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Zhou X, Ren L, Huang J, Zhang Y, Cai Y, Pu J. Novel SCN5A frame‑shift mutation underlying in patient with idiopathic ventricular fibrillation manifested with J wave in inferior lead and prolonged S‑wave in precordial lead. Exp Ther Med 2023; 25:287. [PMID: 37206574 PMCID: PMC10189605 DOI: 10.3892/etm.2023.11986] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 02/01/2023] [Indexed: 05/21/2023] Open
Abstract
Mutations in the SCN5A gene has been recognized as resulting in a series of life-threatening arrhythmias. However, it also causes idiopathic ventricular fibrillation (IVF) with J wave in inferior leads and prolonged S-wave upstroke in precordial leads, which has not been previously reported. The present study aimed to study the mechanisms of a patient with IVF manifested with J wave in inferior leads and prolonged S-wave upstroke in precordial leads. The electrocardiograms (ECG) of the proband were recorded and genetic testing was conducted. Patch-clamp and immunocytochemical studies were performed in heterologously transfected 293 cells. The VF attacks was documented in a 55-year-old male proband with syncope episodes. 12-lead ECG shown the transient J wave in the inferior leads and prolonged S-wave upstroke in precordial V1-V3 leads in the same timeframe. Genetic analysis revealed a novel 1 base deletion (G) at position 839 in exon 2 in SCN5A gene (C280S*fs61), which causes a severe truncation of the sodium channel. The functional study revealed that in 293 cells transfected with mutant channel, no sodium current could be recorded even though the immunocytochemical experiment confirmed the truncated sodium channel existed in cytosol. The kinetics of the wild-type (WT) channel were not altered when co-transfected with C280S*fs61 mutant which suggested a haploinsufficiency effect of sodium channel in the cells. The present study identified a novel C280Sfs*61 mutation that caused the 'loss of function' of the sodium channel by haploinsufficiency mechanism. The reduced sodium channel function in the heart may cause conduction delay that may underlie the manifestation of J wave and prolonged S-wave upstroke associated with IVF.
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Affiliation(s)
- Xiaoqian Zhou
- Department of Cardiology, Shanghai East Hospital, Tongji University, Shanghai 100123, P.R. China
| | - Lan Ren
- Department of Cardiology, Beijing Jishuitan Hospital, Beijing 100035, P.R. China
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100037, P.R. China
| | - Jian Huang
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100037, P.R. China
| | - Yinhui Zhang
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100037, P.R. China
| | - Ying Cai
- Department of Cardiology, Shanghai East Hospital, Tongji University, Shanghai 100123, P.R. China
- Correspondence to: Professor Jielin Pu and Professor Ying Cai, Department of Cardiology, Shanghai East Hospital, Tongji University, 1800 Yuntai Road, Pudong, Shanghai 100123, P.R. China
| | - Jielin Pu
- Department of Cardiology, Shanghai East Hospital, Tongji University, Shanghai 100123, P.R. China
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100037, P.R. China
- Correspondence to: Professor Jielin Pu and Professor Ying Cai, Department of Cardiology, Shanghai East Hospital, Tongji University, 1800 Yuntai Road, Pudong, Shanghai 100123, P.R. China
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ECG Markers of Acute Melatonin Treatment in a Porcine Model of Acute Myocardial Ischemia. Int J Mol Sci 2022; 23:ijms231911800. [PMID: 36233101 PMCID: PMC9570319 DOI: 10.3390/ijms231911800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022] Open
Abstract
In myocardial ischemia, melatonin confers antiarrhythmic action, but its electrocardiographic expression is unclear. We aimed to evaluate the effects of melatonin treatment on electrocardiogram (ECG) parameters reflecting major arrhythmogenic factors and to test the association of these parameters with ventricular fibrillation (VF) incidence. Myocardial ischemia was induced by 40 min coronary artery occlusion in 25 anesthetized pigs. After induction of ischemia, 12 and 13 animals were given melatonin or placebo, respectively. Twelve-lead ECGs were recorded and durations of QRS, QT, Tpeak-Tend intervals and extrasystolic burden were measured at baseline and during occlusion. During ischemia, VF episodes clustered into early and delayed phases (<10 and >20 min, respectively), and QRS duration was associated with VF incidence. QT interval and extrasystolic burden did not differ between the groups. The Tpeak-Tend interval was progressively prolonged, and the prolongation was less pronounced in the treated animals. QRS duration increased, demonstrating two maxima (5−10 and 25 min, respectively). In the melatonin group, the earlier maximum was blunted, and VF development in this period was prevented. Thus, acute melatonin treatment prevented excessive prolongation of the QRS and Tpeak-Tend intervals in the porcine myocardial infarction model, and QRS duration can be used for the assessment of antiarrhythmic action of melatonin.
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Yakkali S, Teresa Selvin S, Thomas S, Bikeyeva V, Abdullah A, Radivojevic A, Abu Jad AA, Ravanavena A, Ravindra C, Igweonu-Nwakile EO, Ali S, Paul S, Hamid P. Why Is There an Increased Risk for Sudden Cardiac Death in Patients With Early Repolarization Syndrome? Cureus 2022; 14:e26820. [PMID: 35971350 PMCID: PMC9374281 DOI: 10.7759/cureus.26820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/13/2022] [Indexed: 11/29/2022] Open
Abstract
The last two decades have changed the viewpoint on early repolarization syndrome (ERS). The prevalence of the early repolarization pattern is variable and ranges between 3-24% depending upon age, gender, and criteria used for J-point upliftment from baseline (0.05mV vs. 1 mV). While this pattern was previously linked with a benign result, multiple recent investigations have found a link between early repolarization and Sudden Cardiac Death (SCD) by causing life-threatening arrhythmias like Ventricular tachycardia/Ventricular fibrillation, a condition known as early repolarization syndrome. The syndrome falls under a broader bracket of J wave syndromes, which can be caused by early repolarization or depolarization abnormalities. The characteristics of early repolarization that are considered high risk for Sudden Cardiac Death include the amplitude of J-point upliftment from baseline ( > 0.2 mV), Inferior-lateral location of Early Repolarization pattern, and horizontal and downsloping ST-segment. Patients with symptomatic early repolarisation patterns on ECG are more likely to have repeated cardiac episodes. Implantable Cardioverter-Defibrillator (ICD) implantation and isoproterenol are the recommended treatments in symptomatic patients. On the other hand, asymptomatic patients with early repolarization patterns are prevalent and have a better outcome. Risk categorization is still obscure in asymptomatic early repolarization patterns. This traditional review outlines the known knowledge of pathophysiology behind the increased risk of sudden cardiac death, risk stratification of patients with ERS, and the treatment guidelines for patients with ERS. Further prospective studies are recommended to elucidate the exact mechanism for ventricular arrhythmogenesis in ERS patients and to risk stratifying asymptomatic patients with ERS.
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Zhang L, Dong S, Zhao W, Li J, Cui L, Han Y, Chu Y. Relationship Between an Ischaemic J Wave Pattern and Ventricular Fibrillation in ST-Elevation Myocardial Infarction Patients. Int J Gen Med 2021; 14:8725-8735. [PMID: 34849013 PMCID: PMC8627274 DOI: 10.2147/ijgm.s337638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/05/2021] [Indexed: 12/02/2022] Open
Abstract
Background This study determined the ischaemic J wave pattern associated with ventricular fibrillation (VF). Methods A total of 262 patients diagnosed with ST-elevation myocardial infarction (STEMI) were recruited from October 2017 to September 2020. All data were collected and analysed, including baseline characteristics, electrocardiogram (ECG), coronary angiography (CAG), and examination outcomes. Results There were 193 STEMI patients with J wave elevation but without an ischaemic J wave (NJ group) and 69 patients with an ischaemic J wave; the latter were then subgrouped into early repolarization pattern (ERP; n=62) and Brugada pattern groups (BrP [anteroseptal ERP]; n=7). Univariate and multivariate logistic regression analyses were used to clarify high-risk factors and characteristics of ischaemic J waves. Multivariate logistic regression analysis revealed that an ischaemic J wave (odds ratio [OR], 9.708; 95% CI, 2.570–36.664; P=0.01) independently predicted VF. In the subgroup analysis, BrP (OR, 31.214; 95% CI, 3.949–246.742; P=0.001), slur morphology of the ERP (OR, 8.15; 95% CI, 1.563–42.558; P<0.05), and the number of leads with an ischaemic J wave > 3 (OR, 16.174; 95% CI, 3.064–85.375; P=0.001) were significantly associated with VF occurrence after adjusting for multiple variables. Conclusion An ischaemic J wave is an independent risk factor for VF in STEMI patients. BrP, slur morphology, and > 3 leads with an ischaemic J wave could increase the incidence of VF.
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Affiliation(s)
- Luyao Zhang
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, Henan Province, 450003, People's Republic of China
| | - Shujuan Dong
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, Henan Province, 450003, People's Republic of China
| | - Wenbo Zhao
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, Henan Province, 450003, People's Republic of China
| | - Jingchao Li
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, Henan Province, 450003, People's Republic of China
| | - Luqian Cui
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, Henan Province, 450003, People's Republic of China
| | - Yongmei Han
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, Henan Province, 450003, People's Republic of China
| | - Yingjie Chu
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, Henan Province, 450003, People's Republic of China
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Good WW, Zenger B, Bergquist JA, Rupp LC, Gillette KK, Gsell MAF, Plank G, MacLeod RS. Quantifying the spatiotemporal influence of acute myocardial ischemia on volumetric conduction velocity. J Electrocardiol 2021; 66:86-94. [PMID: 33836460 DOI: 10.1016/j.jelectrocard.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/28/2021] [Accepted: 03/10/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Acute myocardial ischemia occurs when coronary perfusion to the heart is inadequate, which can perturb the highly organized electrical activation of the heart and can result in adverse cardiac events including sudden cardiac death. Ischemia is known to influence the ST and repolarization phases of the ECG, but it also has a marked effect on propagation (QRS); however, studies investigating propagation during ischemia have been limited. METHODS We estimated conduction velocity (CV) and ischemic stress prior to and throughout 20 episodes of experimentally induced ischemia in order to quantify the progression and correlation of volumetric conduction changes during ischemia. To estimate volumetric CV, we 1) reconstructed the activation wavefront; 2) calculated the elementwise gradient to approximate propagation direction; and 3) estimated conduction speed (CS) with an inverse-gradient technique. RESULTS We found that acute ischemia induces significant conduction slowing, reducing the global median speed by 20 cm/s. We observed a biphasic response in CS (acceleration then deceleration) early in some ischemic episodes. Furthermore, we noted a high temporal correlation between ST-segment changes and CS slowing; however, when comparing these changes over space, we found only moderate correlation (corr. = 0.60). DISCUSSION This study is the first to report volumetric CS changes (acceleration and slowing) during episodes of acute ischemia in the whole heart. We showed that while CS changes progress in a similar time course to ischemic stress (measured by ST-segment shifts), the spatial overlap is complex and variable, showing extreme conduction slowing both in and around regions experiencing severe ischemia.
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Affiliation(s)
- Wilson W Good
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA; Nora Eccles Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA.
| | - Brian Zenger
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA; Nora Eccles Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA; School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jake A Bergquist
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA; Nora Eccles Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
| | - Lindsay C Rupp
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | | | | | | | - Rob S MacLeod
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA; Nora Eccles Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
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J wave is an underestimated ECG marker of risk in acute ischemia. J Electrocardiol 2021; 66:5. [PMID: 33667816 DOI: 10.1016/j.jelectrocard.2021.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 11/21/2022]
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Tsvetkova AS, Bernikova OG, Mikhaleva NJ, Khramova DS, Ovechkin AO, Demidova MM, Platonov PG, Azarov JE. Melatonin Prevents Early but Not Delayed Ventricular Fibrillation in the Experimental Porcine Model of Acute Ischemia. Int J Mol Sci 2020; 22:ijms22010328. [PMID: 33396934 PMCID: PMC7795598 DOI: 10.3390/ijms22010328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/16/2020] [Accepted: 12/26/2020] [Indexed: 01/09/2023] Open
Abstract
Antiarrhythmic effects of melatonin have been demonstrated ex vivo and in rodent models, but its action in a clinically relevant large mammalian model remains largely unknown. Objectives of the present study were to evaluate electrophysiological and antiarrhythmic effects of melatonin in a porcine model of acute myocardial infarction. Myocardial ischemia was induced by 40-min coronary occlusion in 25 anesthetized pigs. After ischemia onset, 12 animals received melatonin (4 mg/kg). 48 intramyocardial electrograms were recorded from left ventricular wall and interventricular septum (IVS). In each lead, activation time (AT) and repolarization time (RT) were determined. During ischemia, ATs and dispersion of repolarization (DOR = RTmax − RTmin) increased reaching maximal values by 3–5 and 20–25 min, respectively. Ventricular fibrillation (VF) incidence demonstrated no relations to redox state markers and was associated with increased DOR and delayed ATs (specifically, in an IVS base, an area adjacent to the ischemic zone) (p = 0.031). Melatonin prevented AT increase in the IVS base, (p < 0.001) precluding development of early VF (1–5 min, p = 0.016). VF occurrence in the delayed phase (17–40 min) where DOR was maximal was not modified by melatonin. Thus, melatonin-related enhancement of activation prevented development of early VF in the myocardial infarction model.
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Affiliation(s)
- Alena S. Tsvetkova
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, 167000 Syktyvkar, Russia; (O.G.B.); (N.J.M.); (A.O.O.); (J.E.A.)
- Correspondence: ; Tel.: +7-908-3280-936
| | - Olesya G. Bernikova
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, 167000 Syktyvkar, Russia; (O.G.B.); (N.J.M.); (A.O.O.); (J.E.A.)
| | - Natalya J. Mikhaleva
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, 167000 Syktyvkar, Russia; (O.G.B.); (N.J.M.); (A.O.O.); (J.E.A.)
| | - Darya S. Khramova
- Department of Molecular Immunology and Biotechnology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, 167000 Syktyvkar, Russia;
| | - Alexey O. Ovechkin
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, 167000 Syktyvkar, Russia; (O.G.B.); (N.J.M.); (A.O.O.); (J.E.A.)
- Department of Therapy, Institute of Medicine, Pitirim Sorokin Syktyvkar State University, 55 Starovskiist., 167001 Syktyvkar, Russia
| | - Marina M. Demidova
- Department of Cardiology, Clinical Sciences, Lund University, 22185 Lund, Sweden; (M.M.D.); (P.G.P.)
- V.A. Almazov National Medical Research Center, 197341 Saint Petersburg, Russia
| | - Pyotr G. Platonov
- Department of Cardiology, Clinical Sciences, Lund University, 22185 Lund, Sweden; (M.M.D.); (P.G.P.)
- Arrhythmia Clinic, Skåne University Hospital, 22185 Lund, Sweden
| | - Jan E. Azarov
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, 167000 Syktyvkar, Russia; (O.G.B.); (N.J.M.); (A.O.O.); (J.E.A.)
- Department of Cardiology, Clinical Sciences, Lund University, 22185 Lund, Sweden; (M.M.D.); (P.G.P.)
- Department of Biochemistry and Physiology, Institute of Medicine, Pitirim Sorokin Syktyvkar State University, 55 Starovskiist., 167001 Syktyvkar, Russia
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Tsvetkova AS, Azarov JE, Bernikova OG, Ovechkin AO, Vaykshnorayte MA, Demidova MM, Platonov PG. Contribution of Depolarization and Repolarization Changes to J-Wave Generation and Ventricular Fibrillation in Ischemia. Front Physiol 2020; 11:568021. [PMID: 33101054 PMCID: PMC7556294 DOI: 10.3389/fphys.2020.568021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/14/2020] [Indexed: 01/11/2023] Open
Abstract
Background: Activation delay in ischemic myocardium has been found to contribute to J-wave appearance and to predict ventricular fibrillation (VF) in experimental myocardial infarction. However, the role of ischemia-related repolarization abnormalities in J-wave generation remains unclear. Objectives: The objective of our study was to assess a contribution of myocardial repolarization changes to J-wave generation in the body surface ECG and VF in a porcine acute myocardial infarction model. Methods: In 22 anesthetized pigs, myocardial ischemia was induced by occlusion of the left anterior descending coronary artery (LAD, n = 14) and right coronary artery (RCA, n = 8). Body surface ECGs were recorded simultaneously with intramyocardial unipolar electrograms led from flexible electrodes positioned across the left ventricular (LV) wall, interventricular septum (IVS), and right ventricular (RV) wall at apical, middle and basal levels of the ventricles (a total of 48 leads). Local activation times (ATs) and activation-repolarization intervals (ARIs, differences between dV/dt maximum during T-wave and dV/dt minimum during QRS) were measured. Results: J-waves appeared in left precordial leads (in 11 out of 14 animals with LAD occlusion) and right precordial leads (in six out of eight animals with RCA occlusion). During ischemic exposure, ATs prolonged, and the activation delay was associated with J-wave development (OR = 1.108 95% CI 1.072-1.144; p < 0.001) and VF incidence (OR = 1.039 95% CI 1.008-1.072; p = 0.015). ARIs shortened in the ischemic regions (in the IVS under LAD-occlusion and the lateral RV base under RCA-occlusion). The difference between maximal ARI in normal zones and ARI in the ischemic zones (ΔARI) was associated with J-wave appearance (OR = 1.025 95% CI 1.016-1.033, p < 0.001) independently of AT delay in multivariate logistic regression analysis. Conclusions: Both AT delay and increase of ΔARIs contributed to the development of J-wave in body surface ECG. However, only AT delay was associated with VF occurrence.
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Affiliation(s)
- Alena S Tsvetkova
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, Syktyvkar, Russia
| | - Jan E Azarov
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, Syktyvkar, Russia.,Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.,Department of Biochemistry and Physiology, Institute of Medicine, Pitirim Sorokin Syktyvkar State University, Syktyvkar, Russia
| | - Olesya G Bernikova
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, Syktyvkar, Russia
| | - Alexey O Ovechkin
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, Syktyvkar, Russia.,Department of Biochemistry and Physiology, Institute of Medicine, Pitirim Sorokin Syktyvkar State University, Syktyvkar, Russia
| | - Marina A Vaykshnorayte
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, Syktyvkar, Russia
| | - Marina M Demidova
- Department of Therapy, Institute of Medicine, Pitirim Sorokin Syktyvkar State University, Syktyvkar, Russia.,V. A. Almazov National Medical Research Center, Saint Petersburg, Russia
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.,Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden
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Ter Haar CC, Kors JA, Peters RJG, Tanck MWT, Snijder MB, Maan AC, Swenne CA, van den Born BJH, de Jong JSSG, Macfarlane PW, Postema PG. Prevalence of ECGs Exceeding Thresholds for ST-Segment-Elevation Myocardial Infarction in Apparently Healthy Individuals: The Role of Ethnicity. J Am Heart Assoc 2020; 9:e015477. [PMID: 32573319 PMCID: PMC7670498 DOI: 10.1161/jaha.119.015477] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Early prehospital recognition of critical conditions such as ST‐segment–elevation myocardial infarction (STEMI) has prognostic relevance. Current international electrocardiographic STEMI thresholds are predominantly based on individuals of Western European descent. However, because of ethnic electrocardiographic variability both in health and disease, there is a need to reevaluate diagnostic ST‐segment elevation thresholds for different populations. We hypothesized that fulfillment of ST‐segment elevation thresholds of STEMI criteria (STE‐ECGs) in apparently healthy individuals is ethnicity dependent. Methods and Results HELIUS (Healthy Life in an Urban Setting) is a multiethnic cohort study including 10 783 apparently healthy subjects of 6 different ethnicities (African Surinamese, Dutch, Ghanaian, Moroccan, South Asian Surinamese, and Turkish). Prevalence of STE‐ECGs across ethnicities, sexes, and age groups was assessed with respect to the 2 international STEMI thresholds: sex and age specific versus sex specific. Mean prevalence of STE‐ECGs was 2.8% to 3.4% (age/sex‐specific and sex‐specific thresholds, respectively), although with large ethnicity‐dependent variability. Prevalences in Western European Dutch were 2.3% to 3.0%, but excessively higher in young (<40 years) Ghanaian males (21.7%–27.5%) and lowest in older (≥40 years) Turkish females (0.0%). Ethnicity (sub‐Saharan African origin) and other variables (eg, younger age, male sex, high QRS voltages, or anterolateral early repolarization pattern) were positively associated with STE‐ECG occurrence, resulting in subgroups with >45% STE‐ECGs. Conclusions The accuracy of diagnostic tests partly relies on background prevalence in healthy individuals. In apparently healthy subjects, there is a highly variable ethnicity‐dependent prevalence of ECGs with ST‐segment elevations exceeding STEMI thresholds. This has potential consequences for STEMI evaluations in individuals who are not of Western European descent, putatively resulting in adverse outcomes with both over‐ and underdiagnosis of STEMI.
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Affiliation(s)
- C Cato Ter Haar
- Department of Cardiology Heart Center Amsterdam UMC University of Amsterdam The Netherlands.,Department of Cardiology Heart-Lung Center Leiden University Medical Center Leiden The Netherlands
| | - Jan A Kors
- Department of Medical Informatics Erasmus MC University Medical Center Rotterdam The Netherlands
| | - Ron J G Peters
- Department of Cardiology Heart Center Amsterdam UMC University of Amsterdam The Netherlands
| | - Michael W T Tanck
- Department of Clinical Epidemiology Biostatistics & Bioinformatics, Amsterdam Public Health Research Institute Amsterdam UMC University of Amsterdam The Netherlands
| | - Marieke B Snijder
- Department of Clinical Epidemiology Biostatistics & Bioinformatics, Amsterdam Public Health Research Institute Amsterdam UMC University of Amsterdam The Netherlands.,Department of Public Health Amsterdam Public Health research institute Amsterdam UMC University of Amsterdam The Netherlands
| | - Arie C Maan
- Department of Cardiology Heart-Lung Center Leiden University Medical Center Leiden The Netherlands
| | - Cees A Swenne
- Department of Cardiology Heart-Lung Center Leiden University Medical Center Leiden The Netherlands
| | - Bert-Jan H van den Born
- Department of Vascular Medicine Amsterdam UMC University of Amsterdam Amsterdam the Netherlands
| | | | | | - Pieter G Postema
- Department of Cardiology Heart Center Amsterdam UMC University of Amsterdam The Netherlands
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Oka E, Iwasaki YK, Maru Y, Fujimoto Y, Hagiwara K, Hayashi H, Yamamoto T, Yodogawa K, Hayashi M, Shimizu W. Prevalence and Significance of an Early Repolarization Electrocardiographic Pattern and Its Mechanistic Insight Based on Cardiac Magnetic Resonance Imaging in Patients With Acute Myocarditis. Circ Arrhythm Electrophysiol 2019; 12:e006969. [PMID: 30879333 DOI: 10.1161/circep.118.006969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND An early repolarization electrocardiographic (ER-ECG) pattern is caused by various pathophysiological conditions and is reported to be a predictor of life-threatening ventricular tachyarrhythmias. However, little evidence has been reported on the prevalence and significance of the ER-ECG pattern in acute myocarditis. This study aimed to investigate the prevalence and significance of the ER-ECG pattern and its mechanistic insight based on the cardiac magnetic resonance findings in patients with acute myocarditis. METHODS Thirty patients (23 men; 39.2±19.1 years) with a diagnosis of acute myocarditis by a clinical presentation between March 2011 and April 2018 were retrospectively evaluated. The patients were divided into 2 groups depending on the presence of an ER-ECG pattern on admission. RESULTS Nine cases had an ER-ECG pattern, which was defined as terminal QRS notching or slurring with an amplitude of >0.1 mV in at least 2 inferior or lateral leads (early repolarization [ER] group), whereas the remaining 21 cases had broad ST-segment elevation or pathological Q waves (non-ER group). The cardiac troponin T level was significantly higher in the non-ER group than ER group (3.2±4.3 versus 0.9±1.2 ng/mL; P=0.036). The ECG changes returned to baseline along with the normalization of the cardiac biomarkers. Nine of the 21 non-ER group patients, but none of the 9 ER group patients, developed a fulminant course and lethal ventricular tachyarrhythmias. T2-weighted cardiac magnetic resonance showed high-intensity signals over the entire transmural left ventricle in the non-ER group, whereas they were localized to the left ventricular epicardium in the ER group. CONCLUSIONS The ER-ECG pattern in acute myocarditis was transient and reversible and was not associated with a worse prognosis. Inflammation/swelling localized to the left ventricular epicardium because of acute myocarditis might provide a mechanistic insight into the ER-ECG pattern.
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Affiliation(s)
- Eiichiro Oka
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yujin Maru
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yuhi Fujimoto
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Kanako Hagiwara
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroshi Hayashi
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Teppei Yamamoto
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Meiso Hayashi
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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11
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Demidova MM, Carlson J, Erlinge D, Platonov PG. Early repolarization pattern on ECG recorded before the acute coronary event does not predict ventricular fibrillation during ST-elevation myocardial infarction. Heart Rhythm 2019; 17:629-636. [PMID: 31734288 DOI: 10.1016/j.hrthm.2019.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Generally considered benign, electrocardiographic (ECG) early repolarization (ER) pattern was claimed to be an indicator of increased susceptibility to ventricular arrhythmias during acute ischemia. OBJECTIVE The purpose of this study was to assess in a nonselected population whether ER pattern documented before ST-elevation myocardial infarction (STEMI) is associated with risk of hemodynamically unstable ventricular tachycardia (VT) or ventricular fibrillation (VF) during acute STEMI. METHODS For STEMI patients admitted for primary percutaneous coronary intervention from 2007-2010, the latest ECGs recorded before STEMI were exported in digital format. After excluding ECGs with paced rhythm and QRS duration ≥120 ms, the remaining ECGs were processed using the Glasgow algorithm allowing automatic ER detection. The association between ER pattern and VT/VF during the first 48 hours of STEMI was tested using logistic regression. RESULTS ECGs recorded before STEMI were available for 1584 patients. Of these patients, 124 did not meet inclusion criteria, leaving 1460 patients available for analysis (age 68 ± 12 years; 67% male). ER pattern was present in 272 patients (18.6%; ER+ group). ER+ and ER- groups did not differ with regard to clinical characteristics. VT/VF during the first 48 hours of STEMI occurred in 19 ER+ (7.0%) and 105 ER- patients (8.8%; P = .398). ER was not associated with any VT/VF (odds ratio [OR] 0.78; 95% confidence interval [CI] 0.47-1.29; P = .324); VT/VF before reperfusion (OR 0.48; 95% CI 0.23-1.001; P = .051); or reperfusion-related VT/VF (OR 1.28; 95% CI 0.55-3.01; P = .569). CONCLUSION In a nonselected population of STEMI patients, the ER pattern on ECG recorded before the acute coronary event was not associated with VT/VF during the first 48 hours of STEMI.
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Affiliation(s)
- Marina M Demidova
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden; National Medical Research Center, St. Petersburg, Russia.
| | - Jonas Carlson
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
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12
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Prolongation of The Activation Time in Ischemic Myocardium is Associated with J-wave Generation in ECG and Ventricular Fibrillation. Sci Rep 2019; 9:12202. [PMID: 31434969 PMCID: PMC6704253 DOI: 10.1038/s41598-019-48710-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 06/17/2019] [Indexed: 12/16/2022] Open
Abstract
J-wave pattern has been recognized as an arrhythmic risk marker, particularly in myocardial infarction patients. Mechanisms underlying J-wave development in ischemia remain unknown. In myocardial infarction model, we evaluated activation time delay as a prerequisite of J-wave appearance and predictor of ventricular fibrillation. Body surface ECGs and myocardial unipolar electrograms were recorded in 14 anesthetized pigs. 48 intramural leads were positioned across ventricular free walls and interventricular septum. Myocardial ischemia was induced by ligation of the left anterior descending coronary artery and the recordings were done during 40-minute coronary occlusion. The local activation times were determined as instants of dV/dt minimum during QRS complex in unipolar electrograms. During occlusion, ventricular local activation time prolonged in the middle portion of the left ventricular free wall, and basal and middle portions of septum, while J-waves appeared in precordial leads in 11 animals. In logistic regression and ROC curve analyses, activation time delay at a given time-point was associated with J-wave development, and a longer activation time was associated with ventricular fibrillation appearance. In experimental coronary occlusion, activation delay in ischemic myocardium was associated with generation of the J waves in the body surface ECG and predicted ventricular fibrillation.
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13
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Haïssaguerre M, Nademanee K, Hocini M, Cheniti G, Duchateau J, Frontera A, Sacher F, Derval N, Denis A, Pambrun T, Dubois R, Jaïs P, Benoist D, Walton RD, Nogami A, Coronel R, Potse M, Bernus O. Depolarization versus repolarization abnormality underlying inferolateral J-wave syndromes: New concepts in sudden cardiac death with apparently normal hearts. Heart Rhythm 2019; 16:781-790. [PMID: 30391571 PMCID: PMC6486498 DOI: 10.1016/j.hrthm.2018.10.040] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Indexed: 12/22/2022]
Abstract
Early repolarization indicates a distinct electrocardiographic phenotype affecting the junction between the QRS complex and the ST segment in inferolateral leads (inferolateral J-wave syndromes). It has been considered a benign electrocardiographic variant for decades, but recent clinical studies have demonstrated its arrhythmogenicity in a small subset, supported by experimental studies showing transmural dispersion of repolarization. Here we review the current knowledge and the issues of risk stratification that limit clinical management. In addition, we report on new mapping data of patients refractory to pharmacologic treatment using high-density electrogram mapping at the time of inscription of J wave. These data demonstrate that distinct substrates, delayed depolarization, and abnormal early repolarization underlie inferolateral J-wave syndromes, with significant implications. Finally, based on these data, we propose a new simplified mechanistic classification of sudden cardiac deaths without apparent structural heart disease.
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Affiliation(s)
- Michel Haïssaguerre
- Bordeaux University Hospital, Bordeaux, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; University of Bordeaux, U1045, Bordeaux, France.
| | | | - Mélèze Hocini
- Bordeaux University Hospital, Bordeaux, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; University of Bordeaux, U1045, Bordeaux, France
| | | | - Josselin Duchateau
- Bordeaux University Hospital, Bordeaux, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; University of Bordeaux, U1045, Bordeaux, France
| | | | - Frédéric Sacher
- Bordeaux University Hospital, Bordeaux, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; University of Bordeaux, U1045, Bordeaux, France
| | - Nicolas Derval
- Bordeaux University Hospital, Bordeaux, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; University of Bordeaux, U1045, Bordeaux, France
| | - Arnaud Denis
- Bordeaux University Hospital, Bordeaux, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; University of Bordeaux, U1045, Bordeaux, France
| | - Thomas Pambrun
- Bordeaux University Hospital, Bordeaux, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; University of Bordeaux, U1045, Bordeaux, France
| | - Rémi Dubois
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; University of Bordeaux, U1045, Bordeaux, France
| | - Pierre Jaïs
- Bordeaux University Hospital, Bordeaux, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; University of Bordeaux, U1045, Bordeaux, France
| | - David Benoist
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; University of Bordeaux, U1045, Bordeaux, France
| | - Richard D Walton
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; University of Bordeaux, U1045, Bordeaux, France
| | | | - Ruben Coronel
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France
| | - Mark Potse
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France
| | - Olivier Bernus
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; University of Bordeaux, U1045, Bordeaux, France
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14
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Almer J, Jennings RB, Ringborn M, Engblom H. Ischemic QRS prolongation as a predictor of ventricular fibrillation in a canine model. SCAND CARDIOVASC J 2018; 52:262-267. [PMID: 30182762 PMCID: PMC6397935 DOI: 10.1080/14017431.2018.1494304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/08/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES An acute coronary occlusion and its possible subsequent complications is one of the most common causes of death. One such complication is ventricular fibrillation (VF) due to myocardial ischemia. The severity of ischemia is related to the amount of coronary arterial collateral flow. In dog studies collateral flow has also been shown to be associated with QRS prolongation. The aim of this study was to investigate whether ischemic QRS prolongation (IQP) is associated with impending VF in an experimental acute ischemia dog model. METHODS Degree of IQP and occurrence of VF were measured in dogs (n = 21) during coronary occlusion for 15 min and also during subsequent reperfusion (experiments conducted in 1984). RESULTS There was a significant difference in absolute IQP between dogs which developed VF during reperfusion (47 ± 29 ms, mean ± SD) and those which did not (12 ± 10 ms; p = .001). CONCLUSIONS IQP during acute coronary occlusion is associated with reperfusion VF in an experimental dog model and might therefore be a potential predictor of malignant arrhythmias in patients with acute coronary syndrome.
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Affiliation(s)
- Jakob Almer
- Department of Clinical physiology and Nuclear medicine, Skåne University Hospital and Lund
University, Lund, Sweden
| | | | | | - Henrik Engblom
- Department of Clinical physiology and Nuclear medicine, Skåne University Hospital and Lund
University, Lund, Sweden
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15
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Bernikova OG, Sedova KA, Arteyeva NV, Ovechkin AO, Kharin SN, Shmakov DN, Azarov JE. Repolarization in perfused myocardium predicts reperfusion ventricular tachyarrhythmias. J Electrocardiol 2018; 51:542-548. [DOI: 10.1016/j.jelectrocard.2017.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Indexed: 11/30/2022]
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16
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Kamakura T, Wada M, Ishibashi K, Inoue YY, Miyamoto K, Okamura H, Nagase S, Noda T, Aiba T, Yasuda S, Shimizu W, Kamakura S, Kusano K. Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome. J Am Heart Assoc 2018; 7:JAHA.117.007942. [PMID: 29436392 PMCID: PMC5850201 DOI: 10.1161/jaha.117.007942] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previously described patients with early repolarization syndrome (ERS) may have experienced silent coronary artery spasm (CAS) because the diagnosis of CAS was mainly based on symptoms or coronary angiography findings, without performing a spasm provocation test. This study investigated the significance of CAS diagnosis and evaluated the incidence of silent CAS in patients with possible ERS (ie, idiopathic ventricular fibrillation [VF] and inferolateral J wave). METHODS AND RESULTS The study included 34 patients with idiopathic VF and inferolateral J wave. Thirteen patients (38%) were diagnosed as having CAS on the basis of coronary angiography with spasm provocation test (n=8) and documentation of spontaneous ST elevation (n=5). Of the 13 patients with CAS, 5 (38%) did not experience chest symptoms before and during VF, and were diagnosed as having silent CAS. The remaining 21 patients (62%), with a negative provocation test result and absence of chest symptoms, were considered to have ERS. During the 92 months of follow-up, patients with CAS receiving appropriate medical treatment with antianginal drugs showed a favorable outcome. In contrast, 4 of 21 patients with ERS (19%) had VF recurrences. The use of monotherapy or combination therapy, consisting of quinidine, cilostazol, and bepridil, in the 4 patients with ERS, was effective in suppressing VF. CONCLUSIONS Approximately 40% of patients with CAS with documented VF and inferolateral J wave did not experience chest symptoms at the first VF, and could have been misdiagnosed as having ERS. The use of the spasm provocation test is considered essential to differentiate patients for optimal medical treatment.
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Affiliation(s)
- Tsukasa Kamakura
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Mitsuru Wada
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Kohei Ishibashi
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Yuko Y Inoue
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Koji Miyamoto
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Hideo Okamura
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Satoshi Nagase
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Takashi Noda
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Takeshi Aiba
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Satoshi Yasuda
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Wataru Shimizu
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan.,Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Shiro Kamakura
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Kengo Kusano
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
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17
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Antzelevitch C, Yan GX, Ackerman MJ, Borggrefe M, Corrado D, Guo J, Gussak I, Hasdemir C, Horie M, Huikuri H, Ma C, Morita H, Nam GB, Sacher F, Shimizu W, Viskin S, Wilde AA. J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge. Europace 2017; 19:665-694. [PMID: 28431071 PMCID: PMC5834028 DOI: 10.1093/europace/euw235] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
| | - Gan-Xin Yan
- Lankenau Medical Center, Wynnewood, Pennsylvania
| | - Michael J. Ackerman
- Departments of Cardiovascular Diseases, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester,Minnesota
| | - Martin Borggrefe
- 1st Department of Medicine–Cardiology, University Medical Centre Mannheim, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Jihong Guo
- Division of Cardiology, Peking University of People's Hospital, Beijing, China
| | - Ihor Gussak
- Rutgers University, New Brunswick, New Jersey
| | - Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Minoru Horie
- Shiga University of Medical Sciences, Ohtsu, Shiga, Japan
| | - Heikki Huikuri
- Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital, and University of Oulu, Oulu, Finland
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Gi-Byoung Nam
- Heart Institute, Asan Medical Center, and Department of Internal Medicine, University of Ulsan College of Medicine Seoul, Seoul, Korea
| | - Frederic Sacher
- Bordeaux University Hospital, LIRYC Institute/INSERM 1045, Bordeaux, France
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Sami Viskin
- Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arthur A.M. Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands and Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia
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18
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Antzelevitch C, Yan GX, Ackerman MJ, Borggrefe M, Corrado D, Guo J, Gussak I, Hasdemir C, Horie M, Huikuri H, Ma C, Morita H, Nam GB, Sacher F, Shimizu W, Viskin S, Wilde AA. J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge. J Arrhythm 2016; 32:315-339. [PMID: 27761155 PMCID: PMC5063270 DOI: 10.1016/j.joa.2016.07.002] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Gan-Xin Yan
- Lankenau Medical Center, Wynnewood, PA, United States
| | - Michael J. Ackerman
- Departments of Cardiovascular Diseases, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, United States
| | - Martin Borggrefe
- 1st Department of Medicine–Cardiology, University Medical Centre Mannheim, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Jihong Guo
- Division of Cardiology, Peking University of People׳s Hospital, Beijing, China
| | - Ihor Gussak
- Rutgers University, New Brunswick, NJ, United States
| | - Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Minoru Horie
- Shiga University of Medical Sciences, Ohtsu, Shiga, Japan
| | - Heikki Huikuri
- Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital, and University of Oulu, Oulu, Finland
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Gi-Byoung Nam
- Heart Institute, Asian Medical Center, and Department of Internal Medicine, University of Ulsan College of Medicine Seoul, Seoul, South Korea
| | - Frederic Sacher
- Bordeaux University Hospital, LIRYC Institute/INSERM 1045, Bordeaux, France
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Sami Viskin
- Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arthur A.M. Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands
- Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Saudi Arabia
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19
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Antzelevitch C, Yan GX, Ackerman MJ, Borggrefe M, Corrado D, Guo J, Gussak I, Hasdemir C, Horie M, Huikuri H, Ma C, Morita H, Nam GB, Sacher F, Shimizu W, Viskin S, Wilde AAM. J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge. Heart Rhythm 2016; 13:e295-324. [PMID: 27423412 PMCID: PMC5035208 DOI: 10.1016/j.hrthm.2016.05.024] [Citation(s) in RCA: 222] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Indexed: 12/16/2022]
Affiliation(s)
| | - Gan-Xin Yan
- Lankenau Medical Center, Wynnewood, Pennsylvania
| | - Michael J Ackerman
- Departments of Cardiovascular Diseases, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester,Minnesota
| | - Martin Borggrefe
- 1st Department of Medicine-Cardiology, University Medical Centre Mannheim, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Jihong Guo
- Division of Cardiology, Peking University of People's Hospital, Beijing, China
| | - Ihor Gussak
- Rutgers University, New Brunswick, New Jersey
| | - Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Minoru Horie
- Shiga University of Medical Sciences, Ohtsu, Shiga, Japan
| | - Heikki Huikuri
- Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital, and University of Oulu, Oulu, Finland
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Gi-Byoung Nam
- Heart Institute, Asan Medical Center, and Department of Internal Medicine, University of Ulsan College of Medicine Seoul, Seoul, Korea
| | - Frederic Sacher
- Bordeaux University Hospital, LIRYC Institute/INSERM 1045, Bordeaux, France
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Sami Viskin
- Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arthur A M Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands and Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia
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20
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Demidova MM, Platonov PG. To the Editor--Dynamic ECG abnormalities at the junction of QRS complex and ST segment as indicators of arrhythmia risk during acute ischemia. Heart Rhythm 2016; 13:e239. [DOI: 10.1016/j.hrthm.2016.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Indexed: 11/29/2022]
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21
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Demidova MM, Martín-Yebra A, Koul S, Engblom H, Martínez JP, Erlinge D, Platonov PG. QRS broadening due to terminal distortion is associated with the size of myocardial injury in experimental myocardial infarction. J Electrocardiol 2016; 49:300-6. [DOI: 10.1016/j.jelectrocard.2016.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Indexed: 11/27/2022]
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22
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Yochai B, Nikus K, Birnbaum Y. About QRS prolongation, distortion and the acuteness score. J Electrocardiol 2016; 49:265-71. [PMID: 26972846 DOI: 10.1016/j.jelectrocard.2016.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Indexed: 01/25/2023]
Affiliation(s)
- Birnbaum Yochai
- The Section of Cardiology, the Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Kjell Nikus
- Cardiology Department, Heart Center, Tampere University Hospital and School of Medicine, University of Tampere, Finland
| | - Yochai Birnbaum
- The Section of Cardiology, the Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
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23
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Abstract
The early repolarisation (ER) pattern is a common ECG finding. Most individuals with the ER pattern are at minimal risk for arrhythmic events. In others, ER increases the arrhythmic risk of underlying cardiac pathology. Rarely ER syndrome will manifest as a primary arrhythmogenic disorder causing ventricular fibrillation (VF). ER syndrome is defined as syncope attributed to ventricular arrhythmias or cardiac arrest attributed to ER following systematic exclusion of other etiologies. Some ECG features associated with ER portend a higher risk. However, clinically useful risk-stratifying tools to identify the asymptomatic patient at high risk are lacking. Patients with asymptomatic ER and no family history of malignant ER should be reassured. All patients with ER should continue to have modifiable cardiac risk factors addressed. Symptomatic patients should be systematically investigated, directed by symptoms.
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Affiliation(s)
| | - Andrew D Krahn
- The Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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24
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Reply to the Editor-Regarding Dynamic ECG Abnormalities at the Junction of QRS Complex and ST Segment as Indicators of Arrhythmia Risk During Acute Ischemia. Heart Rhythm 2016; 13:e239-e240. [PMID: 26775797 DOI: 10.1016/j.hrthm.2016.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Indexed: 11/24/2022]
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