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doi: 10.1097/ALN.0b013e3181c38dc9

Preoperative Electrocardiograms

Alexoudis, Apostolos M.D.*; Spyridonidou, Aliki M.D.; Vogiatzaki, Theodosia M.D., Ph.D.; Iatrou, Christos M.D., Ph.D.

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To the Editor:

We read with interest the recent article by Correll et al. 1 about the use of preoperative electrocardiograms. The authors identified five clinical variables that constitute an independent risk factor for the presence of major electrocardiogram alterations. These variables could refine the criterion for preoperative electrocardiograms ordering.
We also believe that in patients with a family history of premature sudden death (< 35 yr of age at death), preoperative electrocardiogram should be considered. In fact, there is a familial cardiomyopathy, known as arrhythmogenic right ventricular dysplasia or cardiomyopathy, which is the major cause of sudden death in the young and athletes. Although arrhythmogenic right ventricular dysplasia or cardiomyopathy is quite a rare heart disease, it seems that it is also one of the main causes of sudden unexpected perioperative death.2 In one series, among 50 forensic autopsies performed after perioperative death, arrhythmogenic right ventricular dysplasia or cardiomyopathy was detected in 18 patients.3 All these patients were young (< 65 yr), with no previous cardiac history and underwent relative low-risk surgery. At least 50% of patients with arrhythmogenic right ventricular dysplasia or cardiomyopathy have an abnormal electrocardiograph at presentation, but within 6 yr of diagnosis, virtually all patients will have one or more of the following findings during sinus rhythm4: complete or incomplete right bundle branch block, QRS prolongation in the absence of right bundle branch block, epsilon wave in leads V1–V2, T-wave inversion in leads V1–V3, and delayed (i.e., ≥ 55 ms) S-wave upstroke in leads V1–V3.
Apostolos Alexoudis, M.D.,*
Aliki Spyridonidou, M.D.
Theodosia Vogiatzaki, M.D., Ph.D.
Christos Iatrou, M.D., Ph.D.
*Democritus University of Thrace-Greece, Orestiada, Greece.
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1.Correll DJ, Hepner DL, Chang C, Tsen L, Hevelone ND, Bader AM: Preoperative electrocardiograms: Patient factors predictive of abnormalities. Anesthesiology 2009; 110:1217–22

2.Alexoudis AK, Spyridonidou AG, Vogiatzaki TD, Iatrou CA: Anesthetic implications of arrhythmogenic right ventricular dysplasia/cardiomyopathy. Anaesthesia 2009; 64:73–8

3.Tabib A, Loire R, Miras A, Thivolet-Bejui F, Timour Q, Bui-Xuan B, Malicier D: Unsuspected cardiac lesions associated with sudden unexpected perioperative death. Eur J Anaesthesiol 2000; 17:230–5

4.Nasir K, Bomma C, Tandri H, Roguin A, Dalal D, Prakasa K, Tichnell C, James C, Spevak PJ, Marcus F, Calkins H: Electrocardiographic features of arrhythmogenic right ventricular dysplasia/cardiomyopathy according to disease severity. Circulation 2004; 110:1527–34

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