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Paixão MR, Ribas FF, Accorsi TAD, Amicis KD, de Souza JL. Torsades de pointes and myocardial infarction following reversal of supraventricular tachycardia with adenosine: a case report. EINSTEIN-SAO PAULO 2024; 22:eRC0522. [PMID: 38597464 PMCID: PMC11081022 DOI: 10.31744/einstein_journal/2024rc0522] [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: 03/09/2023] [Accepted: 12/12/2023] [Indexed: 04/11/2024] Open
Abstract
Adenosine is an antiarrhythmic drug that slows conduction through the atrioventricular node and acts as a coronary blood vessel dilator. This case report highlights two unusual life-threatening events following the use of adenosine to revert supraventricular tachycardia in a structurally normal heart: non-sustained polymorphic ventricular tachycardia and myocardial infarction. A 46-year-old woman presented to the emergency department with a two-hour history of palpitations and was diagnosed with supraventricular tachycardia. Vagal maneuvers were ineffective, and after intravenous adenosine administration, the patient presented with chest pain and hypotension. The rhythm degenerated into non-sustained polymorphic ventricular tachycardia and spontaneously reverted to sinus rhythm with ST elevation in lead aVR and ST depression in the inferior and anterolateral leads. The patient spontaneously recovered within a few minutes. Despite successful arrhythmia reversal, the patient was admitted to the intensive care unit because of an infarction without obstructive atherosclerosis. This report aims to alert emergency physicians about the potential complications associated with supraventricular tachycardia and its reversal with adenosine.
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Affiliation(s)
- Milena Ribeiro Paixão
- Hospital Israelita Albert EinsteinSao PauloSPBrazilHospital Israelita Albert Einstein, Sao Paulo, SP, Brazil.
| | - Fernando Faglioni Ribas
- Hospital Israelita Albert EinsteinSao PauloSPBrazilHospital Israelita Albert Einstein, Sao Paulo, SP, Brazil.
| | | | - Karine De Amicis
- Hospital Israelita Albert EinsteinSao PauloSPBrazilHospital Israelita Albert Einstein, Sao Paulo, SP, Brazil.
| | - José Leão de Souza
- Hospital Israelita Albert EinsteinSao PauloSPBrazilHospital Israelita Albert Einstein, Sao Paulo, SP, Brazil.
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2
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Elizari MV, Aguinaga L. Argentina's most important contributions in the field of electrophysiology. Heart Rhythm O2 2024; 5:3-7. [PMID: 38312206 PMCID: PMC10837184 DOI: 10.1016/j.hroo.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Latin American electrocardiology emerged internationally thanks to the Argentine School of Electrocardiology. All started when the idea of a different anatomy of the conduction system was not only necessary to change the paradigm of a bifascicular system, but also to question diagnostic electrocardiographic criteria adopted by the scientific community without dispute. Almost every scientific contribution coming from the Argentine School of Electrocardiology represented a significant step forward in the understanding of the electrophysiology of the heart and its electrocardiographic counterpart. There is another reason that increases their value: the noticeable simplicity of the technical facilities with which these studies were done from the modest laboratory in Argentina, whose production was purely and genuinely Latin American. In the following lines we summarize what we consider to be the greatest contributions of the Argentine school to world electrophysiology.
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Affiliation(s)
| | - Luis Aguinaga
- Centro Integral de Arritmias Tucumán, Tucumán, Argentina
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3
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Cossú SF. Cardiac Memory T-wave Inversions Noted with Ventricular Pacing: A Possible Electrocardiographic Marker of Appropriate Conduction System Pacing. J Innov Card Rhythm Manag 2023; 14:5552-5557. [PMID: 37650125 PMCID: PMC10464650 DOI: 10.19102/icrm.2023.14085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 03/21/2023] [Indexed: 09/01/2023] Open
Abstract
Cardiac memory is a common condition occurring after a period of abnormal depolarization, such as with right ventricular apical pacing. With restoration of normal conduction, the T-wave "remembers" the direction of the QRS vector of the previously aberrantly conducted complexes, creating diffusely inverted T-waves on the electrocardiogram. The presence of diffuse T-wave inversions with this phenomenon may be confused with myocardial ischemia and may continue to be present for several weeks after restoration of normal conduction. Here, an interesting electrocardiogram obtained after pacemaker implantation showing the opposite effect, ie, the finding of memory T-waves occurring during pacing after a period of intrinsic atrioventricular nodal conduction, is presented. In this case, the patient had an underlying left bundle branch block, which subsequently normalized as a result of conduction system pacing. The memory T-waves became evident after pacing was performed, suggesting a potential marker for restoration of the normal ventricular activation sequence with left bundle branch pacing and normalization of the baseline intraventricular conduction defect.
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Wu LY, Song YJ, Zhang CL, Liu J. K V Channel-Interacting Proteins in the Neurological and Cardiovascular Systems: An Updated Review. Cells 2023; 12:1894. [PMID: 37508558 PMCID: PMC10377897 DOI: 10.3390/cells12141894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
KV channel-interacting proteins (KChIP1-4) belong to a family of Ca2+-binding EF-hand proteins that are able to bind to the N-terminus of the KV4 channel α-subunits. KChIPs are predominantly expressed in the brain and heart, where they contribute to the maintenance of the excitability of neurons and cardiomyocytes by modulating the fast inactivating-KV4 currents. As the auxiliary subunit, KChIPs are critically involved in regulating the surface protein expression and gating properties of KV4 channels. Mechanistically, KChIP1, KChIP2, and KChIP3 promote the translocation of KV4 channels to the cell membrane, accelerate voltage-dependent activation, and slow the recovery rate of inactivation, which increases KV4 currents. By contrast, KChIP4 suppresses KV4 trafficking and eliminates the fast inactivation of KV4 currents. In the heart, IKs, ICa,L, and INa can also be regulated by KChIPs. ICa,L and INa are positively regulated by KChIP2, whereas IKs is negatively regulated by KChIP2. Interestingly, KChIP3 is also known as downstream regulatory element antagonist modulator (DREAM) because it can bind directly to the downstream regulatory element (DRE) on the promoters of target genes that are implicated in the regulation of pain, memory, endocrine, immune, and inflammatory reactions. In addition, all the KChIPs can act as transcription factors to repress the expression of genes involved in circadian regulation. Altered expression of KChIPs has been implicated in the pathogenesis of several neurological and cardiovascular diseases. For example, KChIP2 is decreased in failing hearts, while loss of KChIP2 leads to increased susceptibility to arrhythmias. KChIP3 is increased in Alzheimer's disease and amyotrophic lateral sclerosis, but decreased in epilepsy and Huntington's disease. In the present review, we summarize the progress of recent studies regarding the structural properties, physiological functions, and pathological roles of KChIPs in both health and disease. We also summarize the small-molecule compounds that regulate the function of KChIPs. This review will provide an overview and update of the regulatory mechanism of the KChIP family and the progress of targeted drug research as a reference for researchers in related fields.
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Affiliation(s)
- Le-Yi Wu
- Department of Pathophysiology, Shenzhen University Medical School, Shenzhen 518060, China
| | - Yu-Juan Song
- Department of Pathophysiology, Shenzhen University Medical School, Shenzhen 518060, China
| | - Cheng-Lin Zhang
- Department of Pathophysiology, Shenzhen University Medical School, Shenzhen 518060, China
| | - Jie Liu
- Department of Pathophysiology, Shenzhen University Medical School, Shenzhen 518060, China
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5
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Milman A, Belhassen B, Sabbag A, Dubnov-Raz G, Beinart R. Asymptomatic Athlete With Short-Coupled Premature Ventricular Contractions. JACC Case Rep 2021; 3:496-501. [PMID: 34317566 PMCID: PMC8311043 DOI: 10.1016/j.jaccas.2020.12.039] [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: 11/06/2020] [Revised: 11/30/2020] [Accepted: 12/14/2020] [Indexed: 11/30/2022]
Abstract
We present an asymptomatic 26-year-old athlete, with no family history of sudden cardiac death and no structural heart disease, who displayed short-coupled premature ventricular contractions on exercise test and Holter monitoring. The rarity of the case as well as management dilemmas are discussed. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Anat Milman
- Leviev Heart Institute, Sheba Medical Center, Tel Hashomer, Israel.,Sports and Exercise Medicine Clinic, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bernard Belhassen
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Heart Institute, Hadassah University Hospital, Jerusalem
| | - Avi Sabbag
- Leviev Heart Institute, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gal Dubnov-Raz
- Sports and Exercise Medicine Clinic, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Beinart
- Leviev Heart Institute, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Simultaneous piezoelectric noninvasive detection of multiple vital signs. Sci Rep 2020; 10:416. [PMID: 31942021 PMCID: PMC6962459 DOI: 10.1038/s41598-019-57326-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 12/26/2019] [Indexed: 11/09/2022] Open
Abstract
The monitoring of vital signs plays a key role in the diagnosis of several diseases. Piezoelectric sensors have been utilized to collect a corresponding representative signal from the chest surface. The subject typically needs to hold his or her breath to eliminate the respiration effect. This work further contributes to the extraction of the corresponding representative vital signs directly from the measured respiration signal. The contraction and expansion of the heart muscles, as well as the respiration activities, will induce a mechanical vibration across the chest wall. The induced vibration is then captured by the piezoelectric sensor placed at the chest surface, which produces an electrical output voltage signal conformally mapped with the respiration-cardiac activities. During breathing, the measured voltage signal is composed of the cardiac cycle activities modulated along with the respiratory cycle activity. A representative model that incorporates the cardiac and respiratory activities is developed and adopted. The piezoelectric and the convolution theories along with Fourier transformation are applied to extract the corresponding cardiac activity signal from the respiration signal. All the results were validated step by step by a conventional apparatus, with good agreement observed.
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Zhao Y, Yun M, Nguyen SA, Tran M, Nguyen TP. In Vivo Surface Electrocardiography for Adult Zebrafish. J Vis Exp 2019. [PMID: 31424443 DOI: 10.3791/60011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The electrocardiogram waveforms of adult zebrafish and those of humans are remarkably similar. These electrocardiogram similarities enhance the value of zebrafish not only as a research model for human cardiac electrophysiology and myopathies but also as a surrogate model in high throughput pharmaceutical screening for potential cardiotoxicities to humans, such as QT prolongation. As such, in vivo electrocardiography for adult zebrafish is an electrical phenotyping tool that is necessary, if not indispensable, for cross-sectional or longitudinal in vivo electrophysiological characterizations. However, too often, the lack of a reliable, practical, and cost-effective recording method remains a major challenge preventing this in vivo diagnostic tool from becoming more readily accessible. Here, we describe a practical, straightforward approach to in vivo electrocardiography for adult zebrafish using a low-maintenance, cost-effective, and comprehensive system that yields consistent, reliable recordings. We illustrate our protocol using healthy adult male zebrafish of 12-18 months of age. We also introduce a rapid real-time interpretation strategy for quality validation to ensure data accuracy and robustness early in the electrocardiogram recording process.
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Affiliation(s)
- Yali Zhao
- Department of Medicine, Division of Cardiology, the Cardiovascular Research Laboratory, David Geffen School of Medicine at UCLA
| | - Morgan Yun
- Department of Medicine, Division of Cardiology, the Cardiovascular Research Laboratory, David Geffen School of Medicine at UCLA
| | - Sean A Nguyen
- Department of Medicine, Division of Cardiology, the Cardiovascular Research Laboratory, David Geffen School of Medicine at UCLA
| | - Michelle Tran
- Department of Medicine, Division of Cardiology, the Cardiovascular Research Laboratory, David Geffen School of Medicine at UCLA
| | - Thao P Nguyen
- Department of Medicine, Division of Cardiology, the Cardiovascular Research Laboratory, David Geffen School of Medicine at UCLA;
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8
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Mauricio B. Rosenbaum and the Argentinian School of Electrocardiography. J Electrocardiol 2018; 51:346-353. [DOI: 10.1016/j.jelectrocard.2017.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Indexed: 11/17/2022]
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