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J Electrocardiol. 2017 Mar - Apr;50(2):214-222. doi: 10.1016/j.jelectrocard.2016.10.002. Epub 2016 Oct 13.

Intra-abdominal hypertension increases spatial QRS-T angle and elevates ST-segment J-point in healthy women undergoing laparoscopic surgery.

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Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Poland. Electronic address:
Department of Family Medicine, Medical University of Lublin, Poland; Institute of Medical Science J. Kochanowski University of Kielce, Poland.
Department of Cardiology, Medical University of Lublin, Poland.
Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Poland.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden, and Nicollier-Schlegel SARL, Trélex, Switzerland.
Intensive Care Unit and High Care Burn Unit, Ziekenhuis Netwerk Antwerp, ZNA Stuivenberg, Antwerp, Belgium.



Intra-abdominal hypertension (IAH) impairs cardiovascular function, however an effect of IAH on cardiac electrophysiology has been poorly documented. The aim of this study was to evaluate the effect of IAH following pneumoperitoneum on vectorcardiographic variables reflecting cardiac repolarisation and depolarisation.


Otherwise healthy women undergoing elective gynaecological laparoscopy were studied. Intra-abdominal pressure (IAP), spatial QRS-T angle and ST-segment J-point (STJ) were observed during surgery and the early postoperative period.


Forty women, ages 22 to 43 were examined. Induction of IAH to 15mmHg significantly widened the spatial QRS-T angle, whereas the Trendelenburg position subsequently reduced this widening. IAH also increased STJ voltage in leads III, aVF, V2 and V3 during surgery, with increased STJ voltage persisting in several leads through the morning of postoperative day 1.


Induction of IAH impacts the relationship between cardiac depolarisation and repolarisation and increases spatial QRS-T angle and STJ voltage.


Depolarisation; Intra-abdominal pressure; Pneumoperitoneum; Repolarisation; Vectorcardiogram

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