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Takahashi K, Morioka H, Uemura S, Okura T, Inoue K. Accidental Hypothermia-Induced J Wave Coupled With Giant R Wave Augmented by Premature Atrial Contraction: A Case Report. Cureus 2024; 16:e60644. [PMID: 38903283 PMCID: PMC11187455 DOI: 10.7759/cureus.60644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/22/2024] Open
Abstract
The 12-lead electrocardiographic findings in hypothermia include the presence of J waves; prolongation of the PR, QRS, and QT intervals; and atrial and ventricular dysrhythmias. Among these findings, the J wave, known as the Osborn wave, is considered pathognomonic. In 1953, the J wave was reported as a specific response to hypothermia in dogs, representing the current at the site of injury instead of a widening of the QRS complex that occurs caused by a conduction delay. The J wave is often accompanied by ventricular fibrillation. For the past 28 years, it was assumed that the hypothermia-induced J wave was mediated by the transient outward current. However, it was recently been reported that the J waves in some patients with hypothermia can be considered delayed conduction-related waveforms. Here, we present a case of hypothermia-induced J waves together with giant R waves, which have not been previously reported during hypothermia, augmented by short RR intervals arising from premature atrial contractions. Our observations indicate that the underlying mechanism for the genesis of J waves is indeed conduction delay and not transient outward currents.
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Affiliation(s)
- Koji Takahashi
- Department of Cardiology, Yawatahama City General Hospital, Ehime, JPN
| | - Hiroe Morioka
- Department of Cardiology, Yawatahama City General Hospital, Ehime, JPN
| | - Shigeki Uemura
- Department of Cardiology, Yawatahama City General Hospital, Ehime, JPN
| | - Takafumi Okura
- Department of Cardiology, Yawatahama City General Hospital, Ehime, JPN
| | - Katsuji Inoue
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Ehime, JPN
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Selli AL, Ghasemi M, Watters T, Burton F, Smith G, Dietrichs ES. Proarrhythmic changes in human cardiomyocytes during hypothermia by milrinone and isoprenaline, but not levosimendan: an experimental in vitro study. Scand J Trauma Resusc Emerg Med 2023; 31:61. [PMID: 37880801 PMCID: PMC10601188 DOI: 10.1186/s13049-023-01134-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/15/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Accidental hypothermia, recognized by core temperature below 35 °C, is a lethal condition with a mortality rate up to 25%. Hypothermia-induced cardiac dysfunction causing increased total peripheral resistance and reduced cardiac output contributes to the high mortality rate in this patient group. Recent studies, in vivo and in vitro, have suggested levosimendan, milrinone and isoprenaline as inotropic treatment strategies in this patient group. However, these drugs may pose increased risk of ventricular arrhythmias during hypothermia. Our aim was therefore to describe the effects of levosimendan, milrinone and isoprenaline on the action potential in human cardiomyocytes during hypothermia. METHODS Using an experimental in vitro-design, levosimendan, milrinone and isoprenaline were incubated with iCell2 hiPSC-derived cardiomyocytes and cellular action potential waveforms and contraction were recorded from monolayers of cultured cells. Experiments were conducted at temperatures from 37 °C down to 26 °C. One-way repeated measures ANOVA was performed to evaluate differences from baseline recordings and one-way ANOVA was performed to evaluate differences between drugs, untreated control and between drug concentrations at the specific temperatures. RESULTS Milrinone and isoprenaline both significantly increases action potential triangulation during hypothermia, and thereby the risk of ventricular arrhythmias. Levosimendan, however, does not increase triangulation and the contractile properties also remain preserved during hypothermia down to 26 °C. CONCLUSIONS Levosimendan remains a promising candidate drug for inotropic treatment of hypothermic patients as it possesses ability to treat hypothermia-induced cardiac dysfunction and no increased risk of ventricular arrhythmias is detected. Milrinone and isoprenaline, on the other hand, appears more dangerous in the hypothermic setting.
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Affiliation(s)
- Anders Lund Selli
- Experimental and Clinical Pharmacology, Department of Medical Biology, Faculty of Health Sciences, UiT - The Arctic University of Norway, Postboks 6050, 9037, Langnes, Tromsø, Norway
| | | | | | - Francis Burton
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
- Clyde Biosciences, Newhouse, Scotland
| | - Godfrey Smith
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
- Clyde Biosciences, Newhouse, Scotland
| | - Erik Sveberg Dietrichs
- Experimental and Clinical Pharmacology, Department of Medical Biology, Faculty of Health Sciences, UiT - The Arctic University of Norway, Postboks 6050, 9037, Langnes, Tromsø, Norway.
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway.
- Institute of Oral Biology, University of Oslo, Oslo, Norway.
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Okada N, Matsuyama T, Morita S, Ehara N, Miyamae N, Okada Y, Jo T, Sumida Y, Watanabe M, Nozawa M, Tsuruoka A, Fujimoto Y, Okumura Y, Hamanaka K, Kitamura T, Nishiyama K, Ohta B. Osborn Wave Is Related to Ventricular Fibrillation and Tachycardia in Hypothermic Patients. Circ J 2020; 84:445-455. [PMID: 31996488 DOI: 10.1253/circj.cj-19-0856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Osborn wave (OW) is often observed in hypothermic patients; however, whether OW in hypothermic patients is related to the development of fatal ventricular arrhythmia, including ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT), remains undetermined. This study aimed to estimate the association between OW and the incidence of fatal ventricular arrhythmias.Methods and Results: This retrospective study used the Japanese Accidental Hypothermia Network registry database and included 572 hypothermic patients. Patients were divided into the OW group (those with OW) and non-OW group (those without OW). The relationship between the development of fatal arrhythmias and presence of OW was assessed using the chi-squared test. All patients who developed VF/VT (n=10) had OW on electrocardiogram upon hospital arrival. The presence of OW had a sensitivity of 100%, specificity of 47.8%, positive predictive value of 4.0%, and negative predictive value of 100% for VF/VT development. The in-hospital mortality rate was 22.3% in the OW group and 21.2% in the non-OW group (P=0.781). CONCLUSIONS OW was observed in all hypothermic patients with VF/VT. The occurrence of ventricular arrhythmias is highly unlikely in the absence of OW on the electrocardiogram. Although the presence of OW might be used to predict these fatal arrhythmias in hypothermic patients, there was no association between the presence of OW and in-hospital mortality.
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Affiliation(s)
- Nobunaga Okada
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine
| | - Sachiko Morita
- Senri Critical Care Medical Center, Saiseikai Senri Hospital
| | - Naoki Ehara
- Department of Emergency, Japanese Red Cross Society Kyoto Daiichi Red Cross Hospital
| | | | - Yohei Okada
- Department of Primary Care and Emergency Medicine, Kyoto University
| | - Takaaki Jo
- Department of Emergency Medicine, Uji-Tokushukai Medical Center
| | - Yasuyuki Sumida
- Department of Emergency Medicine, North Medical Center, Kyoto Prefectural University of Medicine
| | - Makoto Watanabe
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine
| | - Masahiro Nozawa
- Department of Emergency and Critical Care Medicine, Saiseikai Shiga Hospital
| | - Ayumu Tsuruoka
- Emergency and Critical Care Medical Center, Osaka City General Hospital
| | - Yoshihiro Fujimoto
- Department of Emergency, Japanese Red Cross Society Kyoto Daiichi Red Cross Hospital
| | | | - Kunio Hamanaka
- Department of Emergency and Critical Care Medicine, National Hospital Organization Kyoto Medical Center
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine
| | - Kei Nishiyama
- Department of Emergency and Critical Care Medicine, National Hospital Organization Kyoto Medical Center
| | - Bon Ohta
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine
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Successful treatment of electrical storm in a child with early repolarization syndrome with orciprenaline and radiofrequency ablation. Anatol J Cardiol 2019; 22:94-96. [PMID: 31375645 PMCID: PMC6735446 DOI: 10.14744/anatoljcardiol.2019.37085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Electrocardiographic J wave: Early repolarization, Brugada wave, and conduction delay. Heart Rhythm 2018; 16:81-82. [PMID: 30118884 DOI: 10.1016/j.hrthm.2018.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Indexed: 11/21/2022]
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Aizawa Y, Hosaka Y, Oda H, Fuse K, Okabe M, Kaneko Y, Takahashi N, Zaizen H, Aizawa Y, Fukuda K. Dynamicity of hypothermia-induced J waves and the mechanism involved. Heart Rhythm 2018; 16:74-80. [PMID: 30048693 DOI: 10.1016/j.hrthm.2018.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND J waves develop during hypothermia, but the dynamicity of hypothermia-induced J waves is poorly understood. OBJECTIVE The purpose of this study was to investigate the mechanism of the rate-dependent change in the amplitude of hypothermia-induced J waves. METHODS Nineteen patients with severe hypothermia were included (mean age 70 ± 12 years; 16 men [84.2%]). The rectal temperature at the time of admission was 27.8° ± 2.5°C. In addition to prolonged PR, QRS complex, and corrected QT intervals, the distribution of prominent J waves was widespread in all 19 patients. RESULTS Nine patients showed changes in RR intervals. When the RR interval shortened from 1353 ± 472 to 740 ± 391 ms (P = .0002), the J-wave amplitude increased from 0.50 ± 0.29 to 0.61 ±0.27 mV (P = .0075). The J-wave amplitude increased in 7 patients (77.8%) and decreased in 2 patients (22.2%) after short RR intervals. The augmentation of J waves at short RR intervals was associated with a significant prolongation of ventricular activation time (35 ± 5 ms vs 46 ± 5 ms; P = .0020), suggesting accentuated conduction delay. Increased conduction delay at short RR intervals was suggested to accentuate the phase 1 notch of the action potential and J waves in hypothermia. None developed ventricular fibrillation, and in 2 of 9 patients with atrial fibrillation, atrial fibrillation persisted after rewarming to normothermia. CONCLUSION J waves in severe hypothermia were augmented after short RR intervals in 7 patients as expected for depolarization abnormality, whereas 2 patients showed a bradycardia-dependent augmentation as expected for transient outward current-mediated J waves. Increased conduction delay at short RR intervals can be responsible for the accentuation of the transient outward current and J waves during severe hypothermia.
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Affiliation(s)
- Yoshifusa Aizawa
- Research and Development, Tachikawa Medical Center/Niigata University, Nagaoka/Niigata, Japan.
| | - Yukio Hosaka
- Department of Cardiology, Niigata City Hospital, Niigata, Japan
| | - Hirotaka Oda
- Department of Cardiology, Niigata City Hospital, Niigata, Japan
| | - Koichi Fuse
- Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan
| | - Masaaki Okabe
- Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan
| | - Yoshiaki Kaneko
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | | | - Hirofumi Zaizen
- Department of Internal Medicine, Koseiren Ttsurumi Hospital, Oita, Japan
| | - Yoshiyasu Aizawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Lee WS, Nam GB, Kim SH, Choi JH, Jo U, Kim WY, Oh YS, Park KN, Seo GW, Kim KH, Jin ES, Rhee KS, Jung L, Hwang KW, Kim YR, Kwon CH, Kim J, Choi KJ, Kim YH. ECG features and proarrhythmic potentials of therapeutic hypothermia. Heart 2016; 102:1558-65. [DOI: 10.1136/heartjnl-2015-308821] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 04/21/2016] [Indexed: 11/03/2022] Open
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Yamaki M, Sato N, Imanishi R, Sakai H, Kawamura Y, Hasebe N. Low room temperature can trigger ventricular fibrillation in J wave syndromes. HeartRhythm Case Rep 2016; 2:347-350. [PMID: 28491707 PMCID: PMC5419894 DOI: 10.1016/j.hrcr.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Masaru Yamaki
- Department of Cardiology, Nayoro City General Hospital, Hokkaido, Japan
| | - Nobuyuki Sato
- Department of Cardiology, Asahikawa Medical University, Asahikawa, Japan
| | - Rina Imanishi
- Department of Cardiology, Nayoro City General Hospital, Hokkaido, Japan
| | - Hirotsuka Sakai
- Department of Cardiology, Nayoro City General Hospital, Hokkaido, Japan
| | - Yuichiro Kawamura
- Department of Cardiology, Asahikawa Medical University, Asahikawa, Japan
| | - Naoyuki Hasebe
- Department of Cardiology, Asahikawa Medical University, Asahikawa, Japan
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