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Kuroshima T, Wachi S, Kitani Y, Kokita N, Sato N. A case of early repolarization syndrome in which hyponatremia and coronary vasospasms induced ventricular fibrillation. J Electrocardiol 2024; 85:25-30. [PMID: 38823212 DOI: 10.1016/j.jelectrocard.2024.05.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/23/2024] [Accepted: 05/20/2024] [Indexed: 06/03/2024]
Abstract
A 60-year-old man was referred to our hospital presenting with unconsciousness due to severe hyponatremia. The twelve‑lead ECG on admission exhibited prominent J waves in the inferolateral leads. During the treatment for hyponatremia, ventricular fibrillation (VF) occurred and the electrogram (ECG) after the VF incident exhibited marked ST elevation in the inferolateral leads. An Ach provocation test induced vasospasms in the right and left coronary arteries and J wave augmentation, suggesting a high risk for vasospastic angina. Finally, a subcutaneous implantable cardioverter defibrillator was implanted in the patient. We hereby discuss the possible contribution of hyponatremia to VF episodes in early repolarization syndrome based on the present case.
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Affiliation(s)
- Tatsuki Kuroshima
- Emergency and Critical Care Center, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Shutaro Wachi
- Emergency and Critical Care Center, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Yuya Kitani
- Department of Cardiology, Asahikawa Medical University, Asahikawa, Japan
| | - Naohiro Kokita
- Emergency and Critical Care Center, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Nobuyuki Sato
- Education Center, Asahikawa Medical University, Asahikawa, Japan.
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2
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Cardiac Morphofunctional Characteristics of Individuals with Early Repolarization Pattern: A Literature Review. J Cardiovasc Dev Dis 2022; 10:jcdd10010004. [PMID: 36661899 PMCID: PMC9861558 DOI: 10.3390/jcdd10010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
The early repolarization pattern (ERP) is an electrocardiographic phenomenon characterized by the appearance of a distinct J-wave or J-point elevation at the terminal part of the QRS complex. ERP is associated with an increased risk of ventricular arrhythmias in susceptible individuals. The cardiac morphofunctional parameters in subjects with ERP have been characterized mainly by imaging techniques, which suggests that certain changes could be identified in the background of the electrical pathomechanism: however, in this regard, current data are often contradictory or insufficiently detailed. For clarification, a more comprehensive cardiac imaging evaluation of a large patient population is necessary. This review summarizes and analyses the data from the literature related to cardiac morphofunctional characteristics in individuals with ERP.
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Vecchiato M, Baioccato V, Adami PE, Quinto G, Foccardi G, Slanzi G, Battista F, Neunhaeuserer D, Ermolao A. Early repolarization in adolescent athletes: A gender comparison of ECG and echocardiographic characteristics. Scand J Med Sci Sports 2022; 32:1581-1591. [PMID: 36086882 PMCID: PMC9826079 DOI: 10.1111/sms.14232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/18/2022] [Accepted: 08/26/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The early repolarization pattern (ERp) is an electrocardiographic finding previously associated with arrhythmic risk in adults. The purpose of this study is to evaluate the prevalence and characteristics of ERp in a group of adolescent athletes according to gender. Furthermore, potential associations with clinical, electrocardiographic, and echocardiographic parameters are explored. METHODS In this cross-sectional study young athletes (age < 18 years) were consecutively enrolled during the annual pre-participation evaluation, undergoing also transthoracic echocardiography assessment from January 2015 to March 2020. RESULTS The prevalence of ERp was 27% in the whole population. Athletes with ERp were more frequently men practicing endurance sports. Women with ERp showed lower heart rate at rest, greater posterior, and relative ventricular wall thickness than those without ERp. Men with ERp presented higher systolic blood pressure at peak exercise, greater septal wall thickness, and indexed left ventricular mass than those without ERp. Both genders with ERp showed increased QRS voltage and narrower QRS duration. The ERp phenotype in men was more frequently notched with higher amplitude and ascending ST segment. Women's ERp presented more frequently a slurred morphology, especially in the inferior leads, and horizontal ST slope. No differences emerged in the occurrence of arrhythmias at rest and during maximal exercise test between groups, even considering higher risk phenotypes. CONCLUSIONS ERp is an ECG finding compatible with normal cardiac adaptations to training in young athletes. ERp demonstrated gender differences regarding phenotypes previously associated with increased cardiovascular risk, not showing any differences in arrhythmias during maximal exercise test.
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Affiliation(s)
- Marco Vecchiato
- Sports and Exercise Medicine Division, Department of MedicineUniversity of PadovaPadovaItaly
- Clinical Network of Sports and Exercise Medicine of the Veneto RegionPadovaItaly
| | - Veronica Baioccato
- Sports and Exercise Medicine Division, Department of MedicineUniversity of PadovaPadovaItaly
- Clinical Network of Sports and Exercise Medicine of the Veneto RegionPadovaItaly
| | - Paolo Emilio Adami
- World Athletics, Medical ManagerHealth and Science DepartmentMonacoMonaco
| | - Giulia Quinto
- Sports and Exercise Medicine Division, Department of MedicineUniversity of PadovaPadovaItaly
- Clinical Network of Sports and Exercise Medicine of the Veneto RegionPadovaItaly
| | - Giulia Foccardi
- Sports and Exercise Medicine Division, Department of MedicineUniversity of PadovaPadovaItaly
- Clinical Network of Sports and Exercise Medicine of the Veneto RegionPadovaItaly
| | - Giulio Slanzi
- Sports and Exercise Medicine Division, Department of MedicineUniversity of PadovaPadovaItaly
- Clinical Network of Sports and Exercise Medicine of the Veneto RegionPadovaItaly
| | - Francesca Battista
- Sports and Exercise Medicine Division, Department of MedicineUniversity of PadovaPadovaItaly
- Clinical Network of Sports and Exercise Medicine of the Veneto RegionPadovaItaly
| | - Daniel Neunhaeuserer
- Sports and Exercise Medicine Division, Department of MedicineUniversity of PadovaPadovaItaly
- Clinical Network of Sports and Exercise Medicine of the Veneto RegionPadovaItaly
| | - Andrea Ermolao
- Sports and Exercise Medicine Division, Department of MedicineUniversity of PadovaPadovaItaly
- Clinical Network of Sports and Exercise Medicine of the Veneto RegionPadovaItaly
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Claessen FMAP, Peeters HAP, Sorgdrager BJ, van Veldhoven PLJ. Early repolarisation among athletes. BMJ Open Sport Exerc Med 2020; 6:e000694. [PMID: 32231791 PMCID: PMC7101050 DOI: 10.1136/bmjsem-2019-000694] [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] [Accepted: 02/14/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives Traditionally, early repolarisation (ER) is considered a benign ECG variant, predominantly found in youths and athletes. However, a limited number of studies have reported an association between ER and the incidental occurrence of ventricular fibrillation or sudden cardiac death. Yet definite, direct comparisons of the incidence of ER in unselected, contemporary populations in athletes as compared with non-athletes and across different sports are lacking. This study therefore aimed to investigate whether ER is more common among athletes as compared with non-athletes, and if ER patterns differ between sport disciplines based on static and dynamic intensity. Methods To assess ER we retrospectively analysed ECGs of 2241 adult subjects (2090 athletes, 151 non-athletes), who had a sports medical screening between 2010 and 2014 in an outpatient clinic. The outcome was tested for confounders in a multivariable logistic regression analysis. Results ER was found in 502 athletes (24%). We found a 50% higher prevalence of ER in the athlete group compared with the control group (OR 1.5 (SE 0.34), adjusted 95% CI 1.0 to 2.4) in multivariable analysis. A 30% higher prevalence of ER in the inferior leads only (OR 1.3 (SE 0.38), adjusted 95% CI 0.74 to 2.3), a 120% higher prevalence of ER in the lateral leads only (OR 2.2 (SE 1.0), adjusted 95% CI 0.87 to 5.4), and a 20% higher prevalence of ER in the inferior and lateral leads (OR 1.2 (SE 0.49), adjusted 95% CI 0.55 to 2.7) was found in athletes. Conclusion Athletes had a 50% higher prevalence of ER and a 30% higher prevalence of ER in the inferior leads specifically. There was no association between training duration or sports discipline and ER.
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Affiliation(s)
- Femke M A P Claessen
- Sports Medicine, Medisch Centrum Haaglanden, Leidschendam, Zuid-Holland, Netherlands
| | - Heidi A P Peeters
- Cardiology, Medisch Centrum Haaglanden, Leidschendam, Zuid-Holland, Netherlands
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Yoon N, Patocskai B, Antzelevitch C. Epicardial Substrate as a Target for Radiofrequency Ablation in an Experimental Model of Early Repolarization Syndrome. Circ Arrhythm Electrophysiol 2019; 11:e006511. [PMID: 30354293 DOI: 10.1161/circep.118.006511] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Early repolarization syndrome (ERS) is an inherited cardiac arrhythmia syndrome associated with sudden cardiac death. Approaches to therapy are currently very limited. This study probes the mechanisms underlying the electrocardiographic and arrhythmic manifestation of experimental models of ERS and of the ameliorative effect of radiofrequency ablation. METHODS Action potentials, bipolar electrograms, and transmural pseudo-ECGs were simultaneously recorded from coronary-perfused canine left ventricular wedge preparations (n=11). The Ito agonist NS5806 (7-10 μmol/L), calcium channel blocker verapamil (3 μmol/L), and acetylcholine (1-3 μmol/L) were used to pharmacologically mimic the effects of genetic defects associated with ERS. RESULTS The provocative agents induced prominent J waves in the ECG secondary to accentuation of the action potential notch in epicardium but not endocardium. Bipolar recordings displayed low-voltage fractionated potentials in epicardium because of temporal and spatial variability in appearance of the action potential dome. Concealed phase 2 reentry developed when action potential dome was lost at some epicardial sites but not others, appearing in the bipolar electrogram as discrete high-frequency spikes. Successful propagation of the phase 2 reentrant beat precipitated ventricular tachycardia/ventricular fibrillation. Radiofrequency ablation of the epicardium destroyed the cells displaying abnormal repolarization and thus suppressed the J waves and the development of ventricular tachycardia/ventricular fibrillation in 6/6 preparations. CONCLUSIONS Our findings suggest that low-voltage fractionated electrical activity and high-frequency late potentials recorded from the epicardial surface of the left ventricle can identify regions of abnormal repolarization responsible for ventricular tachycardia/ventricular fibrillation in ERS and that radiofrequency ablation of these regions in left ventricular epicardium can suppress ventricular tachycardia/ventricular fibrillation by destroying regions of ER.
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Affiliation(s)
- Namsik Yoon
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea (N.Y.).,Masonic Medical Research Laboratory, Utica, NY (N.Y., B.P., C.A.)
| | - Bence Patocskai
- Institute of Physiology and Pathophysiology, Faculty of Medicine, University of Heidelberg, Germany (B.P.).,DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg-Mannheim, Germany (B.P.).,Masonic Medical Research Laboratory, Utica, NY (N.Y., B.P., C.A.)
| | - Charles Antzelevitch
- Masonic Medical Research Laboratory, Utica, NY (N.Y., B.P., C.A.).,Cardiovascular Research Program, Lankenau Institute for Medical Research, Philadelphia, PA (C.A.).,Lankenau Heart Institute, Philadelphia, PA (C.A.).,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (C.A.)
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Güner A, Güner EG, Yalçın AA, Kalkan AK, Turna Ö, Uslu A. An early repolarization pattern and L-IIB type of isolated single coronary artery anomaly in a patient who suffered sudden cardiac arrest: A fatal coexistence. J Electrocardiol 2019; 57:21-23. [PMID: 31465885 DOI: 10.1016/j.jelectrocard.2019.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/24/2019] [Accepted: 08/13/2019] [Indexed: 01/28/2023]
Abstract
The early repolarization pattern and single coronary artery (SCA) anomaly are rare causes of sudden cardiac arrest. The relationship between the early repolarization pattern and idiopathic ventricular fibrillation has previously been reported. Here, we describe a case of an early repolarization pattern and L-IIB type of isolated SCA anomaly in a patient who suffered a sudden cardiac arrest.
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Affiliation(s)
- Ahmet Güner
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
| | - Ezgi Gültekin Güner
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Arif Yalçın
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali Kemal Kalkan
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Önder Turna
- Department of Radiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Abdulkadir Uslu
- Department of Cardiology, Kosuyolu Kartal Training and Research Hospital, Istanbul, Turkey
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Yoon N, Hong SN, Cho JG, Jeong HK, Lee KH, Park HW. Experimental verification of the value of the T peak -T end interval in ventricular arrhythmia inducibility in an early repolarization syndrome model. J Cardiovasc Electrophysiol 2019; 30:2098-2105. [PMID: 31424133 DOI: 10.1111/jce.14123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/21/2019] [Accepted: 08/03/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION In patients with early repolarization patterns on ECG, many researchers have studied to find predictors of fatal arrhythmia. However, there are no satisfying clinical predictors. We evaluated the value of the Tpeak -Tend interval on pseudo-ECG in canine myocardial wedge preparation models of early repolarization syndrome. METHODS AND RESULTS Transmural pseudo-ECG and endocardial/epicardial action potentials were recorded from coronary-perfused canine left ventricular wedge preparations (n = 34). The Ito agonist NS5806 (8-10 µM), the calcium channel blocker verapamil (3 µM) and acetylcholine (2-3 µM) were used to mimic the disease model. A ventricular arrhythmia induction test was performed. QTpeak , QTend , Tpeak -Tend , and Tpeak -Tend /QTend were measured at 15 to 20 minutes after the provocative agent infusion. Polymorphic ventricular tachycardias (pVT) developed in 23 of the 34 preparations (67%). The maximal values of Tpeak -Tend and Tpeak -Tend /QTend were recorded just before pVT induction. At baseline, without the provocative agents, Tpeak -Tend and Tpeak -Tend /QTend were not different between pVT-induced and pVT-noninduced preparations. The Tpeak -Tend of the pVT-induced preparations was longer than that of non-induced preparations (58 ± 26.8 msec vs 33 ± 6.8 msec, P < .001). The Tpeak -Tend /QTend of pVT- induced preparations was larger than that of noninduced preparations (0.220 ± 0.1017 vs 0.128 ± 0.0312, P < .001). The transmural and epicardial dispersion of repolarization of pVT-induced preparations were larger than those of pVT-noninduced preparations. The transmural dispersion of repolarization showed a positive correlation with Tpeak -Tend . CONCLUSION Tpeak -Tend predicted malignant ventricular arrhythmias in early repolarization syndrome models. Tpeak -Tend reflects the repolarization heterogeneity of ventricular myocardium.
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Affiliation(s)
- Namsik Yoon
- Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Seo Na Hong
- Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jeong Gwan Cho
- Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hyung Ki Jeong
- Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ki Hong Lee
- Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hyung Wook Park
- Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea
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Miragoli M, Goldoni M, Demola P, Paterlini A, Li Calzi M, Gioia MI, Visioli F, Rossi S, Pelà G. Left ventricular geometry correlates with early repolarization pattern in adolescent athletes. Scand J Med Sci Sports 2019; 29:1727-1735. [DOI: 10.1111/sms.13518] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Michele Miragoli
- Department of Medicine and Surgery University of Parma Parma Italy
- CERT, Center of Excellence for Toxicological Research, Department of Medicine and Surgery University of Parma Parma Italy
| | - Matteo Goldoni
- Department of Medicine and Surgery University of Parma Parma Italy
- CERT, Center of Excellence for Toxicological Research, Department of Medicine and Surgery University of Parma Parma Italy
| | - Pierluigi Demola
- Department of Medicine and Surgery University of Parma Parma Italy
- University Hospital of Parma Parma Italy
| | | | - Mauro Li Calzi
- Department of Medicine and Surgery University of Parma Parma Italy
| | | | - Francesco Visioli
- Department of Molecular Medicine University of Padova Parma Italy
- IMDEA‐Food Madrid Spain
| | - Stefano Rossi
- Department of Medicine and Surgery University of Parma Parma Italy
- CERT, Center of Excellence for Toxicological Research, Department of Medicine and Surgery University of Parma Parma Italy
| | - Giovanna Pelà
- Department of Medicine and Surgery University of Parma Parma Italy
- University Hospital of Parma Parma Italy
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Nouraei H, Rabkin SW. The effect of exercise on the ECG criteria for early repolarization pattern. J Electrocardiol 2019; 55:59-64. [PMID: 31078110 DOI: 10.1016/j.jelectrocard.2019.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 02/17/2019] [Accepted: 03/07/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine the effect of exercise and heart rate on the early repolarization (ER) pattern; focusing on the new criteria for identification of ER. METHODS The ECG measurements on the terminal QRS notch or slur found in early repolarization were quantitated before, during and after exercise; specifically: (i) the amplitude at the onset of the notch (Jo) (ii) the amplitude at the peak of the notch (Jp), (iii) the amplitude at the end of the notch (Jt), (iv) the duration from Jo to Jp (D1) and (v) the duration from Jo to Jt (D2). RESULTS All individuals (N = 21) fulfilling the criteria for ER showed complete disappearance of ER after 3 min of exercise. After 5 min of recovery, 29% of subjects showed return of the ER. The return of ER was dynamic with QRS notching of varying extent, without ST elevation, being evident first. The relationship between heart rate and ER was significant and nonlinear, best fit by a second-order polynomial, suggesting that changes in heart rate with exercise was a factor influencing the presence of the ER pattern and the parameters that define ER. CONCLUSION Each of the newly defined characteristics of the ER are modified and eventually disappear with exercise. The return of ER was dynamic with QRS notching of varying extent being evident first. The changes correlated with variations in heart rate, during both exercise and recovery, suggesting, in part, a role in the underlying mechanism of ER.
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Affiliation(s)
- Hirmand Nouraei
- University of British Columbia, Department of Medicine (Cardiology), Vancouver, British Columbia, Canada
| | - Simon W Rabkin
- University of British Columbia, Department of Medicine (Cardiology), Vancouver, British Columbia, Canada.
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Hunuk B, de Asmundis C, Mugnai G, Velagic V, Ströker E, Moran D, Ruggiero D, Hacioglu E, Umbrain V, Verborgh C, Beckers S, Poelaert J, Brugada P, Chierchia GB. Early repolarization pattern as a predictor of atrial fibrillation recurrence following radiofrequency pulmonary vein isolation. Ann Noninvasive Electrocardiol 2019; 24:e12627. [PMID: 30659704 DOI: 10.1111/anec.12627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 11/17/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Early repolarization patterns (ERP) have been found to be associated with poor cardiovascular end points. We aimed to evaluate the ERP prevalence among patients with structurally normal hearts undergoing radiofrequency (RF) pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) ablation and its association with the AF recurrence. METHODS All consecutive patients who underwent RF-PVI as index procedure for paroxysmal AF in our center were evaluated. EXCLUSION CRITERIA structural heart disease, ongoing use of Class I/III antiarrhythmics, complete-bundle-branch-block. Lateral (I, aVL, V5 -V6 ), inferior (II, III, aVF), or infero-lateral (both) ERP were defined in baseline ECG as horizontal/downsloping J-point elevation ≥1 mm in two consecutive leads with QRS slurring/notching. Documented episodes of AF lasting ≥30 s were considered recurrence. RESULTS Of 701 cases, 434 patients (305 males, 58 ± 11 years) were included for analysis. ERP observed in 67 patients (15.4%) (Infero-lateral n = 26, inferior n = 23, lateral n = 18) which were significantly younger, demonstrating longer PR-interval and lower heart rates. At a mean follow-up of 22.1 ± 9.7 months, AF recurrences were found in 107 patients (24.6%). In middle-aged patients (≥40-<60 years; n = 206, 79% male), those with an infero-lateral ERP had higher recurrence compared with the ones without (56.3% vs. 19%; p = 0.002). Infero-lateral ERP was significantly predicting recurrence (HR 2.42, 95% CI 1.21-4.82; p = 0.01). CONCLUSION Early repolarization patterns was more prevalent in our AF population than in the general population. Infero-lateral ERP in baseline ECG might predict AF recurrence in the follow-up after RF-PVI in middle-aged patients.
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Affiliation(s)
- Burak Hunuk
- Department of Cardiology, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Giacomo Mugnai
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Vedran Velagic
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Darragh Moran
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Diego Ruggiero
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Ebru Hacioglu
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Vincent Umbrain
- Department of Anesthesiology, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Christian Verborgh
- Department of Anesthesiology, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Stefan Beckers
- Department of Anesthesiology, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Jan Poelaert
- Department of Anesthesiology, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
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Casado Arroyo R, Sieira J, Kubala M, Latcu DG, Maeda S, Brugada P. Electrophysiological Basis for Early Repolarization Syndrome. Front Cardiovasc Med 2018; 5:161. [PMID: 30460246 PMCID: PMC6232947 DOI: 10.3389/fcvm.2018.00161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 10/19/2018] [Indexed: 12/16/2022] Open
Abstract
During last centuries, Early Repolarization pattern has been interpreted as an ECG manifestation not linked to serious cardiovascular events. This view has been challenged on the basis of sporadic clinical observations that linked the J-wave with ventricular arrhythmias and sudden cardiac death. The particular role of this characteristic pattern in initiating ventricular fibrillation has been sustained by clinical descriptions of a marked and consistent J-wave elevation preceding the onset of the ventricular arrhythmia. Until now, Early Repolarization syndrome patients have been evaluated using ECG and theorizing different interpretations of the findings. Nonetheless, ECG analysis is not able to reveal all depolarization and repolarization properties and the explanation for this clinical events. Recent studies have characterized the epicardial substrate in these patients on the basis of high-resolution data, in an effort to provide insights into the substrate properties that support arrhythmogenicity in these patients. An overview for the current evidence supporting different theories explaining Early Repolarization Syndrome is provided in this review. Finally, future developments in the field directed toward individualized treatment strategies are examined.
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Affiliation(s)
- Rubén Casado Arroyo
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Maciej Kubala
- Department of Cardiology, Centre Hospitalier Universitaire, Amiens, France
| | | | - Shigo Maeda
- Advanced Arrhythmia Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Pedro Brugada
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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de Bliek EC. ST elevation: Differential diagnosis and caveats. A comprehensive review to help distinguish ST elevation myocardial infarction from nonischemic etiologies of ST elevation. Turk J Emerg Med 2018; 18:1-10. [PMID: 29942875 PMCID: PMC6009807 DOI: 10.1016/j.tjem.2018.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 01/28/2018] [Accepted: 01/31/2018] [Indexed: 12/22/2022] Open
Abstract
Prompt diagnosis of acute ST segment elevation myocardial infarction (STEMI) by the initial ECG is important in order to perform an urgent coronary angiography as soon as possible and achieve successful revascularization, therewith improving mortality and morbidity. Several diseases and conditions can mimic an acute myocardial infarction (AMI) but may not benefit from a (percutaneous) revascularization strategy. This narrative clinical review will discuss the ECG features of some of the causes of non-ischemic ST segment elevation to facilitate early recognition, prevent wrongful diagnosis and improve treatment outcomes.
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Georgopoulos S, Letsas KP, Liu T, Kalafateli M, Korantzopoulos P, Bürkle G, Vlachos K, Giannopoulos G, Efremidis M, Deftereos S, Sideris A, Takagi M, Yan GX, Ehrlich JR. A meta-analysis on the prognostic significance of inferolateral early repolarization pattern in Brugada syndrome. Europace 2018; 20:134-139. [PMID: 28087596 DOI: 10.1093/europace/euw394] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 11/07/2016] [Indexed: 01/05/2023] Open
Abstract
Aims The early repolarization (ER) pattern has been linked to an increased risk for arrhythmic death in various clinical settings. There are limited and conflicting data regarding the prognostic significance of ER pattern in Brugada syndrome (BS). The aim of this meta-analysis was to provide a detailed analysis of the currently available studies regarding the arrhythmic risk in patients with BS and ER pattern. Methods and results Current databases were searched until May 2015. A random-effect meta-analysis of the effect of ER pattern on the incidence of arrhythmic events in patients with BS was performed. Five studies were included comprising a total of 1375 patients with BS. An ER pattern was reported in 177 patients (12.8%). During follow-up (44.9-93 months), 143 patients (10.4%) suffered an arrhythmic event. Overall, BS patients with ER pattern displayed an increased risk of arrhythmic events compared to patients without ER (OR 3.29, 95% CI: 2.06 to 5.26, P < 0.00001; Heterogeneity: P = 0.11, I2 = 48%). Three studies provided data regarding ER pattern location. Inferior, lateral, or inferolateral ER pattern location was observed in 20.3%, 32.2%, and 48%, respectively. An inferolateral ER location conferred the higher arrhythmic risk (OR 4.87, 95% CI: 2.64 to 9.01, P< 0.00001; Heterogeneity: P = 0.85, I2 = 0%). Conclusion This meta-analysis suggests that the ER pattern is associated with a high risk of arrhythmic events in patients with BS. In particular, BS patients with inferolateral ER (global ER pattern) displayed the highest arrhythmic risk.
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Affiliation(s)
- Stamatis Georgopoulos
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
| | - Konstantinos P Letsas
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
| | - Tong Liu
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People's Republic of China
| | - Maria Kalafateli
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
| | | | - Gerd Bürkle
- Electrophysiology Section, St. Josefs-Hospital, Wiesbaden, Germany
| | - Konstantinos Vlachos
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
| | - Georgios Giannopoulos
- Second Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece
| | - Michael Efremidis
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
| | - Spyridon Deftereos
- Second Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece
| | - Antonios Sideris
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
| | - Masahiko Takagi
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Gan-Xin Yan
- Lankenau Institute for Medical Research, Wynnewood, PA, USA.,Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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14
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Yoon N, Hong S, Glass A, Kim SS, Kim MC, Cho JY, Lee KH, Sim DS, Yoon HJ, Kim KH, Hong YJ, Park HW, Kim JH, Ahn Y, Jeong M, Park JC, Cho JG. T
peak–Tend interval during therapeutic hypothermia can predict upcoming ventricular fibrillation in subjects with aborted arrhythmic sudden cardiac death: 3-years follow-up results. Europace 2017; 19:iv17-iv24. [DOI: 10.1093/europace/eux281] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 09/12/2017] [Indexed: 11/14/2022] Open
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15
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Rohel G, Perrier E, Delluc A, Monin J, Manen O, Paule P, Piquemal M, Mansourati J, Vinsonneau U. Progression of early repolarization patterns at a four year follow-up in a female flight crew population: Implications for aviation medicine. Ann Noninvasive Electrocardiol 2017; 22. [PMID: 28557343 DOI: 10.1111/anec.12451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/16/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND To assess the prevalence, the appearance, and the distribution, as well as the fluctuation over time of early repolarization patterns after four years in a female population derived from the French aviation sector. METHODS This was a retrospective longitudinal study from 1998 to 2010 of a population of female employees who received a full clinical examination and an electrocardiogram (ECG) upon their recruitment and after a period of four years. RESULTS A total of 306 women were included (average of 25.87 ± 3.3 years of age). The prevalence of early repolarization was 9.2%. The most common appearance was J-point slurring for 64.3% (i.e. 20/28 subjects) that occurred in the inferior leads for 28.6% (i.e. 8/28 subjects). After four years, the prevalence was 7.5%, with a regression of this aspect in five of the subjects. There were no changes in the ECG in terms of the distribution and the appearance among the 23 subjects for whom the aspect persisted. Over the course of this four year period all of the subjects remained asymptomatic. CONCLUSIONS Early repolarization in this largely physically inactive female population was common, and it fluctuated over time. At present, no particular restrictions can be placed on asymptomatic flight crew who exhibit this feature in the absence of a prior medical history for heart disease.
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Affiliation(s)
- Gwénolé Rohel
- Department of Cardiology, Clermont Tonnerre Army Training Hospital, Brest, France
| | - Eric Perrier
- Department of Aerospace Medicine, Percy Army Training Hospital, Clamart, France
| | - Aurélien Delluc
- Department of Internal Medicine, Brest University Hospital La Cavale Blanche, Brest, France
| | - Jonathan Monin
- Department of Aerospace Medicine, Percy Army Training Hospital, Clamart, France
| | - Olivier Manen
- Department of Aerospace Medicine, Percy Army Training Hospital, Clamart, France
| | - Philippe Paule
- Department of Cardiology, Clermont Tonnerre Army Training Hospital, Brest, France
| | - Marie Piquemal
- Department of Cardiology, Clermont Tonnerre Army Training Hospital, Brest, France
| | - Jacques Mansourati
- Department of Cardiology, Brest University Hospital La Cavale Blanche, Brest, France
| | - Ulric Vinsonneau
- Department of Cardiology, Clermont Tonnerre Army Training Hospital, Brest, France
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16
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Eranti A, Aro AL, Kenttä T, Holkeri A, Tikkanen JT, Junttila MJ, Huikuri HV. 12-Lead electrocardiogram as a predictor of sudden cardiac death: from epidemiology to clinical practice. SCAND CARDIOVASC J 2016; 50:253-259. [PMID: 27454252 DOI: 10.1080/14017431.2016.1215520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Sudden cardiac death (SCD) causes a high burden of premature deaths in the population affecting subjects of all ages. The identification of subjects at high risk for SCD is of great importance as the prevention of many of these events would be possible with the treatment of underlying cardiac diseases and the use of implantable cardioverter-defibrillators (ICD). However, the current selection of patients for ICD therapy is based solely on left ventricular ejection fraction, and thus a substantial portion of patients at high risk does not qualify for the therapy. Role of the standard electrocardiogram (ECG) in SCD risk stratification has been under active research during the last decade and multiple abnormalities of depolarization and repolarization on the ECG associated with an increased risk of SCD have been identified. In this review, we describe the basic pathophysiological principles behind these changes. We also review the current knowledge of the prognostic significance of ECG predictors of SCD in the general population, and in patients with coronary heart disease (CHD), heart failure, cardiomyopathies, and in inheritable arrhythmia syndromes. Also, insights into the novel digital ECG signal processing techniques are provided.
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Affiliation(s)
- Antti Eranti
- a Department of Internal Medicine , Päijät-Häme Central Hospital , Lahti , Finland
| | - Aapo L Aro
- b Division of Cardiology , Heart and Lung Center, Helsinki University Central Hospital , Helsinki , Finland
| | - Tuomas Kenttä
- c Medical Research Center Oulu, Oulu University Hospital and University of Oulu , Oulu , Finland
| | - Arttu Holkeri
- b Division of Cardiology , Heart and Lung Center, Helsinki University Central Hospital , Helsinki , Finland
| | - Jani T Tikkanen
- c Medical Research Center Oulu, Oulu University Hospital and University of Oulu , Oulu , Finland
| | - M Juhani Junttila
- c Medical Research Center Oulu, Oulu University Hospital and University of Oulu , Oulu , Finland
| | - Heikki V Huikuri
- c Medical Research Center Oulu, Oulu University Hospital and University of Oulu , Oulu , Finland
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17
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Rattanawong P, Vutthikraivit W, Charoensri A, Jongraksak T, Prombandankul A, Kanjanahattakij N, Rungaramsin S, Wisaratapong T, Ngarmukos T. Fever-Induced Brugada Syndrome Is More Common Than Previously Suspected: A Cross-Sectional Study from an Endemic Area. Ann Noninvasive Electrocardiol 2015; 21:136-41. [PMID: 26178440 DOI: 10.1111/anec.12288] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/16/2015] [Accepted: 05/22/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Brugada syndrome (BrS) is defined as presenting of type-1 Brugada pattern (BrP). BrS can also be induced by fever. This study demonstrated a highest prevalence of fever-induced BrS ever reported. METHOD During May 2014, febrile (oral temperature ≥ 38 °C) and nonfebrile patients underwent standard and high leads (V1 and V2 at 2nd intercostal space) electrocardiogram. Risk factor and cardiac symptoms were recorded. Patients with a persistent of type-1 BrP after fever had subsided were excluded. The prevalence of BrS, type-2 BrP and early repolarization pattern (ERP) were demonstrated. RESULTS A total of 401 patients, 152 febrile, and 249 nonfebrile, were evaluated. BrS was identified in six febrile patients (five males and one female) and two males in nonfebrile patients. The study demonstrated higher prevalence of BrS in febrile group compared to nonfebrile group (4.0% vs 0.8%, respectively, P = 0.037). Among fever-induced BrS patients, three patients (50.0%) experienced cardiac symptoms before and at the time of presentation and two patients (33.3%) had history of first-degree relative sudden death. No ventricular arrhythmia was observed. All of type-1 BrP disappeared after fever had subsided. We found no difference in prevalence of type-2 BrP in febrile and nonfebrile group (2.0% vs 2.8%, respectively, P > 0.05) as well as ERP (3.3% vs 6.4%, respectively, P > 0.05). CONCLUSIONS Our study showed a highest prevalence of fever induced BrS ever reported. A larger study of prevalence, risk stratification, genetic test and management of fever-induced BrS should be done, especially in an endemic area.
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Affiliation(s)
- Pattara Rattanawong
- Division of Cardiovascular Disease, Department of Internal Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | | | | | | | - Napatt Kanjanahattakij
- Department of Internal Medicine, Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand
| | - Sakda Rungaramsin
- Department of Internal Medicine, Buriram Hospital, Buriram, Thailand
| | - Treechada Wisaratapong
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Prince Songkla University, Songkhla, Thailand
| | - Tachapong Ngarmukos
- Division of Cardiovascular Disease, Department of Internal Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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