Suppression of Electrographic Seizures Is Associated with Amelioration of QTc Interval Prolongation in Patients with Traumatic Brain Injury.

Wojciech Dabrowski,Rafael Badenes,Andrzej Jaroszyński,Dorota Siwicka-Gieroba,Magdalena Bielacz,Todd T Schlegel,Sami Zaid,Chiara Robba

doi:10.3390/jcm10225374

Abstract

Introduction: Disorders in electroencephalography (EEG) are commonly noted in patients with traumatic brain injury (TBI) and may be associated with electrocardiographic disturbances. Electrographic seizures (ESz) are the most common features in these patients. This study aimed to explore the relationship between ESz and possible changes in QTc interval and spatial QRS-T angle both during ESz and after ESz resolution. Methods: Adult patients with TBI were studied. Surface 12-lead ECGs were recorded using a Cardiax device during ESz events and 15 min after their effective suppression using barbiturate infusion. The ESz events were diagnosed using Masimo Root or bispectral index (BIS) devices. Results: Of the 348 patients considered for possible inclusion, ESz were noted in 72, with ECG being recorded in 21. Prolonged QTc was noted during ESz but significantly ameliorated after ESz suppression (540.19 ± 60.68 ms vs. 478.67 ± 38.52 ms, p < 0.001). The spatial QRS-T angle was comparable during ESz and after treatment. Regional cerebral oximetry increased following ESz suppression (from 58.4% ± 6.2 to 60.5% ± 4.2 (p < 0.01) and from 58.2% ± 7.2 to 60.8% ± 4.8 (p < 0.05) in the left and right hemispheres, respectively). Conclusion: QTc interval prolongation occurs during ESz events in TBI patients but both it and regional cerebral oximetry are improved after suppression of seizures.

Highlights

Disorders in electroencephalography (EEG) are commonly noted in patients with traumatic brain injury (TBI) and may be associated with electrocardiographic disturbances.Electrographic seizures (ESz) are the most common features in these patients
Electrocardiographic disorders are frequently associated with seizures, which are often observed in patients with traumatic brain injury (TBI)
After admission into the intensive care unit (ICU), all patients achieved an appropriate level of sedation with continuous propofol and fentanyl infusion, and the depth of sedation ranged between 10 and 20 on the bispectral index (BIS) and 5 and 17 on the Patient State Index (PSI)

Summary

Introduction

Disorders in electroencephalography (EEG) are commonly noted in patients with traumatic brain injury (TBI) and may be associated with electrocardiographic disturbances. Electrographic seizures (ESz) are the most common features in these patients. Electrocardiographic disorders are frequently associated with seizures, which are often observed in patients with traumatic brain injury (TBI). Post-traumatic seizures occur in 21–27% of patients and are generally associated with hemorrhagic lesions of the temporal lobe [1,2,3]. The first event of recorded seizures mostly occurs in the first 24 h after TBI, with over one-third being electrographic seizures (ESz—electrographic seizures) [1]. TBI-related seizures can be induced by increased intracranial pressure (ICP), cerebral metabolic crises connected with disturbances in oxidative metabolism and glucose consumption, and impaired redox status of the brain [3]. Seizures impair cerebral metabolism and may induce systemic disorders in the extra-cerebral organs, including cardiac injury [4]

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