyak ritim bozuklukları görülebilmektedir.Bu çalışmadaki amacımız aritmiye neden olarak ölümcül olabilecek elektrik çarpmasına bağlı yaralanmalarda QT, QTc sürelerinin ve QT/QTc, Tp-e/QT, Tp-e/QTc oranlarının çocuklarda aritmi riskini belirleyebilecek bir belirteç olup olmadığını değerlendirmektir.
Materyal method: Çalışmamızda Temmuz 2018 ve Eylül 2019 tarihleri arasında elektrik çarpması şikayeti ile başvuran ve çocuk acilimizde takip edilen 36 hasta alındı. Kontrol grubu olarak da sağlıklı 25 hasta çalışmaya alındı. Hastaların dosyaları retrospektif olarak incelenerek yaş, cinsiyet, klinik bulgu ve fizik muayene bulgusu, vital bulgular, yapılan tedavi ve sonuçları, EKG(elektrokardiyogram) bulguları, DII ve V5 derivasyonlarında QT, QTc süreleri ve QT/QTc, Tp-e/QT ve Tp-e/QTc oranları kaydedilmiştir.
Bulgular: Çalışmamıza elektrik çapması nedeni ile başvuran ve çocuk acilimizde takip edilen 36(%41) hasta alındı. Tüm hastalar çocuk acil servisinde monitorize edilerek hidrasyon ve semptomatik tedavi ile 24 saat takip edilip şifa ile taburcu edildi.İki hastada sinus taşikardisi görüldü diğerlerinde aritmi saptanmadı. EKG' de DII ve V5 derivasyonlarında ölçülen QT, QTc süreleri ve QT/QTc, Tp-e/QT ve Tp-e/QTc oranları arasında her iki grup arasında istatistiksel olarak anlamlı farklılık yoktu (p>0.05).Erkek kız gruplarına bakıldığında da cinsiyet ve EKG'deki QT, QTc süreleri ve QT/QTc, Tp-e/QT ve Tp-e/QTc oranları arasında istatistiksel olarak anlamlı bir farklılık saptanmadı(p>0.05)
Sonuç: Elektrik çarpması malign aritmiye sebep olarak hayatı tehdit eden durumlara sebep olabilir. Kardiyak aritmiyi belirlemede EKG bulguları kullanılmakla birlikte daha çok sayıda belirli yaş gruplarında prospektif yapılacak çalışmalarla QT, QTc sürelerinin ve Tp-e/QT, Tp-e/QTc oranlarının anlamlı aritmojenik bir belirteç olup olmadığı gösterilmelidir.

Keywords

Tp-e/QTc, elektrik yaralanması, çocuk

References

• 1. Searle J, Slagman A, Maass W, Mockel M . Cardiac monitoring in patients with electrical injuries. An analysis of 268 patients at the Charite Hospital. Dtsch Arztebl Int.2013; 110(50):847– 853. https ://doi.org/10.3238/arzte bl.2013.0827.
• 2.Pilecky D, Vamos M, Bogyi P, Muk B et al. Risk of cardiac arrhythmias after electrical accident: a single-center study of 480 patients. Clin Res Cardiol. 2019 ;108(8):901-908. doi: 10.1007/s00392-019-01420-2. 
• 3.Haim A, Zucker N, Levitas A, Sofer S, Katz A, Zalzstein E. Cardiac manifestations following electrocution in children. Cardiol Young. 2008;18(5):458-60. doi: 10.1017/S1047951108002527
• 4.McLeod JS, Maringo AE, Doyle PJ, Vitale L et al. Analysis of Electrocardiograms Associated with Pediatric Electrical Burns. J Burn Care Res. 2018 ;39(1):65-72. doi: 10.1097/BCR.0000000000000591.
• 5.Vural A, Sarak T, Vural S, Yastı AÇ. The importance of electrocardiography in the clinical course of electric injuries Ulus Travma Acil Cerrahi Derg. 2015;21(3):216-9. doi: 10.5505/tjtes.2015.22623.
• 6. Claudet I, Maréchal C, Debuisson C, Salanne S. Risk of arrhythmia an domestic low-voltage electrical injury. Arch Pediatr. 2010;17(4):343-9. doi: 10.1016/j.arcped.2010.01.007
• 7. Bailey B, Gaudreault P, Thivierge RL. Cardiac monitoring of high-risk patients after an electrical injury: a prospective multicentre study.Emerg Med J. 2007; 24 (5): 348-352.
• 8. Smetana P, Schmidt A, Zabel M, Hnatkova K et al. Assessment of repolarization heterogeneity for prediction of mortality in cardiovascular disease: peak to the end of the T wave interval and nondipolar repolarization components. J. Electrocardiol.2011; 44: 301–308.
• 9. Zhao X, Xie Z, Chu Y et al. Association between Tp-e/QT ratio and prognosis in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Clin. Cardiol.2012; 35: 559–564
• 10.Avcı A,Acehan S, Avcı SB, Gulen M,Bulut A,Satar S. QTc, Tp-e interval and Tp-e/QTc ratio in patients with nontraumatic subarachnoid hemorrhage. Am J Emerg Med.2020; 14,DOI:https://doi.org/10.1016/j.ajem.2017
• 11Dokov W, Dokova K.Epidemiology and diagnostic problems of electrical injury in forensic medicine. Forensic Med.2010;126-135 https ://doi.org/10.5772/19434
• 12.Akkas M, Hocagil H, Didem A, Bulent E, Mahir KM, Mahir OM. Cardiac monitorization in patients with electrocution injury. Ulus Travma Acil Cerrahi Derg2012; 18(4):301–305
• 13.Arnoldo BD, Purdue GF, Kowalske K, Helm PA, Burris A, Hunt JL.Electrical injuries: a 20-Year review.J Burn Care Rehabil.2004; 25(6):479–484
• 14.Soar J, Perkins GD, Abbas G, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation.2010; 81(10):1400–1433
• 15.Krämer C, Pfister R, Boekels T, Michels G.Cardiac monitoring always required after electrical injuries? Medizinische Klin.2010; 111(8):708–714. https ://doi.org/10.1007/s0006 3-015-0107-y
• 16.Karataş MB, Onuk T, Güngör B, İpek G, Özcan KS. Assessment of electrocardiographic parameters in patients with electrocution injury.JElectrocardiol. 2015;48(5):809-14. doi: 10.1016/j.jelectrocard.2015.06.009.
• 17.Vural A, Sara T, Vural S, Yastı AÇ. The importance of electrocardiography in the clinical course of electric injuries Ulus Travma Acil Cerrahi Derg, Mayıs 2015, 21, 3.
• 18. Koumbourlis AC. Electrical injuries. Crit Care Med 2002;30(11 Suppl): 424-30.
• 19. Gokdemir MT, Kaya H, Söğüt O, Cevik M.Factors affecting the clinical outcome of low-voltage electrical injuries in children. Pediatr Emerg Care.2013; 29(3):357–359
• 20.Bailey B, Forget S, Gaudreault P.Prevalence of potential risk factors in victims of electrocution. Forensic Sci Int.2001; 123(1):58–62
• 21.Çelik A, Ergün O, Özok G . Pediatric electrical injuries: a review of 38 consecutive patients. J Pediatr Surg.2004; 39(8):1233–1237
• 22. Pawlik AM, Lampart A, Stephan FP, Bingisser R, Ummenhofer W, Nickel CH. Outcomes of electrical injuries in the emergency department: a 10-year retrospective study. Eur J Emerg Med.2016; 23(6):448–454. https ://doi.org/10.1097/MEJ.00000 00000 00028 3
• 23.Türe M, Balık H, Akın A, Bilici M, Nergiz A.The relationship between electrocardiographic data and mortality in children diagnosed with dilated cardiomyopathy. Eur J Pediatr. 2020. doi: 10.1007/s00431-020-03569-9.
• 24. Demirol M, Karadeniz C, Ozdemir R, Çoban Ş, Katipoğlu N, Yozgat Y, Meşe T, Unal N. Prolonged Tp-e Interval and Tp-e/QT Ratio in Children with Mitral Valve Prolapse. Pediatr Cardiol. 2016;37(6):1169-74. doi: 10.1007/s00246-016-1414-7.
• 25. Turker Y, Ozaydin M, Acar G, et al.Predictors of ventricular arrhythmias in patients with mitral valve prolapse. Int J Cardiovasc Imaging. 2010;26(2):139-45. doi: 10.1007/s10554-009-9514-6.
• 26. Antzelevitch C, Fish J. Electrical heterogeneity within the ventricular wall. Basic Res Cardiol 2001;96:517–27
• 27.McLeod JS, Maringo AE, Doyle PJ, et al. Analysis of Electrocardiograms Associated with Pediatric Electrical Burns. J Burn Care Res. 2018;1;39(1):65-72. doi: 10.1097/BCR.0000000000000591.