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(Circulation. 2008;118:977-978.)
© 2008 American Heart Association, Inc.

Images in Cardiovascular Medicine

Brugada-Like ECG Pattern in Severe Hypothermia

Hendrik Bonnemeier, MD; Wanda Mäuser, MD; Heribert Schunkert, MD

From Medizinische Kinik II, Universität zu Lübeck, Lübeck, Germany.

Correspondence to Hendrik Bonnemeier, MD, Medizinische Klinik II, Universität zu Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany. E-mail Bonnemei@medinf.mu-luebeck.de

An extract of the first 250 words of the full text is provided, because this article has no abstract.

On a cold December morning, a 28-year-old student was rescued after he had fallen into a nearly frozen river. He was admitted to the emergency department with severe hypothermia [28.5°C/83°F]. The examination and laboratory tests of the hemodynamically stable patient revealed no abnormality. The initial ECG exhibited sinus bradycardia, QT-interval prolongation, atrial and ventricular ectopy, and giant J waves in all ECG leads (Figure 1). Furthermore, there was a right bundle-branch block pattern and a saddleback-type ST-segment elevation in the precordial leads, ECG abnormalities suggestive of Brugada syndrome (Figure 2).

View larger version (45K):   Figure 1. A 12-channel surface ECG obtained at the patient’s admission shows sinus bradycardia, QT-interval prolongation, atrial and ventricular ectopy, prominent Osborne waves in all leads, a right bundle-branch block pattern, and a saddleback-type ST-segment elevation in V1 and V2.

View larger version (52K):   Figure 2. Detail of the admission ECG shows the Osborne waves and the Brugada-like ECG pattern with saddleback-type ST-segment elevation in V1 and V2.

After uncomplicated rewarming to a body temperature of 36.8°C/98°F, a follow-up ECG 14 hours after admission revealed that all ECG abnormalities had disappeared (Figure 3). The patient recovered quickly, without any significant arrhythmias, and was discharged 6 days after admission.

View larger version (46K):   Figure 3. A 12-channel surface ECG obtained 14 hours after the patient’s admission shows normal sinus rhythm without any depolarization or repolarization abnormalities.

It has been well described that severe hypothermia is associated with sinus bradycardia, prolongation of the PQ and QT intervals, progressive widening of the QRS . . . [Full Text of this Article]