Bailey et al are to be congratulated on conducting a prospective study of electrical injury.1 The “abnormal” ECGs were mostly non‐specific abnormalities, and only occurred in 11% those who were deemed to have a risk factor. As a result, I searched the literature for cases of delayed lethal arrhythmias.
Bailey reported on a 16‐year‐old subject with a past history of palpitations who was assessed for painful burns on both hands after a 750 V DC shock.2 She was found dead 10 h later. No mention of an ECG was made. The coroner concluded that she had died from arrhythmia not necessarily directly related to the electric shock.
The patients reported by Jensen to have delayed dangerous ventricular arrhythmias also had delayed presentations (up to 2 months) and had initial ECG abnormalities.3 The other patient, a 43‐year‐old electrician, was exposed to a 3000 V DC electrical injury. Twelve hours later while playing football, he collapsed and was resuscitated from ventricular fibrillation. Unfortunately, there was no intervening ECG.
Sharma et al describe the case of a 24‐year‐old man who had an ECG 45 min after contacting a 220–240 V alternating current switch.4 This showed low voltage and a first degree atrioventricular (AV) block (PR interval of 0.3 s). After 2 h, he developed a Mobitz type I Wenkebach AV block. The next day, he had complete AV block. Six hours later, he developed ventricular fibrillation and needed defibrillation. He was observed for 6 more weeks without problems.4
So when assessing patients after an electric shock, these reports confirm that one can be confident that if the patient is asymptomatic and has a normal ECG, cardiac monitoring is not required.5 This is reassuring for both patients and staff. Delayed lethal arrhythmia must be exceptionally rare.
Footnotes
Competing interests: None declared.
References
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