title: Injury to the conduction system: management of life-threatening arrhythmias after penetrating cardiac trauma.
abstract: BACKGROUND
  Life-threatening conduction abnormalities after penetrating cardiac injuries (PCIs) are rare, and rapid identification and treatment of these arrhythmias are critical to survival. This study highlights diagnosis and management strategies for conduction abnormalities after PCI.
  
  
  METHODS
  Patients with life-threatening arrhythmias after PCI were identified at an urban, level I trauma center registry.
  
  
  RESULTS
  Seventy-one patients survived to reach the hospital after PCI. Of these, 3 (4%) survivors (male = 3, mean age 41.3, median injury severity score = 25) had critical conduction abnormalities after cardiorrhaphy. All patients had multichamber and atrioventricular nodal injury. After initial cardiorrhaphy and control of hemorrhage, all patients had sustained hypotension with bradycardia from complete heart block. Two patients had ventricular septal defects requiring repair. All 3 patients survived.
  
  
  CONCLUSIONS
  Rapid recognition of injury to the cardiac conduction system after PCI as a source of sustained hypotension is essential to early restoration of cardiac function and survival.
authors.affiliation: Emory University Department of Surgery, Grady Memorial Hospital, 69 Jesse Hill Jr. Drive SE, Glenn Building Suite 308, Atlanta, GA 30303, USA.
authors.forename: Rashi
authors.initials: R
authors.lastname: Jhunjhunwala
authors.affiliation: Emory University Department of Surgery, Grady Memorial Hospital, 69 Jesse Hill Jr. Drive SE, Glenn Building Suite 308, Atlanta, GA 30303, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Dente
authors.affiliation: Emory University Department of Surgery, Grady Memorial Hospital, 69 Jesse Hill Jr. Drive SE, Glenn Building Suite 308, Atlanta, GA 30303, USA.
authors.forename: William Brent
authors.initials: WB
authors.lastname: Keeling
authors.affiliation: Emory University Department of Surgery, Grady Memorial Hospital, 69 Jesse Hill Jr. Drive SE, Glenn Building Suite 308, Atlanta, GA 30303, USA.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Prest
authors.affiliation: Emory University Department of Surgery, Grady Memorial Hospital, 69 Jesse Hill Jr. Drive SE, Glenn Building Suite 308, Atlanta, GA 30303, USA.
authors.forename: Stacy D
authors.initials: SD
authors.lastname: Dougherty
authors.affiliation: Emory University Department of Surgery, Grady Memorial Hospital, 69 Jesse Hill Jr. Drive SE, Glenn Building Suite 308, Atlanta, GA 30303, USA.
authors.forename: Rondi B
authors.initials: RB
authors.lastname: Gelbard
authors.affiliation: Legacy Trauma Specialists, Legacy Emanuel Medical Center, Portland, OR, USA.
authors.forename: William B
authors.initials: WB
authors.lastname: Long
authors.affiliation: Emory University Department of Surgery, Grady Memorial Hospital, 69 Jesse Hill Jr. Drive SE, Glenn Building Suite 308, Atlanta, GA 30303, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Nicholas
authors.affiliation: Emory University Department of Surgery, Grady Memorial Hospital, 69 Jesse Hill Jr. Drive SE, Glenn Building Suite 308, Atlanta, GA 30303, USA. Electronic address: bcmorse@emory.edu.
authors.forename: Bryan C
authors.initials: BC
authors.lastname: Morse
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D053840:Brugada Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D000075224:Cardiac Conduction System Disease; D002304:Cardiac Pacing, Artificial; D006348:Cardiac Surgical Procedures; D006335:Heart Injuries / Q000601:surgery* / Q000628:therapy; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D012042:Registries; D014193:Trauma Centers; D014505:Urban Population; D014950:Wounds, Penetrating / Q000150:complications / Q000601:surgery* / Q000628:therapy
keywords: Arrhythmia after penetrating cardiac injury; Complete heart block; Traumatic VSD; Traumatic arrhythmia; Ventricular septal injury