Electrocardiographic changes predicting sudden death in propofol-related infusion syndrome.
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.
Vernooy
Kevin
K
Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
Delhaas
Tammo
T
Cremer
Olaf L
OL
Di Diego
José M
JM
Oliva
Antonio
A
Timmermans
Carl
C
Volders
Paul G
PG
Prinzen
Frits W
FW
Crijns
Harry J G M
HJ
Antzelevitch
Charles
C
Kalkman
Cornelis J
CJ
Rodriguez
Luz-Maria
LM
Brugada
Ramon
R
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
D006993:Hypnotics and Sedatives; D015742:Propofol