Effects of propofol on ventricular repolarization and incidence of malignant arrhythmias in adults

Background: Propofol is commonly used for procedural sedation in interventional electrophysiology. However, ventricular arrhythmias under Propofol have been reported. Our aim was to investigate ventricular repolarization and incidence of ventricular arrhythmias under Propofol infusion in adults with cardiac arrhythmias. Methods: QRS, QTcB (Bazett), QTcFri (Fridericia), JTc, measurement of T peak to Tend time (T _p-e ) at baseline and under Propofol infusion was performed in 235 patients. Screening for unexpected ventricular arrhythmias was performed in 1165 patients undergoing EP procedures under Propofol. Results: A significant prolongation of T _p-e under Propofol infusion (79.7 ± 17.3 vs. 86.4 ± 22.5 ms, p < 0.001) and of QTcFri (429.3 ± 35.8 vs. 435.5 ± 36.5, p = 0.033) was detected. No significant change of the QTcB interval, JTc interval or QRS duration was observed. One case (0.09%) of ventricular fibrillation during rapid ventricular pacing under Propofol occurred. Conclusion: Although transmural dispersion of ventricular repolarisation is increased under Propofol, incidence of malignant ventricular arrhythmias is low. For evaluation of QT interval under Propofol, Fridericia's correction formula should be used rather than Bazett's formula.