虽然电击伤是急诊室常见的情况，但欧洲目前没有关于这类患者管理的指南、共识和常规建议。有关电击伤导致迟发性心律失常的记录案例很少，且其与电击伤的关系尚未得到充分证实。我们也使用心脏特异性标志物进行心肌损伤的风险分层，但在这种临床情况下，尚没有重要的研究提到它们的实用性。因此，我们回顾性分析了过去23年内所有电击伤病例，以确定心脏心律失常（主要是恶性心律失常和迟发性心律失常）的患病率。我们回顾性搜索了捷克比尔森大学医院在1997年至2020年间诊断为电击伤（ICD诊断代码T754）的所有入院患者。我们使用医院的信息系统来查询伤情，并从患者病历中提取数据。我们在我们医院中发现了333例电击伤病例。男性约占三分之二，女性约占三分之一。儿童约占三分之一。大多数是低电压伤（< 1000 V，占91.6%）。所有参与者都进行了初始心电图检查，77.5%的患者进行了持续心电图监测，通常持续24小时。有39名患者（11.7%）出现心脏心律失常。最常见的心律失常包括：室颤、窦性心动过速、窦性心动过缓和心律不齐、房颤和心房上速。心电图显示28例患者（8.1%）存在心脏传导异常，10例患者（3%）有室上或室下期早搏。在10例（3%）中，我们发现了初始心电图上ST段和T波的变化。31例患者（9.3%）出现了意识丧失，50例患者（15.02%）报告有痺感。最常见的离子紊乱为低钾血症（18%）和低钙血症（3.3%）。离子紊乱患者发生心律失常和新诊断的心脏传导异常的情况较多。在258例（77.48%）患者中测定了肌钙蛋白水平（cTnI或hs-cTnT），其中19例（5.7%）显示超过99百分位数。将近三分之一的患者有不同程度的烧伤，41例患者（12.3%）伴有其他创伤。十一例患者经过院前抢救，三例因意外死亡，另一例因颅内出血而死亡。所有恶性心律失常均发生在电击伤后，未观察到延迟性威胁生命的心律失常，也没有发现任何恶性心律失常的预测因素。虽然有个别观察到心肌肌钙蛋白水平升高，但对风险分层并不有帮助。对于有心律失常的患者，离子紊乱可能更为重要。我们得出结论，无症状、未受伤的成人和儿科患者，初始心电图正常者无需持续心电图监测，可以回家。对高风险患者和入院时有轻微心电图异常的患者的建议则不那么明确。© 2023。作者，专属授权给Springer-Verlag GmbH Germany出版。

Even though electrical injuries are common in the emergency room, guidelines, consensus, and general recommendations for the management of these patients do not exist in Europe. Documented cases of delayed arrhythmias are rare and their connection with electrical injury has not been fully confirmed. We also use cardio-specific markers for the risk stratification of myocardial injury, but there is no significant study referring to their utility in this clinical situation. These reasons led us to retrospectively analyze all cases of electrical injuries over 23 years to determine the prevalence of cardiac arrhythmias (mainly malignant arrhythmias and delayed arrhythmias).We retrospectively searched all patients admitted to the University Hospital in Pilsen, CZ, with a diagnosis of electric injury (ICD diagnostic code T754) from 1997 to 2020. The hospital´s information system was used to research the injury; data were drawn from patient medical records.We identified 333 cases of electrical injury in our hospital. Men accounted for about two-thirds, and women one-third. Children accounted for about one-third of cases. Most were low-voltage injuries (< 1000 V, 91.6%). All participants had an initial ECG, and 77.5% of patients had continuous ECG monitoring, usually lasting 24 h. Cardiac arrhythmias were noticed in 39 patients (11.7%). The most frequent arrhythmias were: ventricular fibrillation, sinus tachycardia, bradycardia and arrhythmia, atrial fibrillation, and supraventricular tachycardia. The ECG showed cardiac conduction abnormalities in 28 patients (8.1%), and ten patients (3%) had supraventricular or ventricular extrasystoles. In ten cases (3%), we found changes in ST segments and T waves on the initial ECG. Thirty-one patients (9.3%) suffered a loss of consciousness and 50 patients (15.02%) reported paresthesia. The most frequent ion disbalances were hypokalemia (18%) and hypocalcemia (3.3%). Patients with an ion disbalance had significantly more arrhythmias and newly diagnosed cardiac conduction abnormalities. Troponin levels (cTnI or hs-cTnT) were measured in 258 cases (77.48%) and found to be elevated above the 99th percentile in 19 cases (5.7%). Almost one-third of patients had burns of various degrees of seriousness, and 41 patients (12.3%) had concomitant traumatic injuries. Eleven patients underwent pre-hospital resuscitation, three died in the hospital, and another died as result of intracranial hemorrhage.All malignant arrhythmias occurred immediately after the electrical injury, delayed life-threatening arrhythmias were not observed, and no predictive factors of malignant arrhythmias were found. While elevations of cardiac troponins were observed sporadically, they did not appear helpful for risk stratification. In patients with arrhythmias, ion disbalance may be more critical. We concluded that asymptomatic, uninjured adult and pediatric patients with normal initial ECG findings do not need continuous ECG monitoring and may be discharged home. Recommendations for high-risk patients and patients with mild ECG abnormalities at admission are less obvious.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.