title: Electrocardiographic changes predicting sudden death in propofol-related infusion syndrome.
abstract: BACKGROUND
  The occurrence of metabolic acidosis, rhabdomyolysis, hyperkalemia, and sudden cardiac death after long-term, high-dose propofol infusion has been referred to as propofol infusion syndrome (PRIS).
  
  
  OBJECTIVE
  The purpose of this study was to explore the ECG abnormalities observed in a patient with PRIS in order to identify possible pathophysiologic mechanisms of the syndrome.
  
  
  METHODS
  ECG changes in the index case were characterized by down-sloping ST-segment elevation in precordial leads V1 to V3 (Brugada-like ECG pattern). We subsequently assessed the relationship between this ECG pattern and the propofol infusion rate, the development of arrhythmias, and the occurrence of sudden death in a previously described cohort of 67 head-injured patients, seven of whom had been identified as having PRIS.
  
  
  RESULTS
  Six of the PRIS patients developed the ECG pattern of ST-segment elevation in leads V1 to V3 and died within hours of irrecoverable electrical storm. This ECG pattern was the first aberration recorded hours before the death of these patients. ECGs that were available for 30 of 60 unaffected patients exhibited a normal pattern. None of the 60 patients developed ventricular arrhythmias.
  
  
  CONCLUSIONS
  Our findings indicate that development of an acquired Brugada-like ECG pattern in severely head-injured patients is a sign of cardiac electrical instability that predicts imminent cardiac death. Future studies will determine whether such an ECG pattern also predicts imminent cardiac arrhythmia in other patient populations.
authors.affiliation: Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
authors.forename: Kevin
authors.initials: K
authors.lastname: Vernooy
authors.forename: Tammo
authors.initials: T
authors.lastname: Delhaas
authors.forename: Olaf L
authors.initials: OL
authors.lastname: Cremer
authors.forename: José M
authors.initials: JM
authors.lastname: Di Diego
authors.forename: Antonio
authors.initials: A
authors.lastname: Oliva
authors.forename: Carl
authors.initials: C
authors.lastname: Timmermans
authors.forename: Paul G
authors.initials: PG
authors.lastname: Volders
authors.forename: Frits W
authors.initials: FW
authors.lastname: Prinzen
authors.forename: Harry J G M
authors.initials: HJ
authors.lastname: Crijns
authors.forename: Charles
authors.initials: C
authors.lastname: Antzelevitch
authors.forename: Cornelis J
authors.initials: CJ
authors.lastname: Kalkman
authors.forename: Luz-Maria
authors.initials: LM
authors.lastname: Rodriguez
authors.forename: Ramon
authors.initials: R
authors.lastname: Brugada
mesh_terms: D000138:Acidosis / Q000139:chemically induced; D058186:Acute Kidney Injury / Q000139:chemically induced; D000293:Adolescent; D016757:Death, Sudden, Cardiac; D004562:Electrocardiography; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D007262:Infusions, Intravenous; D008297:Male; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects*; D012206:Rhabdomyolysis / Q000139:chemically induced; D013577:Syndrome
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol