Effect of tourniquet use on Index of Cardiac-Electrophysiological Balance (ICEB) in upper extremity surgeries, prospective cross-sectional study

Background This study aimed to investigate the effects of tourniquet application during upper extremity surgeries on the Index of Cardiac Electrophysiological Balance (ICEB) and its corrected form (ICEBc), which are novel, non-invasive electrocardiographic markers used to assess arrhythmia risk. Methods This prospective cross-sectional study included 20 patients aged 18–65 years with ASA physical status I–III, scheduled for elective upper extremity fixation surgery. ICEB and ICEBc values were calculated at six different time points perioperatively using electrocardiographic measurements. Additional parameters such as heart rate (HR), QT interval, QRS duration, systolic/diastolic/mean arterial pressure (SAP/DAP/MAP) were also recorded. Data were analyzed using repeated-measures ANOVA and Friedman tests, as appropriate. Results ICEB and ICEBc values showed significant increases after tourniquet deflation compared to baseline (ICEB p < 0.001). QT intervals were also significantly prolonged after deflation (p = 0.021). While tourniquet inflation caused slight decreases in ICEB and ICEBc, these changes were not statistically significant. Heart rate and blood pressure showed expected perioperative fluctuations but did not significantly influence ICEB trends. Conclusions Tourniquet deflation in upper extremity surgeries may cause transient increases in ICEB and ICEBc, suggesting a possible, though limited, impact on cardiac electrophysiological balance. However, given the short duration and smaller ischemic area of upper extremity tourniquet use, the arrhythmogenic risk appears to be minimal. ICEB and ICEBc may serve as useful markers for perioperative cardiac risk stratification and warrant further investigation. Clinical Trial : PRS Number:NCT06936150 / Registration Date : 12.04.2025 /Retrospectively Registered