The QT interval in lightning injury with implications for the ‘cessation of metabolism’ hypothesis

An hypothesis is presented to provide an alternative explanation to the ‘cessation of metabolism’ hypothesis often invoked in lightning injury. ‘Cessation of metabolism’ has been proposed to explain the observation of good recovery after a prolonged period of cardiac arrest in some lightning injured patients. Re-examination of the cases used to support ‘cessation of metabolism’, however, reveals little evidence to justify the hypothesis. Re-evaluation of ECGs from lightning injured patients demonstrates a high incidence of QT prolongation. It is hypothesized that QT prolongation could promote a state of episodic induction of and recovery from Torsades de pointes ventricular tachycardia (VT). As lightning injury is not classically regarded as a cause of QT prolongation, the cardiological literature should include it in future tabulations of causes.