ECG CHANGES IN PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT WITH ELECTROCUTION INJURIES
DOI:
https://doi.org/10.71000/2hp8kk46Keywords:
Emergency Department , Arrhythmias, Cardiac monitoring, Electrocution, Electrocardiography, , High-voltage injury, PrognosisAbstract
Background: Electrocution injuries often lead to a spectrum of cardiovascular disturbances, ranging from transient arrhythmias to fatal cardiac arrest. Despite their clinical significance, the frequency and pattern of electrocardiographic (ECG) abnormalities following electrical injuries remain inadequately reported in local healthcare settings. Understanding these cardiac manifestations is essential for early identification of high-risk patients and for optimizing emergency management protocols.
Objective: To determine the frequency and pattern of ECG abnormalities in patients presenting with electrocution injuries and to assess their association with voltage exposure and time to hospital presentation.
Methods: This observational cross-sectional study was conducted in the Emergency Department of Combined Military Hospital (CMH) Rawalpindi from January 2023 to January 2025 following ethical approval (IRB No. 592). Patients aged 12–80 years who presented within 24 hours of electrocution were included, while those with pre-existing cardiac disease, cardioselective drug use, or unrelated trauma were excluded. A structured proforma recorded demographic details, voltage exposure, contact duration, and time to presentation. Standard 12-lead ECGs were obtained and interpreted by emergency physicians and validated by senior specialists. Data were analyzed using SPSS v22 with significance set at p<0.05.
Results: A total of 120 patients were analyzed (mean age 34.0 ± 13.4 years; 65.0% male). Low-voltage injuries (<1000 V) constituted 81.7% (n=98), while high-voltage injuries (>1000 V) accounted for 18.3% (n=22). Sinus tachycardia was the most frequent ECG finding (36.7%), followed by normal sinus rhythm (20.0%), atrial fibrillation (10.0%), and T-wave abnormalities (9.2%). High-voltage exposure showed greater association with atrial fibrillation (27.3%) and T-wave changes (18.2%). Mortality reached 40% among patients presenting after six hours, compared with 6.7% in those arriving within one hour.
Conclusion: ECG abnormalities are common following electrocution, with high-voltage injuries predisposing to more severe arrhythmias and repolarization changes. Delayed presentation correlates with poorer outcomes, emphasizing the importance of early triage, ECG evaluation, and continuous cardiac monitoring in all electrocution cases.
References
Kroll MW, Luceri RM, Efimov IR, Calkins H. The Mechanism of Death in Electrocution: A Historical Review of the Literature. Am J Forensic Med Pathol. 2025;46(1):3-9.
Venugopal NP. Retinal Evaluation in Electrocution: Its Significance. Neurol India. 2023;71(2):359.
Favia M, Mele F, Introna F, De Donno A. Morphological cardiac changes in electrocution deaths: A literature review. Med Sci Law. 2021;61(1_suppl):130-135.
Gangidi S, Govande M, McCollum K, Lee RC. Electrical shock injuries: an analysis of voltage, frequency, and contact mode determinants. Front Disaster Emerg Med. 2024 Nov 19;2:1477987.
Obeso-Martinez I. Low-Dose Electrocution and Atrial Fibrillation. Adv Emerg Nurs J. 2023;45(4):295-300.
Koren O, Paz E, Rozner E, Mahamid M, Turgeman Y. Late myocardial sequelae of electrical injury. Clin Case Rep. 2020;8(12):3408-3411.
Zhao H, Lei Z, Yang M, Li X, Tang J, Dong Y, Feng J, Bian Y. Epidemiology and Prognostic Factors Analysis of Electrical Injuries in Shaanxi, China: A Single-Center Observational Study of 385 Cases. J Burn Care Res. 2024 Jun 14
Dechent D, Emonds T, Stunder D, Schmiedchen K, Kraus T, Driessen S. Direct current electrical injuries: A systematic review of case reports and case series. Burns. 2020 Mar;46(2):273-282.
Knopov A, Deluca G, Kheirbek T, Musisca NJ. A Consequence of an Electrical-Burn Injury: Atrial Fibrillation. R I Med J. 2024 May 2;107(4):38-40.
Guimarães F, Camões J, Mesquita A, Gomes E, Araujo R. A Case Report: Low Voltage Electric Injuries Culminating in Cardiac Arrest and Direct Lung Injury. Cureus. 2020;12(10):e11261.
Maritz SM, Motsepe TA, Gamizelo S. Electrocution induced cardiac dysrhythmia: an Izinyoka case. Int Surg J. 2025;12(3):395-8.
Lenstra JJ, Kuznecova-Keppel Hesselink L, la Bastide-van Gemert S, Jacobs B, Nijsten MWN, van der Horst ICC et al. The Association of Early Electrocardiographic Abnormalities With Brain Injury Severity and Outcome in Severe Traumatic Brain Injury. Front Neurol. 2021;11:597737.
Rattan A, Goyal D. ECG monitoring in high voltage electric injury patients presenting with normal ECG: Time to revisit practice? J Electrocardiol. 2021;68:164–166.
Lee JH, Lee DH, Lee BK, Cho YS, Kim DK, Jung YH. Role of electrocardiogram findings in predicting 48-h mortality in patients with traumatic brain injury. BMC Neurol. 2022;22(1):190.
Seyfrydova M, Rokyta R, Rajdl D, Huml M. Arrhythmias and laboratory abnormalities after an electrical accident: a single-center, retrospective study of 333 cases. Clin Res Cardiol. 2023;112(12):1835-47.
Ghosh S, Chandra A, Sen S, Dutta S. Atrial fibrillation following low voltage electrical injury. BMJ Case Rep. 2021;14(1).
Knopov A, Deluca G, Kheirbek T, Musisca NJ. A Consequence of an Electrical-Burn Injury: Atrial Fibrillation. R I Med J (2013). 2024;107(5):18-20.
Rattan A, Goyal D. ECG monitoring in high voltage electric injury patients presenting with normal ECG: Time to revisit practice? J Electrocardiol. 2021;68:164-6.
Welzel G, Schuster S. Electric catfish hearts are not intrinsically immune to electric shocks. J Exp Biol. 2022;225(15).
Corrall S, Laws S, Rice A. Low-voltage electrical injuries and the electrocardiogram: is a 'normal' electrocardiogram sufficient for safe discharge from care? A systematic review. Br Paramed J. 2023;8(3):27-36.
Ahmed J, Stenkula C, Omar S, Ghanima J, Bremtun FF, Bergan J, et al. Patient outcomes after electrical injury - a retrospective study. Scand J Trauma Resusc Emerg Med. 2021;29(1):114.
Svendsen TB, Bærheim D, Dale J, Goffeng LO, Vesterfjell SP, Ofstad EH, et al. Patients with low-voltage electric shock referred to an Emergency Department. Tidsskr Nor Laegeforen. 2022;141(1).
Pilecky D, Kovács E, Zima E. [Risk of arrhythmias and cardiac complications after electrical injury]. Orv Hetil. 2020;161(47):1979-88.
Dharanindra M, Pothineni RB, Gontla DK, P SR, Shriram Dhanasekaran K. Successful Management of an Occupational High-Voltage Electric Injury Associated With High-Risk Factors and a Clinically Significant Arrhythmia. Cureus. 2023;15(7):e41940.
Basuki A, Song A, Yovita NV, Suryadinata KL, Sagala AE. The treatment challenges and limitation in high-voltage pediatric electrical burn at rural area: A case report. Int J Surg Case Rep. 2021;82:105857.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Amer Iqbal, Tamkeen Pervez, Muhammad Ashfaq, Riaz Ahmad, Anees Ur Rehman, Zeeshan Munir (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
