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Osborn waves following out-of-hospital cardiac arrest—Effect of level of temperature management and risk of arrhythmia and death

Hadziselimovic, Edina; Thomsen, Jakob Hartvig; Kjaergaard, Jesper; Køber, Lars; Graff, Claus; Pehrson, Steen LU ; Nielsen, Niklas LU ; Erlinge, David LU ; Frydland, Martin and Wiberg, Sebastian, et al. (2018) In Resuscitation 128. p.119-125
Abstract

Background: The Osborn or J-wave, an upright deflection of the J-point on the electrocardiogram (ECG), is often observed during severe hypothermia. A possible relation between Osborn waves (OW) and increased risk of ventricular arrhythmia has been reported. We sought to determine whether the level of targeted temperature management (TTM) following out-of-hospital cardiac arrest (OHCA) affects the prevalence of OW and to assess the associations between OW and risk of ventricular arrhythmia and death. Methods and results: The present study is part of the TTM-trial ECG-substudy (including OHCA-patients randomized to TTM at 33 °C vs. 36 °C from 24 of 36 sites). Serial 12-lead ECGs from 680 (94%) patients were analysed and stratified by OW... (More)

Background: The Osborn or J-wave, an upright deflection of the J-point on the electrocardiogram (ECG), is often observed during severe hypothermia. A possible relation between Osborn waves (OW) and increased risk of ventricular arrhythmia has been reported. We sought to determine whether the level of targeted temperature management (TTM) following out-of-hospital cardiac arrest (OHCA) affects the prevalence of OW and to assess the associations between OW and risk of ventricular arrhythmia and death. Methods and results: The present study is part of the TTM-trial ECG-substudy (including OHCA-patients randomized to TTM at 33 °C vs. 36 °C from 24 of 36 sites). Serial 12-lead ECGs from 680 (94%) patients were analysed and stratified by OW at predefined time-points (0, 4, 28, 36, 72-h after admission). On admission, the overall prevalence of OW was 16%, increasing to 32% at target temperature, with higher prevalence in the 33 °C-group (40% vs. 23%, p < 0.0001). No difference in prevalence was found between the 33 °C- and 36 °C-groups on admission (18% vs. 14%, p =.11) or after rewarming (13% vs. 10%, p =.44). OW were not associated with increased risk of ventricular arrhythmia (Odds ratio = 0.78 (0.51–1.20), p =.26), but associated with significantly lower 180-day mortality as compared to no OW (38% vs. 52%, plog-rank = 0.001) in univariable analyses only. Conclusion: OW are frequent during TTM, particularly in patients treated with 33 °C. OW are not associated with increased risk of ventricular arrhythmia, and may be considered a benign physiological phenomenon, associated with lower mortality in univariable analyses.

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publication status
published
subject
keywords
Cardiac arrest, Cardiac arrhythmia, Hypothermia, J-waves, Osborn waves, Out-of-hospital cardiac arrest, Repolarization, Targeted temperature management, Therapeutic hypothermia, TTM, Ventricular arrhythmia
in
Resuscitation
volume
128
pages
7 pages
publisher
Elsevier
external identifiers
  • scopus:85047072104
ISSN
0300-9572
DOI
10.1016/j.resuscitation.2018.04.037
language
English
LU publication?
no
id
74cdb5a4-f0c1-4674-a458-1efb8dccfb03
date added to LUP
2018-05-29 14:23:31
date last changed
2018-11-21 21:40:05
@article{74cdb5a4-f0c1-4674-a458-1efb8dccfb03,
  abstract     = {<p>Background: The Osborn or J-wave, an upright deflection of the J-point on the electrocardiogram (ECG), is often observed during severe hypothermia. A possible relation between Osborn waves (OW) and increased risk of ventricular arrhythmia has been reported. We sought to determine whether the level of targeted temperature management (TTM) following out-of-hospital cardiac arrest (OHCA) affects the prevalence of OW and to assess the associations between OW and risk of ventricular arrhythmia and death. Methods and results: The present study is part of the TTM-trial ECG-substudy (including OHCA-patients randomized to TTM at 33 °C vs. 36 °C from 24 of 36 sites). Serial 12-lead ECGs from 680 (94%) patients were analysed and stratified by OW at predefined time-points (0, 4, 28, 36, 72-h after admission). On admission, the overall prevalence of OW was 16%, increasing to 32% at target temperature, with higher prevalence in the 33 °C-group (40% vs. 23%, p &lt; 0.0001). No difference in prevalence was found between the 33 °C- and 36 °C-groups on admission (18% vs. 14%, p =.11) or after rewarming (13% vs. 10%, p =.44). OW were not associated with increased risk of ventricular arrhythmia (Odds ratio = 0.78 (0.51–1.20), p =.26), but associated with significantly lower 180-day mortality as compared to no OW (38% vs. 52%, p<sub>log-rank</sub> = 0.001) in univariable analyses only. Conclusion: OW are frequent during TTM, particularly in patients treated with 33 °C. OW are not associated with increased risk of ventricular arrhythmia, and may be considered a benign physiological phenomenon, associated with lower mortality in univariable analyses.</p>},
  author       = {Hadziselimovic, Edina and Thomsen, Jakob Hartvig and Kjaergaard, Jesper and Køber, Lars and Graff, Claus and Pehrson, Steen and Nielsen, Niklas and Erlinge, David and Frydland, Martin and Wiberg, Sebastian and Hassager, Christian},
  issn         = {0300-9572},
  keyword      = {Cardiac arrest,Cardiac arrhythmia,Hypothermia,J-waves,Osborn waves,Out-of-hospital cardiac arrest,Repolarization,Targeted temperature management,Therapeutic hypothermia,TTM,Ventricular arrhythmia},
  language     = {eng},
  month        = {07},
  pages        = {119--125},
  publisher    = {Elsevier},
  series       = {Resuscitation},
  title        = {Osborn waves following out-of-hospital cardiac arrest—Effect of level of temperature management and risk of arrhythmia and death},
  url          = {http://dx.doi.org/10.1016/j.resuscitation.2018.04.037},
  volume       = {128},
  year         = {2018},
}