Electrocardiographic changes during cholangiopancreatography: ST segment

The existence of normal or abnormal pre-ERCP electrocardiogram had little prognostic value in predicting the change of electrocardiographic changes developing during the procedure (Table 4). Of the 22 patients who had clinical, radiological and echocardiographic evidence of heart disease, unifocal ventricular extrasystoles developed in eight, multifocal ventricular extrasystoles developed in three, atrial extrasystoles developed in six and sinus tachycardia in 20.

ST segment changes (depression or elevation) during ERCP, in comparison with the baseline electrocardiogram, were considered as sign of myocardial ischemia. Sixteen (53%) patients developed ST segment changes (15 ST depression and one ST elevation) during the procedure. In all patients the changes were asymptomatic. In all instances the ST segment changes disappeared when the endoscope was withdrawn. There were no significant ST segment changes in the control group during chest, bone, abdomen and small bowel through studies.

TABLE 4 Prevalences of PACs, ST, and PVCs during Holter monitoring of patients with ERCP and in control subjects

Control Subjects (n) ERCP Patients (n) P
PACs 5 19 <0.05
ST 0 27 <0.05
PVCs 3 9 <0.05

ERCP Endoscopic retrograde cholangiopancreatography; PACs Premature atrial complexes; PVCs Premature ventricular complexes; ST Sinus tachycardia;

Laboratory

In all patients oxygen saturation decreased during ERCP from a mean baseline 91.4% to a minimum of 78.6% (P<0.05). Saturation recovered to the baseline level 30 min after the study. Linear regression analysis was performed for arterial oxygen saturation and ST segment in 16 patients. A significant correlation was found between oxygen saturation and ST segment changes (Figure 2).

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Figure 2) Linear regression shown significant correlation between oxygen saturation and ST segment depression. 95% confidence lines

extrasystoles

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