This prospective observational cohort study evaluated the effect of cardiac autonomic neuropathy (CAN) on perioperative ventricular repolarization, specifically QT and corrected QT (QTc) intervals, in patients undergoing elective coronary artery bypass grafting (CABG) surgery under general anesthesia. The study was conducted in a tertiary care university hospital between October 2023 and December 2024. Adult patients scheduled for isolated elective CABG surgery with sinus rhythm on preoperative electrocardiography were screened for eligibility. Cardiac autonomic function was assessed preoperatively using standardized Ewing's cardiovascular reflex tests. Patients were classified into two groups according to test results: CAN-positive (≥2 abnormal tests) and CAN-negative (\<2 abnormal tests). QT and QTc intervals were measured at predefined perioperative time points, including before anesthesia induction, baseline, before intubation, at 1 and 30 minutes after intubation, before cannulation, and 24 hours postoperatively. The primary objective was to compare perioperative QT and QTc interval changes between patients with and without CAN. Secondary outcomes included QT and QTc variability (ΔQT, ΔQTc) and the incidence of clinically significant QTc prolongation.
This prospective observational study was designed to evaluate the impact of cardiac autonomic neuropathy (CAN) on perioperative ventricular repolarization parameters, specifically QT and corrected QT (QTc) intervals, in patients undergoing elective coronary artery bypass grafting (CABG) surgery under general anesthesia. The study was conducted at a tertiary care university hospital within the Departments of Anesthesiology and Cardiovascular Surgery between October 2023 and December 2024. Patients scheduled for elective isolated CABG surgery with sinus rhythm on preoperative electrocardiography were screened for eligibility. Cardiac autonomic function was assessed preoperatively using standardized Ewing's cardiovascular reflex tests. Based on test results, patients were classified into two groups: CAN-positive (≥2 abnormal tests) and CAN-negative (\<2 abnormal tests). QT and QTc intervals were measured at predefined perioperative time points, and variability of repolarization parameters was also assessed. The primary aim was to compare perioperative QT and QTc interval changes between patients with and without CAN.
Study Type
OBSERVATIONAL
Enrollment
60
Sultangazi Haseki Training and Research Hospital
Istanbul, Turkey (Türkiye)
Health Science University, Haseki Training and Research Hospital
Istanbul, Turkey (Türkiye)
Perioperative change in corrected QT (QTc) interval
Corrected QT (QTc) interval measured from lead II electrocardiography using Bazett's formula and compared between patients with and without cardiac autonomic neuropathy at predefined perioperative time points.
Time frame: Before anesthesia induction (baseline), immediately before tracheal intubation, 1 minute after intubation, 30 minutes after intubation, before cardiopulmonary bypass cannulation, and 24 hours after surgery.
QT interval variability (ΔQT)
Difference between the maximum and minimum QT interval recorded during the perioperative period.
Time frame: From anesthesia induction to 24 hours after surgery.
Corrected QT interval variability (ΔQTc)
Difference between the maximum and minimum QTc interval recorded during the perioperative period.
Time frame: From anesthesia induction to 24 hours after surgery.
Incidence of QTc prolongation
Number and proportion of patients with QTc interval ≥470 ms during the perioperative period.
Time frame: From anesthesia induction to 24 hours after surgery.
Incidence of clinically significant QTc change
Number and proportion of patients with QTc interval increase (ΔQTc) ≥60 ms during the perioperative period.
Time frame: From anesthesia induction to 24 hours after surgery.
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