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Sudden cardiac arrest: ECG repolarization after resuscitation
Nicolas Lellouche1, Frederic Sacher, Pierre Jorrot
1Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris et INSERM U 841, Creteil, France. nicolellouche@yahoo.com
Journal of Cardiovascular Electrophysiology
|August 25, 2010
Summary
Early repolarization (ERep) on ECG after cardiac arrest indicates a non-ischemic event. ST elevation suggests acute myocardial infarction, while ERep predicts future ERep syndrome.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Electrocardiography
Background:
- Early repolarization (ERep) abnormalities are frequently observed on electrocardiograms (ECGs) immediately after cardiac arrest.
- Characterizing these repolarization abnormalities and their correlation with acute coronary angiography is crucial for patient management.
Purpose of the Study:
- To analyze electrocardiographic repolarization patterns in patients immediately following cardiac arrest.
- To correlate these patterns with findings from acute coronary angiography.
- To assess the prognostic value of repolarization patterns in survivors.
Main Methods:
- 225 consecutive patients with out-of-hospital cardiac arrest and successful resuscitation underwent acute coronary angiography.
- The initial ECG post-resuscitation was analyzed by two independent cardiologists.
- Patients were classified into four repolarization patterns: no ST elevation/ERep, ST elevation without ERep, ST elevation with ERep, and ERep only.
Main Results:
- Repolarization patterns were distributed as: Pattern 1 (50%), Pattern 2 (33%), Pattern 3 (8%), and Pattern 4 (9%).
- Acute myocardial ischemia was significantly associated with Pattern 2 (ST elevation without ERep) (82%, P < 0.0001).
- Isolated ERep (Pattern 4) was associated with non-ischemic events (80%) and higher rates of future ERep on follow-up ECG (88% in survivors).
Conclusions:
- In cardiac arrest patients, ST elevation on ECG strongly suggests acute myocardial infarction.
- The presence of early repolarization (ERep) on ECG post-cardiac arrest is indicative of a non-ischemic event.
- ERep is also a marker for the development of future early repolarization syndrome.
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