Evaluation of electrocardiographic parameters in patients who had lung resections

Abstract

Background/Aim: The anatomic location of the heart in the mediastinal space may change and significant electrophysiological changes may appear after pneumonectomy, lobectomy, and segmentectomy. The aim of the present study was to perform a comprehensive investigation of electrocardiographic alterations after lung resection. Methods: In this retrospective cohort study, sixty-six patients (9 females, 57 males) who had lung resections were enrolled. Electrocardiograms of preoperative (24 hours before operation) and postoperative periods (after operation 7 (2) days) were analyzed. Result: Postoperative mean Pmin and QRS duration levels were lower than the respective preoperative values. In comparison with preoperative values, postoperative mean P dispersion, QTmax, QTmin, QT mean, QTd, QTc, QTc dispersion, JT, JTc, mean Tpe/QTmean, mean Tpe/QTc ratio (%), and mean Tpe/JT ratio (%) levels were found to be significantly higher. Postoperative mean pulse, mean Pmax, mean PR interval, mean RR, and mean Tpe/JTc ratio were not significantly different when compared with preoperative levels. Conclusion: Alterations in electrocardiography parameters reflecting the electrophysiology of the heart since heart position basically changes after lung resection may appear.

Keywords

• Electrocardiography
• Pneumonectomy
• QRS
• P dispersion

Kaynakça

1. 1. Guyton AC and Hall JE. Textbook of medical physiology. Philadelphia: Saunders; Vol. 548. 1986.
2. 2. Amar D, Burt M, Reinsel RA, Leung DH. Relationship of early postoperative dysrhythmias and long-term outcome after resection of non-small cell lung cancer. Chest. 1996;110(2):437-9. doi: 10.1378/chest.110.2.437
3. 3. Vasic N, Dimic JS, Stevic R, Milenkovic B, Djukanovic V. Acute Pseudoischemic ECG abnormalities after right pneumonectomy. Case reports in surgery. 2017. doi: 10.1155/2017/7872535
4. 4. Firstenberg MS. Principles and Practice of Cardiothoracic Surgery. BoD–Books on Demand; 2013. doi: 10.5772/56726
5. 5. Kopec SE, Irwin RS, Umali TCB, Balikian JP, Conlan AA. The postpneumonectomy state. Chest. 1998;114(4):1158-84. doi: 10.1378/chest.114.4.1158
6. 6. Bazwinsky WI, Paulsen F, Stövesandt D, Holzhausen HJ, Heine HJ, Peschke E, et al. Anatomical changes after pneumonectomy. Annals of Anatomy-Anatomischer Anzeiger. 2011;193(2):168-72. doi: 10.1016/j.aanat.2011.01.002
7. 7. Foroulis CN, Kotoulas CS, Kakouros S, Evangelatos G, Chassapis C, Konstantinou M, et al. Study on the late effect of pneumonectomy on right heart pressures using Doppler echocardiography. European journal of cardio-thoracic surgery. 2004;26(3):508-14. doi: 10.1016/j.ejcts.2004.05.036
8. 8. Chhabra L, Bajaj R, Chaubey VK, Kothagundla C, Spodick DH. Electrocardiographic impacts of lung resection. Journal of electrocardiology. 2013;46(6):697-e1. doi: 10.1016/j.jelectrocard.2013.05.140

9. 9. Rena O, Papalia E, Oliaro A, Casadio C, Ruffini E, Filosso P, et al. Supraventricular arrhythmias after resection surgery of the lung. European journal of cardio-thoracic surgery. 2001;20(4):688-93. doi: 10.1016/S1010-7940(01)00890-9
10. 10. Fernando HC, Jaklitsch MT, Walsh GL, Tisdale JE, Bridges CD, Mitchell JD, et al. The Society of Thoracic Surgeons practice guideline on the prophylaxis and management of atrial fibrillation associated with general thoracic surgery: executive summary. The Annals of thoracic surgery. 2011;92(3):1144-52. doi: 10.1016/j.athoracsur.2011.06.104
11. 11. Uguz B, Tiryakioglu S, Dal E, Tihan AK, Yalin K, Ozkan H. Acute Effects of Synthetic Cannabinoids on Ventricular Repolarization. Sanamed. 2020;15(3):249-54. doi: 10.24125/sanamed.v15i3.453
12. 12. Aktas I, Karakus A, Camci S, Ari H, Ari S, Tutuncu A, et al. The effect of levosimendan on Tp-e interval, Tp-e/QT ratio, Tp-e/QTc ratio and QRS interval in heart failure patients. The European Research Journal. 2017;3(3):220-6. doi: 10.18621/eurj.278899
13. 13. Dzikowicz DJ, Carey MG. Obesity and hypertension contribute to prolong QRS complex duration among middle‐aged adults. Annals of Noninvasive Electrocardiology. 2019;24(6): e12665. doi: 10.1111/anec.12665
14. 14. Hamauchi S, Furuse J, Takano T, Munemoto Y, Furuya K, Baba H, et al. A multicenter, open‐label, single‐arm study of anamorelin (ONO‐7643) in advanced gastrointestinal cancer patients with cancer cachexia. Cancer. 2019;125(23):4294-302. doi: 10.1002/cncr.32406
15. 15. Yun Y, Kim YH, Kwon JE. The change of QRS duration after pulmonary valve replacement in patients with repaired tetralogy of Fallot and pulmonary regurgitation. Korean Journal of Pediatrics. 2018;61(11):362. doi: 10.3345/kjp.2018.06765
16. 16. Guntekin U, Gunes Y, Tuncer M, Gumrukcuoglu HA, Kaya Y. The effect of altitude on P‐wave and QT duration and dispersion. Pacing and clinical electrophysiology. 2008;31(7):889-92. doi: 10.1111/j.1540-8159.2008.01104.x
17. 17. Tükek T, Yildiz P, Akkaya V, Akif Karan M, Atilgan D, Yilmaz V, et al. Factors associated with the development of atrial fibrillation in COPD patients: The role of P‐wave dispersion. Annals of noninvasive electrocardiology. 2002;7(3):222-7. doi: 10.1111/j.1542-474X.2002.tb00167.x
18. 18. Senen K, Turhan H, Erbay AR, Basar N, Yasar AS, Sahin O, et al. P‐wave duration and P‐wave dispersion in patients with dilated cardiomyopathy. European journal of heart failure. 2004;6(5):567-9. doi: 10.1016/j.ejheart.2003.12.020
19. 19. Arslan BO, Fırat H, Ardıç S. Obstrüktif Uyku Apne Sendrom’lu Hastalarda P Dalga Dispersiyonu, QT Dalga Dispersiyonu ve P Dalga Amplütüdünün Değerlendirilmesi. Journal of Turkish Sleep Medicine. 2017;4:84-9. doi: 10.4274/jtsm.63935
20. 20. Bogossian H, Frommeyer G, Ninios I, Hasan F, Nguyen QS, Karosiene Z, et al. New formula for evaluation of the QT interval in patients with left bundle branch block. Heart Rhythm. 2014;11(12):2273-7. doi: 10.1016/j.hrthm.2014.08.026