Could (High Resolution) Signal Averaged Ecg Explain the Cause of Sudden Death in Yellow

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COULD (HIGH RESOLUTION) SIGNAL AVERAGED ECG EXPLAIN THE CAUSE OF SUDDEN DEATH IN YELLOW OLEANDER POISONING ?

W Taggu1, A Gurtoo2, R Anilkumar3, J Balachander4, T Manimaran5, A Taggu6,

R Singh7, KR Sethuraman8

1Registrar Cardiology, NHS Trust Eastbourne DGH, Eastbourne, East Sussex, UK, 2Dept of Medicine, Lady Harding's Medical College, New Delhi, India, 3Dept of Cardiology, University hospital JIPMER, Pondicherry, India, 4HOD Dept of Cardiology, University hospital JIPMER, Pondicherry, India, 5Sr Registrar Cardiology, University hospital JIPMER, Pondicherry, India, 6Registrar Anaesthesiology, University hospital, JIPMER, Pondicherry, India, 7Registarar A&E, University hospital, JIPMER, Pondicherry, India, 8HOD Medicine, University hospital, JIPMER, Podicherry, India

Could High resolution Signal Averaged ECG explain the cause of sudden death in Yellow Oleander poisoning?Taggu W, Gurtoo A, Anilkumar R, Balachander J, Manimaran T, Taggu A, Singh R, Sethuraman KRDepartment of Medicine and Cardiology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, IndiaThe Yellow Oleander plant (Cerebra thevetia peruviana juss) is a common source of accidental poisoning worldwide. Although timely medical intervention reduces the mortality, a sub-group of patients who sustain sudden cardiac death, the cause remains elusive.In animal models cardiac damage in YOP is caused by inflammation and degenerative changes. Abnormal late potentials in post myocardial infarction and dilated cardiomyopathy patients were associated with higher prevalence of VF and sudden cardiac death. There is no human study on late potentials and sudden death in YOP.METHODSA Prospective study at University hospital JIPMER in South India, 72 patients with acute Yellow Oleander poisoning were studied. Hypokalemia, bradycardia and hypotension correction were prioritised. The standard surface ECG from CCU was compared with the SAECG recorded 12 hrs post poisoning. RESULTS: 72 patients were studied. Mean age 23.4 years (range 13-70). 41(56%) were females compared to 31(43%) males. 62(86%) patients had abnormal surface ECG of which sinus bradycardia 28(38%), sinoatrial block 5 (7%), AV block 15 (20%), sinus arrhythmia 8(11%), junctional escape rhythm 3(4%) and AV dissociation 3(4%) were observed.3 (4%) patients had sudden cardiac death whose initial ECG showed sinus bradycardia followed by electromechanical dissociation despite achieving normal serum potassium level and temporary intracardiac pacing. All 72 patients had normal SAECG.CONCLUSION: Contrary to the belief that YOP may induce focal areas of abnormal myocardium leading to sudden death, no abnormal latepotentials were found in our study. Histopathological analysis and autonomic dysfunction studies may shed light into this hitherto unfocussed area.