ECG CHANGES IN PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT WITH ELECTROCUTION INJURIES

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.