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Clin Res Cardiol. 2019 Aug;108(8):901-908. doi: 10.1007/s00392-019-01420-2. Epub 2019 Feb 15.

Risk of cardiac arrhythmias after electrical accident: a single-center study of 480 patients.

Author information

1
Department of Internal Medicine III, Klinikum Passau, Innstrasse 76, 94032, Passau, Germany. pileckyd@gmail.com.
2
Department of Cardiology, Medical Centre, Hungarian Defence Forces, Róbert K. krt. 44, Budapest, 1134, Hungary. pileckyd@gmail.com.
3
Department of Cardiology, University Hospital Frankfurt, Goethe University, Theodor-Stern Kai 7, 60590, Frankfurt, Germany.
4
Department of Cardiology, Medical Centre, Hungarian Defence Forces, Róbert K. krt. 44, Budapest, 1134, Hungary.
5
Department of Emergency Medicine, Medical Centre, Hungarian Defence Forces, Róbert K. krt. 44, Budapest, 1134, Hungary.
6
Semmelweis University Heart and Vascular Centre, Városmajor u. 68, Budapest, 1122, Hungary.

Abstract

OBJECTIVE:

Patients with electrical injury are considered to be at high risk of cardiac arrhythmias. Due to the small number of studies, there is no widely accepted guideline regarding the risk assessment and management of arrhythmic complications after electrical accident (EA). Our retrospective observational study was designed to determine the prevalence of ECG abnormalities and cardiac arrhythmias after EA, to evaluate the predictive value of cardiac biomarkers for this condition and to assess in-hospital and 30-day mortality.

METHODS:

Consecutive patients presenting after EA at the emergency department of our institution between 2011 and 2016 were involved in the current analysis. ECG abnormalities and arrhythmias were analyzed at admission and during ECG monitoring. Levels of cardiac troponin I, CK and CK-MB were also collected. In-hospital and 30-day mortality data were obtained from hospital records and from the national insurance database.

RESULTS:

Of the 480 patients included, 184 (38.3%) had suffered a workplace accident. The majority of patients (96.2%) had incurred a low-voltage injury (< 1000 V). One hundred and four (21.7%) patients had a transthoracic electrical injury while 13 (2.7%) patients reported loss of consciousness. The most frequent ECG disorders at admission were sinus bradycardia (< 60 bpm, n = 50, 10.4%) and sinus tachycardia (> 100 bpm, n = 21, 4.4%). Other detected arrhythmias were as follows: newly diagnosed atrial fibrillation (n = 1); frequent multifocal atrial premature complexes (n = 1); sinus arrest with atrial escape rhythm (n = 2); ventricular fibrillation terminated out of hospital (n = 1); ventricular bigeminy (n = 1); and repetitive nonsustained ventricular tachycardia (n = 1). ECG monitoring was performed in 182 (37.9%) patients for 12.7 ± 7.1 h at the ED. Except for one case with regular supraventricular tachycardia terminated via vagal maneuver and one other case with paroxysmal atrial fibrillation, no clinically relevant arrhythmias were detected during the ECG monitoring. Cardiac troponin I was measured in 354 (73.8%) cases at 4.6 ± 4.3 h after the EA and was significantly elevated only in one resuscitated patient. CK elevation was frequent, but CK-MB was under 5% in all patients. Both in-hospital and 30-day mortality were 0%.

CONCLUSIONS:

Most of cardiac arrhythmias in patients presenting after EA can be diagnosed by an ECG on admission, thus routine ECG monitoring appears to be unnecessary. In our patient cohort cardiac troponin I and CK-MB were not useful in risk assessment after EA. Late-onset malignant arrhythmias were not observed.

KEYWORDS:

Arrhythmia; Cardiac monitoring; Cardiac necroenzymes; Electrical accident

PMID:
30771067
PMCID:
PMC6652167
DOI:
10.1007/s00392-019-01420-2
[Indexed for MEDLINE]
Free PMC Article

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