Change in the value of the QT interval at various stages of the perioperative period in patients with coronary ischemic heart disease under general anesthesia

Objective. To evaluate the status of QT interval derivatives in patients with chronic IHD during different perioperative periods of planned open cholecystectomy under general anaesthesia and to determine the possibility of using meldonium for prevention of QT interval dysfunction. 

Materials and methods. Patients with the diagnosis of cholelithiasis with verified forms of chronic CHD (angina I and II AC) were divided into 2 groups: Group 1 was the control group with conventional perioperative therapy, and Group 2 was the main group with additional meldonium. The dynamics of the corrected QT interval (QTc) and the variance of the QT interval (DQT) were assessed. Analysis was performed by means of daily Holter ECG monitoring, in which 6 time periods were singled out: 1 - the day before the operation (18 hours); 2 - hours before the operation; 3 - induction into anesthesia; 4 - maintenance of anesthesia; 5 - withdrawal from anesthesia; 6 - the day 2 after the operation (18 hours).

Results. The increase in QTc and DQT values during induction, maintenance and withdrawal from anesthesia was detected only in the control group. The inclusion of meldonium in perioperative therapy in patients with CHD was accompanied by the absence of QTc interval prolongation and an increase in DQT values in the periods of induction, exit and maintenance of anaesthesia.

Conclusion. The perioperative period was accompanied by a prolongation of the QTc interval and an increase in DQT values in the group receiving conventional therapy. The inclusion of meldonium was accompanied by no increase in QTc and DQT during most follow-up periods.

1. Vetshev P.S., Sulimov V.A., Nogtev P.V. Cholecystocardial syndrome in clinical practice. Klinicheskiye perspektivy gastro-enterologii, gepatologii. 2004;(6):15-19. (in Russ.)

2. Grin V.K. Dispersion of the QT interval. Donetsk: UkrNTEK. 2003.193 p. (in Russ.)

3. Gubergritz N. B. Cholelithiasis in lectures by S. P. Botkin. Unіversitets’ka klіnіka. 2008;4(1):56-67 (in Russ.)

4. Dovgalevskiy P.Ya., Rybak O.K., Burlaka A.N., Lazareva E.V., Katkova L.A., Dovgalevskiy Ya.P., Rakovskiy M.E. Temporal inhomogeneity of ventricular myocardial repolarization in practically healthy people: normative values of the duration and variance of the QT interval and its derivatives. Journal of arrhythmology. 2006;(44):30-34 (in Russ.)

5. Limankina I.N. Long QT interval syndrome and problems of safety of psychopharmacotherapy. Journal of arrhythmology. 2008;(52):66-71 (in Russ.)

6. Mikhin V.P. Cytoprotection in cardiology: achievements and perspectives. Part 2. he Russian Archives of Internal Medicine. 2014;2(16):33-41 (in Russ.)

7. Mikhin V.P. Cytoprotection in cardiology: achievements and prospects. Cardiology. 2015;55(10):90-95 (in Russ.). DOI: 10.18565/cardio.2015.10.90-95

8. Morgan-Jr. J. Edward, Murray Mikhael M. J. Clinical Anesthesiology. trans. from English 4th ed. Moscow: BINOM, 2014. 1203 p. (in Russ.)

9. Sinkov A.V. The syndrome of prolonged and shortened QT interval in clinical practice. Russian Medical Journal. 2014;22(23):1732-1736 (in Russ.)

10. Tkachenko, V.I. Normal human physiology. 2nd ed. Moscow: Meditsina, 2005. 910 p. (in Russ.)

11. Furman N.V., Shmatova S.S. Clinical significance of drug-induced intervals QT and QTc prolongation. Rational pharmacotherapy in cardiology. 2013;9(3): 311-315 (in Russ.)

12. Balasubramaniyam N., Palaniswamy C., Aronow W.S., Khera S., Balasubramanian G., Harikrishnan P., Doshi J.V., Nabors C. et al. Association of corrected QT interval with long-term mortality in patients with syncope. Arch Med Sci. 2013;9(6): 1049-1054. DOI: 10.5114/aoms.2013.39383.

13. Bazett H.C. An analysis of the time relations of electro cardiograms. Heart. 1920;(7):353-370.

14. Bello C.L., Mulay M., Huang X., Patyna S., Dinolfo M., Levine S., Van Vugt A., Toh M. et al. Electrocardiographic characterization of the QTc interval in patients with advanced solid tumors: pharmacokinetic-pharmacodynamic evaluation of sunitinib. Clin Cancer Res. 2009;15(22):7045-7052. DOI: 10.1158/1078-0432.CCR-09-1521

15. Chugh S.S., Reinier K., Singh T., Uy-Evanado A., Socoteanu C., Peters D., Mariani R., Gunson K. et al. Determinants of prolonged QT interval and their contribution to sudden death risk in coronary artery disease: the Oregon Sudden Unexpected Death Study. Circulation. 2009;119(5):663-670. DOI: 10.1161/CIRCULATIONAHA.108.797035

16. Crotti L., Celano G., Dagradi F., Schwartz P.J. Congenital long QT syndrome. Orphanet J Rare Dis. 2008;(3):18. DOI: 10.1186/1750-1172-3-18

17. Day C.P., McComb J.M., Campbell R.W. QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Br Heart J. 1990;63(6): 342-344. DOI: 10.1136/hrt.63.6.342

18. Etchegoyen C.V., Keller G.A., Mrad S., Cheng S., Di Girolamo G. Drug-induced QT Interval Prolongation in the Intensive Care Unit. Curr Clin Pharmacol. 2017;12(4):210-222. DOI: 10.2174/1574884713666180223123947

19. Foroughi M., Karkhaneh Yousefi Z., Majidi Tehrani M., Noori Foroutaghe A., Ghanavati A., Hassantash S.A. Prolonged QT interval and coronary artery bypass mortality due to heart failure. Asian Cardiovasc Thorac Ann. 2009;17(6):604-607. DOI: 10.1177/0218492309349068

20. Higham P.D., Campbell R.W. QT dispersion. Br Heart J. 1994;71(6):508-510. DOI: 10.1136/hrt.71.6.508

21. Kim T.Y., Choi B.J., Koo Y., Lee S., Yoon D. Development of a Risk Score for QT Prolongation in the Intensive Care Unit Using Time-Series Electrocardiogram Data and Electronic Medical Records. Healthc Inform Res. 2021;27(3):182-188. DOI: 10.4258/hir.2021.27.3.182.

22. Kligfield P., Lax K.G., Okin P.M. QT interval-heart rate relation during exercise in normal men and women: definition by linear regression analysis. J Am Coll Cardiol. 1996;28(6):1547-1555. DOI: 10.1016/s0735-1097(96)00351-8

23. Reilly J.G., Ayis S.A., Ferrier I.N., Jones S.J., Thomas S.H. QTc-interval abnormalities and psychotropic drug therapy in psychiatric patients. Lancet. 2000;355(9209):1048-1052. DOI: 10.1016/s0140-6736(00)02035-3

24. Schwartz P.J. The long QT syndrome. New York: Futura Publishing Company, 1997. 427 p.

25. Taran L.M., Szilagyi N. The duration of the electrical systole, Q-T, in acute rheumatic carditis in children. Am Heart J. 1947;33(1):14-26. DOI: 10.1016/0002-8703(47)90421-3

26. Trinkley K.E., Page R.L. 2nd, Lien H., Yamanouye K., Tisdale J.E. QT interval prolongation and the risk of torsades de pointes: essentials for clinicians. Curr Med Res Opin. 2013;29(12):1719-1726. DOI: 10.1185/03007995.2013.840568

27. van de Kraats G.B., Slob J., Tenback D.E. Reduction of prolonged QTc-interval related risks in treatment with neuropharmacological drugs. Recommendations for clinical practice. Tijdschr Psychiatr. 2007;49(1): 43-47. (in Dutch)

28. Vieweg W.V., Wood M.A., Fernandez A., Beatty-Brooks M., Hasnain M., Pandurangi A.K. Proarrhythmic risk with antipsychotic and antidepressant drugs: implications in the elderly. Drugs Aging. 2009;26(12):997-1012. DOI: 10.2165/11318880-000000000-00000

29. Yi G., Crook R., Guo X.H., Staunton A., Camm A.J., Malik M. Exercise-induced changes in the QT interval duration and dispersion in patients with sudden cardiac death after myocardial infarction. Int J Cardiol. 1998;63(3):271-279. DOI: 10.1016/s0167-5273(97)00318-5

30. Yi G., Poloniecki J., Dickie S., Elliott P.M., Malik M., McKenna W.J. Is QT dispersion associated with sudden cardiac death in patients with hypertrophic cardiomyopathy? Ann Noninvasive Electrocardiol. 2001;6(3):209-215. DOI: 10.1111/j.1542-474x.2001.tb00110.x