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Durmuş G et al, 2017: Assessment of electrocardiographic parameters in adult patients undergoing extracorporeal shockwave lithotripsy.

Durmuş G, Kalyoncuoğlu M, Karataş MB, Çanga Y, Öztürk S, Özal E, Çakıllı Y, Kırış T, Güngör B, Alper AT, Can MM, Bolca O.
Department of Cardiology, Haseki Training and Research Hospital, İstanbul, Turkey.

Abstract

OBJECTIVE: Extracorporeal shock wave lithotripsy (ESWL) is a safe and effective treatment for urinary tract calculi. While serious side effects are rare, transient cardiac arrhythmias may occur. New electrocardiographic (ECG) parameters, such as P wave dispersion (PWD), QT dispersion (QTd), T peak to T end (Tp-e) interval, Tp-e interval/QT ratio, and Tp-e interval/corrected QT ratio have been defined to help predict atrial and ventricular arrhythmias. However, effect of ESWL on these ECG parameters has not been previously investigated. The present study was an examination of the effect of ESWL on ECG parameters.
METHODS: Total of 40 consecutive patients who underwent ESWL were prospectively enrolled in the study. Pre-procedure ECG parameters were compared with post-procedure ECG parameters.
RESULTS: PWD values were significantly longer on post-procedure ECG compared with pre-procedure ECG (p=0.017). Corrected QT duration and QTd were significantly longer on postprocedure ECG compared with pre-procedure ECG (p=0.046 and p=0.008, respectively). In addition, Tp-e interval, Tp-e interval/QT ratio, and Tp-e interval/QTc ratio were significantly longer post procedure (p=0.035, p=0.045, and p=0.022, respectively). In univariate correlation analysis, duration of procedure was significantly correlated with post-procedure PWD, QTc, and QTD values.
CONCLUSION: Clinical use of ECG parameters may be helpful in monitoring of patients receiving ungated ESWL in order to detect cardiac dysrhythmia.

Turk Kardiyol Dern Ars. 2017 Jul;45(5):408-414. doi: 10.5543/tkda.2017.59084.

 

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Commenti 1

Peter Alken il Lunedì, 05 Marzo 2018 13:33

11 cardiologist writing about the differences between pre- and post-ESWL ECGs in 40 patients treated in 4 different clinics during a 3-months period. This reflects academic rules in medicine in Turkey where it is necessary to author a set number of publications to get certain academic degrees.

According to the authors - no urologist was involved - ESWL was performed without sedation or anesthesia and patients did not receive any medication during procedure.
The E-1000 electrohydraulic lithotripter (EMD Medical Technologies, Ankara, Turkey) is advertised for “anesthesia-free treatment”. Searching for publications on that machine I only found one report
(Özgür BC et al. Pediatric extracorporeal shock wave lithotripsy: multi-institutional results. Urologia 2016; 83 (2): 83-86) on ESWL in children; they were all treated under general anesthesia or sedation with fentanyl. I am not sure if in the present series ESWL was really done without any medication that could have had an influence on the post ESWL-ECG.
“No ventricular or atrial extrasystole was observed on pre-procedure ECGs of study population. Atrial extrasystole developed in 4 (10%) patients and ventricular extrasystole developed in 3 (8%) patients during periprocedural period.” I was disappointed to see that the authors do not describe if the ECG changes seen after ESWL and regarded as an effect of the latter were in some way correlated to the 7 cases with - clinical insignificant - extrasystoles.

11 cardiologist writing about the differences between pre- and post-ESWL ECGs in 40 patients treated in 4 different clinics during a 3-months period. This reflects academic rules in medicine in Turkey where it is necessary to author a set number of publications to get certain academic degrees. According to the authors - no urologist was involved - ESWL was performed without sedation or anesthesia and patients did not receive any medication during procedure. The E-1000 electrohydraulic lithotripter (EMD Medical Technologies, Ankara, Turkey) is advertised for “anesthesia-free treatment”. Searching for publications on that machine I only found one report (Özgür BC et al. Pediatric extracorporeal shock wave lithotripsy: multi-institutional results. Urologia 2016; 83 (2): 83-86) on ESWL in children; they were all treated under general anesthesia or sedation with fentanyl. I am not sure if in the present series ESWL was really done without any medication that could have had an influence on the post ESWL-ECG. “No ventricular or atrial extrasystole was observed on pre-procedure ECGs of study population. Atrial extrasystole developed in 4 (10%) patients and ventricular extrasystole developed in 3 (8%) patients during periprocedural period.” I was disappointed to see that the authors do not describe if the ECG changes seen after ESWL and regarded as an effect of the latter were in some way correlated to the 7 cases with - clinical insignificant - extrasystoles.
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