ECG changes after pneumonectomy may develope due to

  Anatomic changes in the thorax: mediastinal shift, diaphragmatic elevation, cardiac herniation.

  Hemodynamic changes (increased load on right ventricle, especially after right pneumectomy).

  Biochemical changes (hypoxia).

  Postoperative pericarditis.



ECG changes after lung resection are also influenced by

  The extent of resection:
- small segmental resection (segmentectomy)
- resection of an entire lobe (lobectomy)
- resection of an entire lung (pneumonectomy)

  The laterality of pneumonectomy: left- or right-sided.

  Chemotherapy (in some patients)

  Radiotherapy (in some patients)



ECG changes that may be observed after pneumonectomy

  Sinus tachycardia

  Atrial fibrillation

  ST depression

  ST elevation and PR depression (pericarditis)

  Negative T waves in inferior and lateral leads (7%)

  New onset of (incomplete or complete) right bundle branch block (RBBB) (5%)



Additional ECG changes that may be observed after LEFT-sided pneumonectomy

  Delayed precordial R/S transition.

  Left axis deviation (acute postoperative phase). Right axis deviation (several months or a year after the surgery).

  QS pattern in leads V1 and V2.



Additional ECG changes that may be observed after RIGHT-sided pneumonectomy

  Early precordial R/S transition.

  Right axis deviation

  Low voltage (due to cardiac herniation).



References

  J Electrocardiol 2013;46(6):697.e1-8..

  N Engl J Med 1983;308(24):1481-1482.

  Anesth Essays Res 2015;9(2):263-265.

  J Anesth 2010;24(6):926-929.

  Ann Thorac Surg 2011;92(1):244-249.

  Ann Thorac Surg 1992;53(4):642-647..




ECG 1a. The ECG above belongs to a 69 years-old man who had undergone total right pneumonectomy.
It was recorded at a standard calibration of 10 mm/mV.
Early R/S transition is seen. Leads V1 to V3 show negative T waves.

Click here for a more detailed ECG



ECG 1b. The ECG above belongs to the same patient.
It was recorded immediately after the ECG 1a, but at a calibration of 20 mm/mV.

Click here for a more detailed ECG



Figure 1. Above is his chest X-ray (4 months ago). He had undergone radiotherapy in the past.
He had Vena Cava Superior Syndrome and a stent was implanted.
Chemotherapy and radiotherapy are additional factors which may modify the ECG.