The cardiac rhythm in accidental hypothermia

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Summary

An analysis of the ECGs from 60 patients with accidental hypothermia reveals several facts concerning rhythmicity.

Echocardiograms were useful to determine the precise rhythm in cases without discernible P waves. Atrial fibrillation (AF) was unusual in mild hypothermia (>32.0°C). AF was often observed in moderate (32.0–26.0°C) and moderately deep (<26.0°C) hypothermia. However, about half of the cases with moderately deep hypothermia remained in sinus, atrial, or junctional rhythm.

AF was usually converted to sinus rhythm without any antiarrhythmic agents soon after normothermia was restored. There was no significant difference in the mortality rate between the AF and non-AF groups. Therefore, no aggressive treatment for this arrhythmia seems to be necessary.

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    Nine studies were conducted in the United States of America (Frank et al., 1997; Hannan et al., 2010; Hicks et al., 1956; Insler et al., 2000; Mowery et al., 2011; Phillips, 1997; Spaniol et al., 1994; Vassallo et al., 1999; Waibel et al., 2009), four in the United Kingdom (Fleming & Muir, 1956; Graham et al., 2001; Janke et al., 1996; Rankin & Rae, 1984), and three in Canada (Cheng et al., 1996; Nathan & Polis, 1995; Wong et al., 1999). Two studies were conducted in both Australia (Emslie-Smith et al., 1959; Karalapillai et al., 2011) and Austria (Pezawas et al., 2007, 2004) and single studies were completed in Croatia (Durakovic et al., 1999), Japan (Okada, 1984), Italy (Ranucci et al., 2007), Norway (Ovrum et al., 2000), Finland (Tiainen et al., 2009), Brazil (de Souza et al., 2007), and Germany (Storm et al., 2011). The study by Karalapillai et al. (2011) had the largest sample size which included 43,158 participants.

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From the Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Mita, Minatoku, Tokyo, Japan.

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