Elective lung resection increases spatial QRS-T angle and QTc interval
Abstract
Background: Lung resection changes intra-thoracic anatomy, which may affect electrocardiographic results. While postoperative cardiac arrhythmias have been recognized after lung resection, no study has documented changes in vectorcardiographic variables in patients undergoing this surgery. The purpose of this study was to analyse changes in spatial QRS-T angle (spQRS-T) and corrected QT interval (QTc) after lung resection.
Methods: Adult patients undergoing elective lung resection under general anaesthesia were studied. The patients were allocated into four groups: those undergoing (1) left lobectomy (LL); (2) left pneumonectomy (LP); (3) right lobectomy (RL); and (4) right pneumonectomy (RP). The spQRS-T angle and QTc interval were measured one day before surgery (baseline) and 24, 48 and 72 h after surgery.
Results: Seventy-one adult patients (47 men and 24 women) aged 47–80 (65 ± 7) years were studied. In the study group as a whole, lung resection was associated with significant increases in spQRS-T (p < 0.001) and QTc (p < 0.05 at 24 and 48 h and p < 0.01 at 72 h). The greatest changes were noted in patients undergoing LP. Postoperative atrial fibrillation (AF) was noted in 6.4% of patients studied, in whom the widest spQRS-T angle and the most prolonged QTc intervals were also noted.
Conclusions: Lung resection widens the spQRS-T angle and prolongs the QTc interval, especially in patients undergoing LP. While postoperative AF was a relatively rare complication after lung resection in this study, it was associated with the widest spQRS-T angles and most prolonged QTc intervals.
Keywords: vectorcardiographyspatial QRS-T anglecorrected QT intervalatrial fibrillationgeneral anaesthesia
References
- Giambrone GP, Wu X, Gaber-Baylis LK, et al. Incidence and implications of postoperative supraventricular tachycardia after pulmonary lobectomy. J Thorac Cardiovasc Surg. 2016; 151(4): 982–988.
- Sanecka A, Biernacka EK, Szperl M, et al. QTc prolongation in patients with hearing loss: Electrocardiographic and genetic study. Cardiol J. 2016; 23(1): 34–41.
- Lee JH, Lim C, Kim JS, et al. Early and mid-term results of coronary endarterectomy: Influence of cardiopulmonary bypass and surgical techniques. Cardiol J. 2017; 24(3): 242–249.
- Elrakhawy HM, Alassal MA, Elsadeck N, et al. Predictive factors of supraventricular arrhythmias after noncardiac thoracic surgery: a multicenter study. Heart Surg Forum. 2014; 17(6): E308–E312.
- Iwata T, Nagato K, Nakajima T, et al. Risk factors predictive of atrial fibrillation after lung cancer surgery. Surg Today. 2016; 46(8): 877–886.
- Rena O, Papalia E, Oliaro A, et al. Supraventricular arrhythmias after resection surgery of the lung. Eur J Cardiothorac Surg. 2001; 20(4): 688–693.
- Chhabra L, Bajaj R, Chaubey VK, et al. Electrocardiographic impacts of lung resection. J Electrocardiol. 2013; 46(6): 697.e1–697.e8.
- Ivanovic J, Maziak DE, Ramzan S, et al. Incidence, severity and perioperative risk factors for atrial fibrillation following pulmonary resection. Interact Cardiovasc Thorac Surg. 2014; 18(3): 340–346.
- Güven O, Sazak H, Alagöz A, et al. The effects of local anaesthetics on QT parameters during thoracic epidural anaesthesia combined with general anaesthesia: ropivacaine versus bupivacaine. Balkan Med J. 2013; 30(4): 410–414.
- Brunelli A, Cassivi SD, Fibla J, et al. External validation of the recalibrated thoracic revised cardiac risk index for predicting the risk of major cardiac complications after lung resection. Ann Thorac Surg. 2011; 92(2): 445–448.
- Miura N, Kohno M, Ito K, et al. Lung cancer surgery in patients aged 80 years or older: an analysis of risk factors, morbidity, and mortality. Gen Thorac Cardiovasc Surg. 2015; 63(7): 401–405.
- Kocatürk M, Salci H, Yilmaz Z, et al. Pre- and post-operative cardiac evaluation of dogs undergoing lobectomy and pneumonectomy. J Vet Sci. 2010; 11(3): 257–264.
- Draisma HHM, Schalij MJ, van der Wall EE, et al. Elucidation of the spatial ventricular gradient and its link with dispersion of repolarization. Heart Rhythm. 2006; 3(9): 1092–1099.
- Cortez DL, Schlegel TT. When deriving the spatial QRS-T angle from the 12-lead electrocardiogram, which transform is more Frank: regression or inverse Dower? J Electrocardiol. 2010; 43(4): 302–309.
- Yamazaki T, Froelicher VF, Myers J, et al. Spatial QRS-T angle predicts cardiac death in a clinical population. Heart Rhythm. 2005; 2(1): 73–78.
- Borleffs CJ, Scherptong RWC, Man SC, et al. Predicting ventricular arrhythmias in patients with ischemic heart disease: clinical application of the ECG-derived QRS-T angle. Circ Arrhythm Electrophysiol. 2009; 2(5): 548–554.
- Voulgari C, Pagoni S, Tesfaye S, et al. The spatial QRS-T angle: implications in clinical practice. Curr Cardiol Rev. 2013; 9(3): 197–210.
- Borleffs CJ, Scherptong RWC, Man SC, et al. Predicting ventricular arrhythmias in patients with ischemic heart disease: clinical application of the ECG-derived QRS-T angle. Circ Arrhythm Electrophysiol. 2009; 2(5): 548–554.
- Michishita R, Ishikawa-Takata K, Yoshimura E, et al. Influence of dietary sodium and potassium intake on the heart rate corrected-QT interval in elderly subjects. J Nutr Sci Vitaminol. 2015; 61(2): 138–146.
- Thomas SHL, Behr ER. Pharmacological treatment of acquired QT prolongation and torsades de pointes. Br J Clin Pharmacol. 2016; 81(3): 420–427.
- Paventi S, Santevecchi A, Ranieri R. Effects of sevoflurane versus propofol on QT interval. Minerva Anestesiol. 2001; 67(9): 637–640.
- De Vecchis R, Ariano C, Di Biase G, et al. Malignant ventricular arrhythmias resulting from drug-induced QTc prolongation: a retrospective study. J Clin Med Res. 2018; 10(7): 593–600.
- Steinberg C. Diagnosis and clinical management of long-QT syndrome. Curr Opin Cardiol. 2018; 33(1): 31–41.
- Ekici Y, Bozbas H, Karakayali F, et al. Effect of different intra-abdominal pressure levels on QT dispersion in patients undergoing laparoscopic cholecystectomy. Surg Endosc. 2009; 23(11): 2543–2549.
- Dabrowski W, Jaroszynski A, Jaroszynska A, et al. Intra-abdominal hypertension increases spatial QRS-T angle and elevates ST-segment J-point in healthy women undergoing laparoscopic surgery. J Electrocardiol. 2017; 50(2): 214–222.
- Mirbolouk F, Arami S, Salari A, et al. Corrected QT-interval and dispersion after revascularization by percutaneous coronary intervention and coronary artery bypass graft surgery in chronic ischemia. J Invasive Cardiol. 2014; 26(9): 444–450.
- Wang Z, Yuan J, Chu W, et al. Evaluation of left and right ventricular myocardial function after lung resection using speckle tracking echocardiography. Medicine (Baltimore). 2016; 95(31): e4290.
- Edenbrandt L, Pahlm O. Vectorcardiogram synthesized from a 12-lead ECG: superiority of the inverse Dower matrix. J Electrocardiol. 1988; 21(4): 361–367.
- Xue QT. Interval Measurement: What Can We Really Expect? Computers in Cardiology. 2006; 33(385): 388.
- Kück K, Isaksen JL, Graff C, et al. Spatial QRS-T angle variants for prediction of all-cause mortality. J Electrocardiol. 2018; 51(5): 768–775.
- Zhang ZM, Rautaharju PM, Prineas RJ, et al. Electrocardiographic QRS-T angle and the risk of incident silent myocardial infarction in the Atherosclerosis Risk in Communities study. J Electrocardiol. 2017; 50(5): 661–666.
- Kamphuis V, Blom N, Zwet Ev, et al. Normal values of the ventricular gradient and QRS-T angle, derived from the pediatric electrocardiogram. J Electrocardiol. 2018; 51(3): 490–495.
- Kenttä T, Karsikas M, Kiviniemi A, et al. Dynamics and rate-dependence of the spatial angle between ventricular depolarization and repolarization wave fronts during exercise ECG. Ann Noninvasive Electrocardiol. 2010; 15(3): 264–275.
- Obata Y, Ruzankin P, Ong QiJ, et al. The impact of posture on the cardiac depolarization and repolarization phases of the QT interval in healthy subjects. J Electrocardiol. 2017; 50(5): 640–645.
- Dabrowski W, Schlegel TT, Wosko J, et al. Changes in spatial QRS-T angle and QTc interval in patients with traumatic brain injury with or without intra-abdominal hypertension. J Electrocardiol. 2018; 51(3): 499–507.
- Gul EE, Can I, Ozbek O. Displacement of the heart by diaphragm: is this heart alternating? J Electrocardiol. 2011; 44(4): 465–466.
- Yamada N. Effects of respiration on the vectorcardiogram obtained with the Frank lead system. Acta Med Okayama. 1985; 39(4): 297–313.
- Pratt CM, Al-Khalidi HR, Brum JM, et al. Cumulative experience of azimilide-associated torsades de pointes ventricular tachycardia in the 19 clinical studies comprising the azimilide database. J Am Coll Cardiol. 2006; 48(3): 471–477.
- Muensterman ET, Tisdale JE. Predictive analytics for identification of patients at risk for QT interval prolongation: a systematic review. Pharmacotherapy. 2018; 38(8): 813–821.
- Oji M, Terao Y, Toyoda T, et al. Differential effects of propofol and sevoflurane on QT interval during anesthetic induction. J Clin Monit Comput. 2013; 27(3): 243–248.
- Chang DJ, Kweon TD, Nam SB, et al. Effects of fentanyl pretreatment on the QTc interval during propofol induction. Anaesthesia. 2008; 63(10): 1056–1060.
- Kuenszberg E, Loeckinger A, Kleinsasser A, et al. Sevoflurane, but not propofol, significantly prolongs the Q-T interval. Anesth Analg. 2000; 90(1): 25–27.