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

Edina Hadziselimovic; Jakob Hartvig Thomsen; Jesper Kjaergaard; Lars Køber; Claus Graff; Steen Pehrson; Niklas Nielsen; David Erlinge; Martin Frydland; Sebastian Wiberg; Christian Hassager

doi:10.1016/j.resuscitation.2018.04.037

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

Edina Hadziselimovic, Jakob Hartvig Thomsen, Jesper Kjaergaard, Lars Køber, Claus Graff, Steen Pehrson, Niklas Nielsen, David Erlinge, Martin Frydland, Sebastian Wiberg, Christian Hassager

Department of Clinical Medicine

4 Citations (Scopus)

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 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%, p_log-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.

Original language	English
Journal	Resuscitation
Volume	128
Pages (from-to)	119-125
ISSN	0300-9572
DOIs	https://doi.org/10.1016/j.resuscitation.2018.04.037
Publication status	Published - Jul 2018

Keywords

Aged
Arrhythmias, Cardiac/etiology
Electrocardiography
Female
Humans
Hypothermia, Induced/adverse effects
Kaplan-Meier Estimate
Male
Middle Aged
Out-of-Hospital Cardiac Arrest/mortality
Risk Factors

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10.1016/j.resuscitation.2018.04.037

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Hadziselimovic, E., Thomsen, J. H., Kjaergaard, J., Køber, L., Graff, C., Pehrson, S., Nielsen, N., Erlinge, D., Frydland, M., Wiberg, S., & Hassager, C. (2018). Osborn waves following out-of-hospital cardiac arrest: Effect of level of temperature management and risk of arrhythmia and death. Resuscitation, 128, 119-125. https://doi.org/10.1016/j.resuscitation.2018.04.037

@article{deb4cebf935a4f5d89c652d566b21af7,

title = "Osborn waves following out-of-hospital cardiac arrest: Effect of level of temperature management and risk of arrhythmia and death",

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 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.",

keywords = "Aged, Arrhythmias, Cardiac/etiology, Electrocardiography, Female, Humans, Hypothermia, Induced/adverse effects, Kaplan-Meier Estimate, Male, Middle Aged, Out-of-Hospital Cardiac Arrest/mortality, Risk Factors",

author = "Edina Hadziselimovic and Thomsen, {Jakob Hartvig} and Jesper Kjaergaard and Lars K{\o}ber and Claus Graff and Steen Pehrson and Niklas Nielsen and David Erlinge and Martin Frydland and Sebastian Wiberg and Christian Hassager",

year = "2018",

month = jul,

doi = "10.1016/j.resuscitation.2018.04.037",

language = "English",

volume = "128",

pages = "119--125",

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publisher = "Elsevier Ireland Ltd",

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TY - JOUR

T1 - Osborn waves following out-of-hospital cardiac arrest

T2 - Effect of level of temperature management and risk of arrhythmia and death

AU - Hadziselimovic, Edina

AU - Thomsen, Jakob Hartvig

AU - Kjaergaard, Jesper

AU - Køber, Lars

AU - Graff, Claus

AU - Pehrson, Steen

AU - Nielsen, Niklas

AU - Erlinge, David

AU - Frydland, Martin

AU - Wiberg, Sebastian

AU - Hassager, Christian

PY - 2018/7

Y1 - 2018/7

N2 - 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.

AB - 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.

KW - Aged

KW - Arrhythmias, Cardiac/etiology

KW - Electrocardiography

KW - Female

KW - Humans

KW - Hypothermia, Induced/adverse effects

KW - Kaplan-Meier Estimate

KW - Male

KW - Middle Aged

KW - Out-of-Hospital Cardiac Arrest/mortality

KW - Risk Factors

U2 - 10.1016/j.resuscitation.2018.04.037

DO - 10.1016/j.resuscitation.2018.04.037

M3 - Journal article

C2 - 29723608

SN - 0300-9572

VL - 128

SP - 119

EP - 125

JO - Resuscitation

JF - Resuscitation

ER -

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

Abstract

Keywords

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