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Pérez-Riera AR, Barbosa-Barros R, da Silva Rocha M, Paixão-Almeida A, Daminello-Raimundo R, de Abreu LC, Yanowitz F, Baranchuk A, Nikus K. Congenial short QT syndrome: A review focused on electrocardiographic features. J Electrocardiol 2024:S0022-0736(24)00060-8. [PMID: 38714466 DOI: 10.1016/j.jelectrocard.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/20/2024] [Accepted: 04/27/2024] [Indexed: 05/09/2024]
Abstract
Congenital short QT syndrome is a very low prevalence inherited primary arrhythmia syndrome first reported in 2000 by Gussak et al., who described two families with a short QT interval, syncope, and sudden cardiac death. In 2004, Ramon Brugada et al. identified the first genetic type of this entity. To date, a total of nine genotypes have been described. The diagnosis is easy from the electrocardiogram (ECG), not only due to the short QT duration, but also based on other aspects covered in this review. During 24-h Holter monitoring, paroxysmal atrial fibrillation spontaneously converting to sinus rhythm may be found. Even though the T wave may appear symmetric on the ECG, the T loop of the vectorcardiogram confirms that the T wave is constantly asymmetric due to the presence of dashes closer to each other in the efferent branch. In this review, we also describe the minus-plus T wave sign that we have described in a previously published article. In addition to congenital causes, we briefly highlight the existence of numerous acquired causes of short QT interval.
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Universidade Nove de Julho (UNINOVE), Mauá, SP, Brazil; Faculdade de Medicina FMABC, Santo André, SP, Brazil; Hospital do Coração (HCor), São Paulo, SP, Brazil.
| | | | | | | | | | - Luiz Carlos de Abreu
- Faculdade de Medicina FMABC, Santo André, SP, Brazil; Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Frank Yanowitz
- Intermountain Medical Center, Intermountain Heart Institute, Department of Internal Medicine, The University of Utah, Salt Lake City, UT, USA
| | | | - Kjell Nikus
- Faculty of Medicine and Life Sciences, Tampere University, and Heart Center, Tampere University Hospital, Tampere, Finland
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Pérez-Riera AR, Barbosa-Barros R, Andreou AY, Fiol-Sala M, Birnbaum Y, da Silva Rocha M, Daminello-Raimundo R, de Abreu LC, Nikus K. Left septal fascicular block: Evidence, causes, and diagnostic criteria. Heart Rhythm 2023; 20:1558-1569. [PMID: 37586583 DOI: 10.1016/j.hrthm.2023.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/18/2023]
Abstract
The existence of a tetrafascicular intraventricular conduction system is widely accepted by researchers. In this review, we have updated the criteria for left septal fascicular block (LSFB) and the differential diagnosis of prominent anterior QRS forces. More and more evidence points to the fact that the main cause of LSFB is critical proximal stenosis of the left anterior descending coronary artery before its first septal perforator branch. The most important characteristic of LSFB that has been incorporated in the corresponding diagnostic electrocardiographic criteria is its transient/intermittent nature mostly observed in clinical scenarios of acute (ie, acute coronary syndrome including vasospastic angina) or chronic (ie, exercise-induced ischemia) ischemic coronary artery disease. In addition, the phenomenon proved to be phase 4 bradycardia rate dependent and induced by early atrial extrastimulus. Finally, we believe that intermittent LSFB has the same clinical significance as "Wellens syndrome" and the "de Winter pattern" in the acute coronary syndrome scenario.
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário Saúde ABC, Santo André, São Paulo, Brazil; Clínica Médica, Universidade Uninove, Mauá, São Paulo, Brazil.
| | - Raimundo Barbosa-Barros
- Coronary Center of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Andreas Y Andreou
- Department of Cardiology, Limassol General Hospital, Limassol, Cyprus; University of Nicosia Medical School, Nicosia, Cyprus
| | - Miguel Fiol-Sala
- Balearic Islands Institute for Health Research, Hospital Son Espases, Palma de Mallorca, Spain
| | - Yochai Birnbaum
- Department of Medicine Cardiology, Baylor College of Medicine, Houston, Texas
| | | | - Rodrigo Daminello-Raimundo
- Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário Saúde ABC, Santo André, São Paulo, Brazil
| | - Luiz Carlos de Abreu
- Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário Saúde ABC, Santo André, São Paulo, Brazil; Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Kjell Nikus
- Heart Center, Tampere University Hospital, Tampere, Finland; Faculty of Medicine, Tampere University, Tampere, Finland
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Pérez-Riera AR, Barbosa-Barros R, da Silva-Rocha M, Daminello-Raimundo R, Carlos-de-Abreu L, Nikus K. Profesor Dr. José Manuel Rivero Carvallo: un gigante universal y mexicano de la semiología cardiovascular. ACM 2023; 93:127-130. [PMID: 37037225 PMCID: PMC10161811 DOI: 10.24875/acm.220001591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Affiliation(s)
- Andrés R. Pérez-Riera
- Laboratory of Research Methodology and Scientific Writing, Centro Universitário Saúde ABC, Santo André, SP, Brazil
- Medical Clinic, Universidade Uninove, Mauá, SP, Brazil
- Correspondence: Andrés R. Pérez-Riera E-mail:
| | - Raimundo Barbosa-Barros
- Coronary Center of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Fortaleza, Brazil
| | | | - Rodrigo Daminello-Raimundo
- Laboratory of Research Methodology and Scientific Writing, Centro Universitário Saúde ABC, Santo André, SP, Brazil
| | - Luiz Carlos-de-Abreu
- Laboratory of Research Methodology and Scientific Writing, Centro Universitário Saúde ABC, Santo André, SP, Brazil
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Kjell Nikus
- Heart Center, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Nikus K, Punkka O, Barbosa-Barros R, Daminello-Raimundo R, de Abreu LC, Pérez-Riera AR. Northwest axis in the electrocardiogram - A sign of right ventricular remodeling in tetralogy of Fallot. A case report. J Electrocardiol 2022; 74:101-103. [PMID: 36088787 DOI: 10.1016/j.jelectrocard.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/25/2022] [Accepted: 08/28/2022] [Indexed: 12/13/2022]
Abstract
The typical ECG changes in tetralogy of Fallot are right axis deviation, large R waves in the anterior precordial leads and large S waves in the lateral precordial leads. We present a patient with extreme deviation of the frontal QRS axis between -90° and ± 180°. The child underwent open heart surgery twice before one year of age and a third time at nine years of age. The axis change persisted into adulthood.
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Affiliation(s)
- Kjell Nikus
- Heart Center, Tampere University Hospital, Finland; Faculty of Medicine and Health Technology, Tampere University, Finland.
| | - Olli Punkka
- Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Raimundo Barbosa-Barros
- Coronary Center of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Rodrigo Daminello-Raimundo
- Laboratório de Delineamento de Pesquisas e Escrita Científica, Centro Universitário FMABC, Santo André, São Paulo, Brazil
| | - Luiz Carlos de Abreu
- Laboratório de Delineamento de Pesquisas e Escrita Científica, Centro Universitário FMABC, Santo André, São Paulo, Brazil; Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Andrés Ricardo Pérez-Riera
- Laboratório de Delineamento de Pesquisas e Escrita Científica, Centro Universitário FMABC, Santo André, São Paulo, Brazil; Clínica Médica e suas Especialidades, Universidade Uninove, Mauá, SP, Brazil
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de Andrade AT, Barbosa-Barros R, Nikus K, Raimundo RD, de Abreu LC, Sacilotto L, Darriuex FCC, Yanowitz FG, Brugada P, Pérez-Riera AR. Transient ascending ST-segment depression and widening of the S wave in 3-channel Holter monitoring-A sign of dromotropic disturbance in the right ventricular outflow tract in the Brugada syndrome: A report of five cases. Ann Noninvasive Electrocardiol 2021; 27:e12917. [PMID: 34882891 PMCID: PMC8916569 DOI: 10.1111/anec.12917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/12/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Brugada syndrome (BrS) is somewhat a challenging diagnosis, due to its dynamic pattern. One of the aspects of this disease is a significant conduction disorder located in the right ventricular outflow tract (RVOT), which can be explained as a consequence of low expression of Connexin-43. This decreased conduction speed is responsible for the typical electrocardiographic pattern. Opposite leads located preferably in inferior leads of the electrocardiogram may show a deep and widened S wave associated with ascending ST segment depression. Holter monitoring electrocardiographic (ECG) aspects is still a new frontier of knowledge in BrS, especially in intermittent clinical presentations. METHODS We describe, as an exploratory analysis, five case series of intermittent type 1 BrS to demonstrate the appearance of ascending ST segment depression and widening of the S wave, during 3-channel 24h-Holter monitoring (C1, C2 and C3) with bipolar leads. RESULTS In the five cases described, the ST segment depression was observed mainly in C2, but in some cases also in C1 and C3. Only case 1 presented concomitant intermittent elevation of the ST segment in C1. All cases were intermittent. CONCLUSION The recognition of an ECG pattern with ascending ST-segment depression and widening of the S wave in 3-channel Holter described in this case series should raise a suspicion of the BrS and suggests the counterpart of a dromotropic disturbance registered in the RVOT and/or reciprocal changes.
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Affiliation(s)
| | | | - Kjell Nikus
- Heart Center, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Rodrigo D Raimundo
- Laboratório de Delineamento de Estudos e Escrita Científica, Centro Universitário FMABC, Centro Universitário FMABC, Santo André, Brazil
| | - Luiz C de Abreu
- Laboratório de Delineamento de Estudos e Escrita Científica, Centro Universitário FMABC, Centro Universitário FMABC, Santo André, Brazil.,Universidade Federal do Espírito Santo, Departamento de Educação Integrada em Saúde, UFES, Vitória, Brazil
| | - Luciana Sacilotto
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Francisco C C Darriuex
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Frank G Yanowitz
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Pedro Brugada
- University Hospital of Brussel (UZ Brussel-VUB), Jette, Belgium
| | - Andrés Ricardo Pérez-Riera
- Laboratório de Delineamento de Estudos e Escrita Científica, Centro Universitário FMABC, Centro Universitário FMABC, Santo André, Brazil
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Santos Neto F, Pisani CF, Darrieux FCDC, Cirino CMF, Hachul DT, Santos AM, Pérez-Riera AR, Barbosa-Barros R, Scanavacca M. Validation of a Simple Electrocardiographic Algorithm for Detection of Ventricular Tachycardia. Arq Bras Cardiol 2021; 116:454-463. [PMID: 33566932 PMCID: PMC8159554 DOI: 10.36660/abc.20190501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 09/04/2020] [Indexed: 12/17/2022] Open
Abstract
Fundamento O diagnóstico diferencial de taquicardia de QRS largo, entre taquicardia ventricular (TV) ou taquicardia supraventricular com condução aberrante (TSV-A) é algumas vezes difícil de ser feito na sala de emergência. Objetivo Avaliar a acurácia de um algoritmo novo e simples para a detecção de TV no eletrocardiograma (ECG) em pacientes com taquicardia de QRS largo. Métodos ECGs de 12 derivações para detecção de taquicardia de QRS largo foram obtidos prospectivamente de 120 pacientes durante estudo eletrofisiológico. Seis médicos com diferentes experiências analisaram os ECGs, e fizeram o diagnóstico com base no algoritmo D12V16, que envolve a análise da polaridade predominante do complexo QRS nas derivações I, II, V1 e V6. O diagnóstico foi comparado com os obtidos pelo algoritmo tradicional de Brugada e pelo estudo eletrofisiológico, o qual é considerado padrão ouro. Adotou-se um nível de significância de 5% (p<0,05) nas análises estatísticas. Resultados De acordo com o estudo eletrofisiológico, 82 ECGs eram de TV e 38 de TSV-A. Doenças cardíacas estruturais estavam presentes em 71 (86,6%) dos pacientes com TV e em oito (21,1%) com TSV-A. O algoritmo de Brugada teve uma maior sensibilidade global (87,2%), enquanto o algoritmo D12V16 apresentou maior especificidade global (85,1%) para TV. Tanto o algoritmo D12V16 como o de Brugada apresentou um alto valor preditivo positivo (90,9% vs. 85,8%, respectivamente) e acurácia similar (73,8% vs. 81,4%, respectivamente) para o diagnóstico de TV. Nos avaliadores experientes, a acurácia foi maior utilizando o algoritmo de Brugada que o algoritmo D12V16, mas a acurácia dos dois algoritmos foi similar segundo os avaliadores menos experientes. Conclusão O algoritmo simplificado pode ser um método útil para reconhecer TV no ECG, principalmente para médicos menos experientes. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)
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Affiliation(s)
- Francisco Santos Neto
- Messejana - Dr. Carlos Alberto Studart Gomes (HM) Hospital , Fortaleza , CE - Brasil
| | - Cristiano F Pisani
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas Instituto do Coração, São Paulo , SP - Brasil
| | | | - Celia M F Cirino
- Messejana - Dr. Carlos Alberto Studart Gomes (HM) Hospital , Fortaleza , CE - Brasil
| | - Denise Tessariol Hachul
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas Instituto do Coração, São Paulo , SP - Brasil
| | - Astrid M Santos
- Messejana - Dr. Carlos Alberto Studart Gomes (HM) Hospital , Fortaleza , CE - Brasil
| | | | | | - Mauricio Scanavacca
- Messejana - Dr. Carlos Alberto Studart Gomes (HM) Hospital , Fortaleza , CE - Brasil
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Pérez-Riera AR, Barbosa-Barros R, Thomaz de Andrade A, Pontes Rodrigues R, Yanowitz F, Daminello Raimundo R, de Abreu LC, Nikus K, Brugada P. Relevance of the vectorcardiogram in the Brugada syndrome with "northwest QRS axis". J Electrocardiol 2021; 66:125-128. [PMID: 33906061 DOI: 10.1016/j.jelectrocard.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/01/2021] [Accepted: 04/16/2021] [Indexed: 11/16/2022]
Abstract
The outcome in the Brugada syndrome (BrS) is more benign in female than in male individuals. However, outcome could be adversely affected by sinus node dysfunction (SND). Long sinus pauses indicate an overlap between the phenotypes of BrS and SND. We present a 29-year-old woman with syncopal episodes at rest since adolescence.
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário Saúde ABC, Santo André, São Paulo, Brazil.
| | - Raimundo Barbosa-Barros
- Coronary Center of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Antonio Thomaz de Andrade
- Coronary Center of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Raiza Pontes Rodrigues
- Coronary Center of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Frank Yanowitz
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, UT, United States; The University of Utah, Department of Internal Medicine, Salt Lake City, UT, United States
| | - Rodrigo Daminello Raimundo
- Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário Saúde ABC, Santo André, São Paulo, Brazil
| | - Luiz Carlos de Abreu
- Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário Saúde ABC, Santo André, São Paulo, Brazil; Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Kjell Nikus
- Heart Center, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Pedro Brugada
- Cardiovascular Division, Free University of Brussels (UZ Brussel) VUB, Brussels, Belgium
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Pérez-Riera AR, Barbosa-Barros R, Daminello-Raimundo R, de Abreu LC, Nikus K. The Vectorcardiogram and the Main Dromotropic Disturbances. Curr Cardiol Rev 2021; 17:50-59. [PMID: 32778036 PMCID: PMC8142362 DOI: 10.2174/1573403x16666200810105504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/27/2020] [Accepted: 04/27/2020] [Indexed: 02/01/2023] Open
Abstract
Until the mid-1980s, it was believed that the vectorcardiogram (VCG) presented a greater specificity, sensitivity and accuracy in comparison to the 12-lead electrocardiogram (ECG), in the cardiology diagnosis. Currently, the VCG still is superior to the ECG in specific situations, such as in the evaluation of myocardial infarctions when associated with intraventricular conduction disturbances, in the identification and location of accessory pathways in ventricular preexcitation, in the differential diagnosis of patterns varying from normal of electrical axis deviation, in the evaluation of particular aspects of Brugada syndrome, Brugada phenocopies, concealed form of arrhythmogenic right ventricular cardiomyopathy and zonal or fascicular blocks of the right bundle branch on right ventricular free wall.VCG allows us to analyze the presence of left septal fascicular block more accurately than ECG and in the diagnosis of the interatrial blocks and severity of some chambers enlargements. The three-dimensional spatial orientation of both the atrial and the ventricular activity provides a far more complete observation tool than the linear ECG. We believe that the ECG/VCG binomial simultaneously obtained by the technique called electro-vectorcardiography (ECG/VCG) brought a significant gain for the differential diagnosis of several pathologies. Finally, in the field of education and research, VCG provided a better and more rational tridimensional insight into the electrical phenomena that occurs spatially, and represented an important impact on the progress of electrocardiography.
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Affiliation(s)
- Andrés R Pérez-Riera
- Laboratorio de Delineamento de Estudos e Escrita Científica, Centro Universitario Saude ABC, Santo Andre, Sao Paulo, Brazil
| | - Raimundo Barbosa-Barros
- Coronary Center of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceara, Brazil
| | - Rodrigo Daminello-Raimundo
- Laboratorio de Delineamento de Estudos e Escrita Científica, Centro Universitario Saude ABC, Santo Andre, Sao Paulo, Brazil
| | - Luiz C de Abreu
- Laboratorio de Delineamento de Estudos e Escrita Científica, Centro Universitario Saude ABC, Santo Andre, Sao Paulo, Brazil
| | - Kjell Nikus
- Heart Center, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Pérez-Riera AR, Barbosa-Barros R, Pereira-Rejálaga LE, Nikus K, Shenasa M. Electrocardiographic and Echocardiographic Abnormalities in Patients with Risk Factors for Atrial Fibrillation. Card Electrophysiol Clin 2021; 13:211-219. [PMID: 33516399 DOI: 10.1016/j.ccep.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The electrocardiogram and various echocardiography modalities are important risk markers for atrial fibrillation (AF). Electrocardiographic criteria of left atrial enlargement, advanced interatrial block, and PR-interval prolongation are atrial risk markers for AF. Transthoracic echocardiography is elementary for risk stratification of AF. Transesophageal echocardiography is a valuable tool to detect cardiac sources of embolism if early cardioversion is necessary. Intracardiac echocardiography is a real-time tool for guidance of percutaneous interventions, including radiofrequency ablation and left atrial appendage closure in patients with AF.
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Centro Universitário Saúde ABC, Laboratório de Metodologia de Pesquisa e Escrita Científica, Santo André, São Paulo, Brazil
| | | | | | - Kjell Nikus
- Heart Center, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Mohammad Shenasa
- Department of Cardiovascular Services, Heart and Rhythm Medical Group, 18324 Twin Creeks Road, Monte Sereno, CA 95030, USA.
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Manzzardo J, Barbosa-Barros R, Nikus K, Pérez-Riera AR. A rare combination of atrial and intraventricular conduction disturbances: Atypical type I advanced interatrial block, left posterior fascicular block and transient right bundle branch block. J Electrocardiol 2021; 65:45-49. [PMID: 33497882 DOI: 10.1016/j.jelectrocard.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/01/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
According to the first 2012 consensus report about interatrial block, the diagnosis of advanced interatrial block (A-IAB) consists of a P-wave duration ≥120 ms with biphasic "plus-minus" (±) polarity in the three leads of the inferior wall in the electrocardiogram. At the end of 2018, a new concept was introduced: the atypical A-IAB due to changes in the polarity or duration of the P-wave. The prevalence of these atypical patterns in different scenarios is currently unknown, but the patterns should be considered as risk factors of embolic stroke of undetermined source. When the A-IAB pattern is associated with clinical arrhythmic manifestations, it is known as the Bayés' Syndrome. We present a characteristic case of atypical A-IAB, and the rare left posterior fascicular block and transient right bundle branch block.
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Affiliation(s)
- Juan Manzzardo
- Servicio de Cardiología, Hospital Ítalo Alfredo Perrupato, San Martín, Mendoza, Argentina
| | - Raimundo Barbosa-Barros
- Coronary Center of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Kjell Nikus
- Heart Center, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Andrés Ricardo Pérez-Riera
- Laboratório de Delineamento de Estudos e Escrita Científica, Centro Universitário Saúde ABC, Santo André, São Paulo, Brazil.
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Pérez-Riera AR, Yanowitz F, Barbosa-Barros R, Daminello-Raimundo R, de Abreu LC, Nikus K, Brugada P. Electrocardiographic "Northwest QRS Axis" in the Brugada Syndrome: A Potential Marker to Predict Poor Outcome. JACC Case Rep 2020; 2:2230-2234. [PMID: 34317146 PMCID: PMC8299847 DOI: 10.1016/j.jaccas.2020.07.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/13/2020] [Accepted: 07/22/2020] [Indexed: 02/07/2023]
Abstract
Conduction delay in the right ventricular outflow tract as manifested in the electrocardiogram constitutes a high-risk predictor of ventricular arrhythmias in patients with Brugada syndrome. We present a case with a right QRS axis between –90° and ±180°. This feature has never been reported in the context of Brugada syndrome. (Level of Difficulty: Advanced.)
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Key Words
- AF, atrial fibrillation
- BrS, Brugada syndrome
- ECG, electrocardiogram
- EPS, electrophysiological study
- ICD, implantable cardioverter defibrillator
- RVOT, right ventricular outflow tract
- SCD, sudden cardiac death
- SSS, sick sinus syndrome
- VF, ventricular fibrillation
- VTA, ventricular tachyarrhythmia
- peripheral right blocks
- right distal blockages
- terminal conduction delay
- zonal right blocks
- zonal right conduction defect
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário Saúde ABC, Santo André, São Paulo, Brazil
| | - Frank Yanowitz
- Intermountain Medical Center, Intermountain Heart Institute, Department of Internal Medicine, The University of Utah, Salt Lake City, Utah
| | - Raimundo Barbosa-Barros
- Coronary Center of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Rodrigo Daminello-Raimundo
- Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário Saúde ABC, Santo André, São Paulo, Brazil
| | - Luiz Carlos de Abreu
- Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário Saúde ABC, Santo André, São Paulo, Brazil.,Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Kjell Nikus
- Heart Center, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pedro Brugada
- Cardiovascular Division, Free University of Brussels (UZ Brussel) VUB, Brussels, Belgium
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12
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Pérez-Riera AR, Barbosa-Barros R, Raimundo RD, Abreu LCD, Almeida MCD, Nikus K. Forças Anteriores Proeminentes do QRS Durante Suboclusão Transitória do Tronco da Coronária Esquerda. Arq Bras Cardiol 2020; 115:1-5. [PMID: 32935755 PMCID: PMC8386954 DOI: 10.36660/abc.20180363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 08/18/2019] [Indexed: 11/18/2022] Open
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13
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Pérez-Riera AR, Barbosa-Barros R, Baueb-Soler F, Daminello-Raimundo R, de Abreu LC, Nikus K. Unusual ventricular activation produced by temporary transvenous cardiac pacing: electrovectorcardiographic findings. Arch Cardiol Mex 2020; 90:16-20. [PMID: 31996859 DOI: 10.24875/acm.19000167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Complete heart block (CHB) results from dysfunction of the cardiac conduction system, which results in complete electrical dissociation. The ventricular escape rhythm can have its origin anywhere from the atrioventricular node to the bundle branch-Purkinje system. CHB typically results in bradycardia, hypotension, fatigue, hemodynamic instability, syncope, or even Stokes-Adams syndrome. Escape rhythm originating above the bifurcation of the His bundle (HB) produces narrow QRSs with relatively rapid heart rate (HR) (except in cases of His system disease). We present a middle-aged man with an HR of 34 bpm, progressive fatigue, in whom a temporary pacemaker was implanted in the subtricuspid region. The post-intervention electrocardiogram had unusual features.
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Affiliation(s)
- Andrés R Pérez-Riera
- Laboratorio de Metodología de la Investigación y Escritura Científica, Faculdade de Medicina do ABC, Santo André
| | | | - Fábio Baueb-Soler
- Departamento de Cardiología, Clínica Médica e Diagnóstica Soler, São Paulo, Brazil
| | - Rodrigo Daminello-Raimundo
- Laboratorio de Metodología de la Investigación y Escritura Científica, Faculdade de Medicina do ABC, Santo André
| | - Luiz C de Abreu
- Laboratorio de Metodología de la Investigación y Escritura Científica, Faculdade de Medicina do ABC, Santo André
| | - Kjell Nikus
- Centro del Corazón, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere, Finland
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14
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Pérez-Riera AR, Barbosa-Barros R, Daminello-Raimundo R, de Abreu LC, Nikus K. Current aspects of the basic concepts of the electrophysiology of the sinoatrial node. J Electrocardiol 2019; 57:112-118. [DOI: 10.1016/j.jelectrocard.2019.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/16/2019] [Accepted: 08/19/2019] [Indexed: 12/14/2022]
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15
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Pérez-Riera AR, Barbosa-Barros R, Belhassen B. Letter by Pérez-Riera et al Regarding Article, “Left-Dominant Arrhythmogenic Cardiomyopathy With Heterozygous Mutations in
DSP
and
MYBPC3”. Circ Cardiovasc Imaging 2019; 12:e009680. [DOI: 10.1161/circimaging.119.009680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Laboratório de Metodologia de Pesquisa e Escrita Científica, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil (A.R.P.-R.)
| | - Raimundo Barbosa-Barros
- Coronary Center of the Hospital de Messejana Dr Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil (R.B.-B.)
| | - Bernard Belhassen
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel (B.B.)
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16
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Xu G, Gottschalk BH, Pérez-Riera A, Barbosa-Barros R, Dendramis G, Carrizo AG, Agrawal S, Bayés de Luna A, Jastrzębski M, Tomcsányi J, Baranchuk A. Link between Brugada phenocopy and myocardial ischemia: Results from the International Registry on Brugada Phenocopy. Pacing Clin Electrophysiol 2019; 42:658-662. [PMID: 30924150 DOI: 10.1111/pace.13678] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/12/2019] [Accepted: 03/04/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Brugada phenocopies clinical entities that have indistinguishable electrocardiographic (ECG) patterns from true congenital Brugada syndrome. However, they are induced by other clinical circumstances such as myocardial ischemia. The purpose of our study was to examine the clinical features and pathogenesis of ischemia-induced Brugada phenocopy (BrP). METHODS Data from 17 cases of ischemia-induced BrP were collected from the International Registry (www.brugadaphenocopy.com). Data were extracted from these publications and authors were contacted to provide further insight into each case. RESULTS Of the patients included in this study, 71% were male. Mean age was 59 ± 11 years (range: 38-76). Type-1 Brugada ECG pattern occurred in 15/17 (88%) of the cases, while a type-2 Brugada ECG pattern was observed in the other 2/17 (12%). In all cases, the Brugada ECG pattern resolved upon correction of the ischemia, indicating ischemia as the inducing circumstance. No arrhythmic events have been detected acutely or during the follow-up. Reported time to resolution ranged from 2 minutes to 5 hours. Provocative challenges using sodium channel blocking agents were performed in 7/17 cases (41%), and all failed to induce a Brugada ECG pattern (BrP Class A). The remaining 10/17 cases (59%) did not undergo provocative testing due to various clinical reasons. CONCLUSIONS Myocardial ischemia is a commonly reported etiology of BrP. Importantly, this study found no association between BrP induced by myocardial ischemia and sudden cardiac death or malignant ventricular arrhythmias.
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Affiliation(s)
- Grace Xu
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Byron H Gottschalk
- Department of Anesthesiology and Perioperative Medicine, Western University, London, Ontario, Canada
| | - Andrés Pérez-Riera
- Laboratory Design of Studies and Scientific Writing, ABC Faculty of Medicine, ABC Foundation, Santo André, São Paulo, Brazil
| | - Raimundo Barbosa-Barros
- Coronary Center of the Messejana's Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Gregory Dendramis
- Cardiovascular Division, Pietro Cosma Hospital, ULSS 6 Euganea, Camposampiero, Padova, Italy
| | - Aldo G Carrizo
- Cardiology Division, McMaster University, Hamilton, Ontario, Canada
| | - Sahil Agrawal
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Antonio Bayés de Luna
- Institut Català Ciències Cardiovasculars-St. Pau Hospital, and Quiron Barcelona Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Marek Jastrzębski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Cracow, Poland
| | - János Tomcsányi
- Cardiology Department, St. John of God Hospital, Budapest, Hungary
| | - Adrian Baranchuk
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
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17
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Pérez-Riera AR, Barbosa-Barros R, Daminello-Raimundo R, de Abreu LC, de Almeida MC, Rankinen J, Baeub Soler F, Nikus K. Re-evaluating the electro-vectorcardiographic criteria for left bundle branch block. Ann Noninvasive Electrocardiol 2019; 24:e12644. [PMID: 30938470 DOI: 10.1111/anec.12644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/03/2019] [Accepted: 01/23/2019] [Indexed: 11/26/2022] Open
Abstract
The criteria for left bundle branch block have gained growing interest in the last few years. In this overview, we discuss diagnostic and prognostic aspects of different criteria. It was already shown that stricter criteria, including longer QRS duration and slurring/notching of the QRS, better identify responders to cardiac resynchronization therapy. We also include aspects of ST/T concordance and discordance and vectorcardiography, which could further improve in the fine-tuning of the left bundle branch criteria.
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Affiliation(s)
| | - Raimundo Barbosa-Barros
- Coronary Center, de Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | | | - Luiz Carlos de Abreu
- Study Design and Scientific Writing Laboratory, ABC Faculty of Medicine, Santo André, São Paulo, Brazil
| | - Marcos Célio de Almeida
- IInstitute of Biology-Genetics and Morphology, University of Brasília, Brasília, Federal District, Brazil
| | - Jani Rankinen
- Heart Center, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | | | - Kjell Nikus
- Heart Center, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
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18
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Xu G, Gottschalk B, Pérez-Riera A, Barbosa-Barros R, Dendramis G, Carrizo A, Agrawal S, de Luna AB, Baranchuk A. Relationship between Brugada Phenocopy and Myocardial Ischemia: Results from the International Registry on Brugada Phenocopy. J Electrocardiol 2019. [DOI: 10.1016/j.jelectrocard.2019.01.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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19
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Pérez-Riera AR, Barbosa-Barros R, Daminello-Raimundo R, de Abreu LC, García-Niebla J, de Deus Morais MJ, Nikus K, Marcus FI. Epsilon wave: A review of historical aspects. Indian Pacing Electrophysiol J 2019; 19:63-67. [PMID: 30796961 PMCID: PMC6450822 DOI: 10.1016/j.ipej.2019.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 02/18/2019] [Indexed: 11/28/2022] Open
Abstract
The epsilon wave of the electrocardiogram (ECG) together with fragmented QRS (fQRS), the terminal conduction delay, incomplete right bundle branch block (IRBBB) and complete/advanced RBBB (CRBBB) of peripheral origin are part of a spectrum of ventricular depolarization abnormalities of arrhythmogenic cardiomyopathy(AC). Although the epsilon wave is considered a major diagnostic criterion for AC since 2010 (AC Task Force Criteria), its diagnostic value is limited because it is a sign of the later stage of the disease. It would be more appropriate to say that the epsilon wave is a “hallmark” of AC, but is of low diagnostic sensitivity. Although the epsilon wave has high specificity for AC, it can be present in other pathological conditions. In this update we will cover the nomenclature, association with disease states and electrocardiographic aspects of the epsilon wave.
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Laboratório de Pesquisa e Escrita Científica da Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil.
| | - Raimundo Barbosa-Barros
- Coronary Center of the Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Rodrigo Daminello-Raimundo
- Laboratório de Pesquisa e Escrita Científica da Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
| | - Luiz Carlos de Abreu
- Laboratório de Pesquisa e Escrita Científica da Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
| | - Javier García-Niebla
- Servicios Sanitarios del Área de Salud de El Hierro, Valle del Golfo Health Center, Islas Canarias, Spain
| | - Mauro José de Deus Morais
- Laboratório de Pesquisa e Escrita Científica da Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil; Centro de Ciências da Saúde e Desporto, Universidade Federal do Acre, Rio Branco, Acre, Brazil
| | - Kjell Nikus
- Heart Center, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | - Frank I Marcus
- Sarver Heart Center, The University of Arizona Health Sciences Hospital, Tucson, AZ, USA
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20
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Pérez-Riera AR, Barbosa-Barros R, Daminello-Raimundo R, de Abreu LC, Nikus K. The tetrafascicular nature of the intraventricular conduction system. Clin Cardiol 2018; 42:169-174. [PMID: 30294894 DOI: 10.1002/clc.23093] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/28/2018] [Accepted: 10/02/2018] [Indexed: 11/10/2022] Open
Abstract
The existence of a tetrafascicular intraventricular conduction system remains debatable. A consensus statement ended up with some discrepancies and, despite agreeing on the possible existence of an anatomical left septal fascicle, the electrocardiographic and vectorcardiographic characteristics of left septal fascicular block (LSFB) were not universally accepted. The most important criteria requested to confirm the existence of LSFB is its intermittent nature. So far, our group has published cases of transient ischemia-induced LSFB and phase 4 or bradycardia-dependent LSFB. Finally, anatomical, anatomopathological, histological, histopathological, electrocardiographic, vectorcardiographic, body surface potential mapping, and electrophysiology studies support the fact that the left bundle branch divides into three fascicles or a "fan-like interconnected network."
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Affiliation(s)
- Andrés R Pérez-Riera
- Design of Studies and Scientific Writing Laboratory, ABC Faculty of Medicine, São Paulo, Brazil
| | - Raimundo Barbosa-Barros
- Coronary Center of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Brazil
| | | | - Luiz C de Abreu
- Design of Studies and Scientific Writing Laboratory, ABC Faculty of Medicine, São Paulo, Brazil
| | - Kjell Nikus
- Heart Center, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
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21
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Liu Y, Pérez-Riera AR, Barbosa-Barros R, Daminello-Raimundo R, de Abreu LC, Nikus K, Baranchuk A. Severe hypercalcemia from multiple myeloma as an acquired cause of short QT. J Electrocardiol 2018; 51:939-940. [PMID: 30497751 DOI: 10.1016/j.jelectrocard.2018.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/11/2018] [Accepted: 07/26/2018] [Indexed: 12/26/2022]
Abstract
An otherwise healthy 64-year-old man with recently diagnosed multiple myeloma was admitted to hospital with hypercalcemia and renal failure. Despite his electrocardiogram showing short QT/QTc intervals, he was admitted without cardiac monitoring. He died suddenly a few hours later, likely from a fatal arrhythmia. This case illustrates that pronounced QT shortening from hypercalcemia is an underappreciated malignant finding that can portend a significant risk for arrhythmia and sudden cardiac death. In addition, we also discuss the causes of hypercalcemia associated short QT/QTc intervals and its ECG features.
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Affiliation(s)
- Yingwei Liu
- Division of Cardiology, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada
| | | | | | | | | | | | - Adrian Baranchuk
- Division of Cardiology, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada.
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22
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Xu G, Gottschalk B, Pérez-Riera A, Barbosa-Barros R, Dendramis G, Carrizo A, Agrawal S, de Luna AB, Baranchuk A. Relationship between Brugada Phenocopy and Myocardial Ischemia: Results from the International Registry on Brugada Phenocopy. J Electrocardiol 2018. [DOI: 10.1016/j.jelectrocard.2018.10.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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23
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Pérez-Riera AR, Barbosa-Barros R, Daminello-Raimundo R, de Abreu LC, Nikus K. Electro-vectorcardiographic and electrophysiological aspects of Ebstein's anomaly. Ann Noninvasive Electrocardiol 2018; 24:e12590. [PMID: 30106198 DOI: 10.1111/anec.12590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 06/17/2018] [Accepted: 07/25/2018] [Indexed: 11/26/2022] Open
Abstract
Ebstein's anomaly is a congenital heart disease where the most important anatomic feature is the inferior displacement of the tricuspid valve leaflets. Vectorcardiographic features are mainly forgotten and electrocardiographic features may be unrecognized by cardiologists handling adult patients.
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Design of Studies and Scientific Writing Laboratory in the ABC School of Medicine, Santo Andre, Sao Paulo, Brazil
| | - Raimundo Barbosa-Barros
- Coronary Center of the Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceara, Brazil
| | - Rodrigo Daminello-Raimundo
- Design of Studies and Scientific Writing Laboratory in the ABC School of Medicine, Santo Andre, Sao Paulo, Brazil
| | - Luiz Carlos de Abreu
- Design of Studies and Scientific Writing Laboratory in the ABC School of Medicine, Santo Andre, Sao Paulo, Brazil
| | - Kjell Nikus
- Heart Center, Faculty of Medicine and Life Sciences, Tampere University Hospital, University of Tampere, Tampere, Finland
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24
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García-Niebla J, Pérez-Riera AR, Barbosa-Barros R, Díaz-Muñoz J, Daminello-Raimundo R, de Abreu LC, Nikus K. Acute inferior myocardial infarction with right ventricular involvement and several clinical-electrocardiographic markers of poor prognosis. Ann Noninvasive Electrocardiol 2018; 24:e12592. [PMID: 30106201 DOI: 10.1111/anec.12592] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 07/13/2018] [Indexed: 12/01/2022] Open
Abstract
Right ventricular involvement in inferior myocardial infarction is a marker of poor prognosis. We present a case of a 62-year-old man with very recent onset of acute chest pain and cardiac shock with the triad of elevated jugular venous pressure, distension of the jugular veins on inspiration, and clear lung fields. In addition, the admission electrocardiogram showed a slurring J wave or lambda-like wave and conspicuous ST segment depression in several leads, predominantly in the lateral precordial (V4-V6), all clinical-electrocardiographic features of ominous prognosis.
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Affiliation(s)
- Javier García-Niebla
- Servicios Sanitarios del Área de Salud de El Hierro, Valle del Golfo Health Center, Islas Canarias, Spain
| | - Andrés Ricardo Pérez-Riera
- Design of Studies and Scientific Writing Laboratory in the ABC School of Medicine, Santo André, São Paulo, Brazil
| | - Raimundo Barbosa-Barros
- Coronary Center of the Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Jorge Díaz-Muñoz
- Servicios Sanitarios del Área de Salud de El Hierro, Valle del Golfo Health Center, Islas Canarias, Spain
| | - Rodrigo Daminello-Raimundo
- Design of Studies and Scientific Writing Laboratory in the ABC School of Medicine, Santo André, São Paulo, Brazil
| | - Luiz Carlos de Abreu
- Design of Studies and Scientific Writing Laboratory in the ABC School of Medicine, Santo André, São Paulo, Brazil
| | - Kjell Nikus
- Heart Center, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
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25
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Pérez-Riera AR, Barbosa-Barros R, de Rezende Barbosa MPC, Daminello-Raimundo R, de Abreu LC, Nikus K. Left bundle branch block: Epidemiology, etiology, anatomic features, electrovectorcardiography, and classification proposal. Ann Noninvasive Electrocardiol 2018; 24:e12572. [PMID: 29932265 DOI: 10.1111/anec.12572] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 04/28/2018] [Accepted: 05/14/2018] [Indexed: 01/25/2023] Open
Abstract
In left bundle branch block (LBBB), the ventricles are activated in a sequential manner with alterations in left ventricular mechanics, perfusion, and workload resulting in cardiac remodeling. Underlying molecular, cellular, and interstitial changes manifest clinically as changes in size, mass, geometry, and function of the heart. Cardiac remodeling is associated with progressive ventricular dysfunction, arrhythmias, and impaired prognosis. Clinical and diagnostic notions about LBBB have evolved from a simple electrocardiographic alteration to a critically important finding affecting diagnostic and clinical management of many patients. Advances in cardiac magnetic resonance imaging have significantly improved the assessment of patients with LBBB and provided additional insights into pathophysiological mechanisms of left ventricular remodeling. In this review, we will discuss the epidemiology, etiologies, and electrovectorcardiographic features of LBBB and propose a classification of the conduction disturbance.
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Affiliation(s)
- Andrés R Pérez-Riera
- Design of Studies and Scientific Writing Laboratory, ABC School of Medicine, São Paulo, Brazil
| | - Raimundo Barbosa-Barros
- Coronary Center, Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | | | | | - Luiz C de Abreu
- Design of Studies and Scientific Writing Laboratory, ABC School of Medicine, São Paulo, Brazil
| | - Kjell Nikus
- Heart Center, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Finland
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26
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Pérez-Riera AR, Barbosa-Barros R, Cabral de Oliveira MF, Daminello-Raimundo R, de Abreu LC, Nikus K. Transient left anterior and septal fascicular blocks after self-expandable percutaneous transcatheter aortic valve implantation. Ann Noninvasive Electrocardiol 2018; 24:e12553. [PMID: 29675905 DOI: 10.1111/anec.12553] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/21/2018] [Indexed: 12/22/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is indicated in severe symptomatic aortic stenosis, when there is intermediate-high surgical risk, or a condition considered inoperable, as in the case of "porcelain aorta" that could turn clamping or cannulation of the ascending aorta hazardous in open-heart surgery. Among the complications of this less invasive procedure, intraventricular conduction disorders subsequent to the procedure stand out. TAVI causes worsening of intraventricular dromotropic disorders in more than 75% of the cases, with the presence of preexisting right bundle branch block and first-degree atrioventricular block, deep prosthesis implant, male gender, size of the aortic annulus smaller than the prosthesis, and porcelain aorta being predictive of requirement for permanent pacemaker implant.
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Affiliation(s)
- Andrés R Pérez-Riera
- Design of Studies and Scientific Writing Laboratory, ABC School of Medicine, Santo André, São Paulo, Brazil
| | - Raimundo Barbosa-Barros
- Coronary Center of the Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | | | - Rodrigo Daminello-Raimundo
- Design of Studies and Scientific Writing Laboratory, ABC School of Medicine, Santo André, São Paulo, Brazil
| | - Luiz C de Abreu
- Design of Studies and Scientific Writing Laboratory, ABC School of Medicine, Santo André, São Paulo, Brazil
| | - Kjell Nikus
- Heart Center, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
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27
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Pérez-Riera AR, Barbosa-Barros R, Daminello-Raimundo R, de Abreu LC, Nikus K. Electro-vectorcardiographic demonstration of bifascicular block associated with ventricular preexcitation. Ann Noninvasive Electrocardiol 2018; 24:e12550. [PMID: 29673006 DOI: 10.1111/anec.12550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 03/21/2018] [Indexed: 11/28/2022] Open
Abstract
Down syndrome occurs more frequently in the offsprings of older pregnant women and may be associated with atrioventricular septal defect. This refers to a broad spectrum of malformations characterized by a deficiency of the atrioventricular septum and abnormalities of the atrioventricular valves caused by an abnormal fusion of the superior and inferior endocardial cushions with the midportion of the atrial septum and the muscular portion of the ventricular septum.
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Affiliation(s)
- Andrés R Pérez-Riera
- Design of Studies and Scientific Writing Laboratory, ABC School of Medicine, Santo André, São Paulo, Brazil
| | - Raimundo Barbosa-Barros
- Coronary Center of the Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Rodrigo Daminello-Raimundo
- Design of Studies and Scientific Writing Laboratory, ABC School of Medicine, Santo André, São Paulo, Brazil
| | - Luiz Carlos de Abreu
- Design of Studies and Scientific Writing Laboratory, ABC School of Medicine, Santo André, São Paulo, Brazil
| | - Kjell Nikus
- Heart Center, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
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Pérez-Riera AR, Barbosa-Barros R, Daminello-Raimundo R, de Abreu LC, Nikus K. Transient left septal fascicular block and left anterior fascicular block as a consequence of proximal subocclusion of the left anterior descending coronary artery. Ann Noninvasive Electrocardiol 2018; 24:e12546. [PMID: 29672995 DOI: 10.1111/anec.12546] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/23/2018] [Indexed: 11/27/2022] Open
Abstract
The association of left anterior fascicular block (LAFB) with left septal fascicular block (LSFB) characterizes a left bifascicular block subtype rarely described in the literature, probably due to the fact that most researchers are not aware of the existence of the left septal fascicle. We describe a case with this transient intraventricular dromotropic disturbance due to left anterior descending coronary artery subocclusion.
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Affiliation(s)
| | | | | | - Luiz Carlos de Abreu
- Design of Studies and Scientific Writing Laboratory, ABC School of Medicine, São Paulo, Brazil
| | - Kjell Nikus
- Heart Center, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
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Pérez-Riera AR, Barbosa-Barros R, Lima Aragão W, Daminello-Raimundo R, de Abreu LC, Tonussi Mendes Rossette do Valle JE, Esposito Sorpreso IC, Nikus K. Transient left septal fascicular block in the setting of acute coronary syndrome associated with giant slurring variant J-wave. Ann Noninvasive Electrocardiol 2018; 23:e12536. [PMID: 29476573 DOI: 10.1111/anec.12536] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 01/10/2018] [Indexed: 12/23/2022] Open
Abstract
We report a case of acute coronary syndrome with transient prominent anterior QRS forces (PAF) caused by proximal subocclusion of the left anterior descending (LAD) coronary artery before the first septal perforator branch. The ECG change indicates left septal fascicular block (LSFB) with associated slurring-type giant J-wave. Currently, this J-wave variant is considered as a lambda-like wave or QRS-ST-T "triangulation". Its presence is indicative of poor prognosis because of the risk for cardiac arrest as a consequence of ventricular tachycardia/ventricular fibrillation (VT/VF).
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Design of Studies and Scientific Writing Laboratory in the ABC School of Medicine, Santo André, São Paulo, Brazil
| | - Raimundo Barbosa-Barros
- Coronary Center of the Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Brazil
| | - Wallam Lima Aragão
- Coronary Center of the Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Brazil
| | - Rodrigo Daminello-Raimundo
- Design of Studies and Scientific Writing Laboratory in the ABC School of Medicine, Santo André, São Paulo, Brazil
| | - Luiz Carlos de Abreu
- Design of Studies and Scientific Writing Laboratory in the ABC School of Medicine, Santo André, São Paulo, Brazil
| | | | | | - Kjell Nikus
- Heart Center, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
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Barbosa-Barros R, Pérez-Riera AR, Koivula K, de Carvalho Santos J, de Abreu LC, Nikus K. Acute coronary syndrome of very unusual etiology. Ann Noninvasive Electrocardiol 2018; 23:e12531. [PMID: 29356195 DOI: 10.1111/anec.12531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 11/30/2017] [Indexed: 11/28/2022] Open
Abstract
Aortitis is one of many possible manifestations of tertiary syphilis. Aortic disease is the most common of all cardiovascular syphilitic lesions. Aortic diseases caused by tertiary syphilis include aortitis, aortic root dilation, aneurysm formation, aortic regurgitation and coronary ostial stenosis. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. We report a case of a 40-year-old male patient admitted with a clinical picture of acute coronary syndrome (unstable angina). He had no risk factors for coronary artery disease. The physical examination revealed nothing remarkable. The admission electrocardiogram (ECG) showed ST segment depression in the anterolateral and inferior leads (Figure 1). The coronary angiogram showed critical ostial stenosis of the right (RCA) and left main coronary artery (Figure 2a, b). Cardiac-computed tomography showed aortic wall thickening with involvement of bilateral coronary ostia (Figure 2b, c). The patient was referred for coronary bypass surgery after treatment with two doses of penicillin G. The laboratory test was strongly positive for syphilitic infection. Postoperative treatment with benzathine penicillin, in doses recommended for tertiary syphilis, was implemented.
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Affiliation(s)
- Raimundo Barbosa-Barros
- Coronary Center of the Messejana's Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Andrés R Pérez-Riera
- Laboratory Design of Studies and Scientific Writing, ABC Faculty of Medicine, ABC Foundation, Santo André, São Paulo, Brazil
| | - Kimmo Koivula
- Faculty of Medicine and Life Sciences and Clinic of Internal medicine, Helsinki University Hospital, University of Tampere, Tampere, Finland
| | - Jairo de Carvalho Santos
- Coronary Center of the Messejana's Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Luiz C de Abreu
- Laboratory Design of Studies and Scientific Writing, ABC Faculty of Medicine, ABC Foundation, Santo André, São Paulo, Brazil
| | - Kjell Nikus
- Faculty of Medicine and Life Sciences, Heart Center, Tampere University Hospital, University of Tampere, Tampere, Finland
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Nikus K, Pérez-Riera AR, Konttila K, Barbosa-Barros R. Electrocardiographic recognition of right ventricular hypertrophy. J Electrocardiol 2018; 51:46-49. [DOI: 10.1016/j.jelectrocard.2017.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Indexed: 11/27/2022]
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Pérez-Riera AR, Barbosa-Barros R, Daminello Raimundo R, da Costa de Rezende Barbosa MP, Esposito Sorpreso IC, de Abreu LC. The congenital long QT syndrome Type 3: An update. Indian Pacing Electrophysiol J 2018; 18:25-35. [PMID: 29101013 PMCID: PMC5840852 DOI: 10.1016/j.ipej.2017.10.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/27/2017] [Accepted: 10/30/2017] [Indexed: 01/28/2023] Open
Abstract
Congenital long QT syndrome type 3 (LQT3) is the third in frequency compared to the 15 forms known currently of congenital long QT syndrome (LQTS). Cardiac events are less frequent in LQT3 when compared with LQT1 and LQT2, but more likely to be lethal; the likelihood of dying during a cardiac event is 20% in families with an LQT3 mutation and 4% with either an LQT1 or an LQT2 mutation. LQT3 is consequence of mutation of gene SCN5A which codes for the Nav1.5 Na+ channel α-subunit and electrocardiographically characterized by a tendency to bradycardia related to age, prolonged QT/QTc interval (mean QTc value 478 ± 52 ms), accentuated QT dispersion consequence of prolonged ST segment, late onset of T wave and frequent prominent U wave because of longer repolarization of the M cell across left ventricular wall.
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Metodologia da Pesquisa e Escrita Científica da Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil.
| | - Raimundo Barbosa-Barros
- Centro Coronariano do Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Rodrigo Daminello Raimundo
- Metodologia da Pesquisa e Escrita Científica da Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
| | | | | | - Luiz Carlos de Abreu
- Program in Molecular and Integrative Physiological Sciences (MIPS), Department of Environmental Health, Harvard T.H. Chan School of Public Health, USA
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Abstract
Although the electrocardiograph (ECG) was invented more than 100 years ago, it remains the most commonly used test in clinical medicine. It is easy to perform, relatively cheap, and results are readily available. Interpretation, however, needs expertise and knowledge. New data, phenomenon, and syndromes are continually discovered by the ECG. It is important to differentiate between normal and abnormal ECGs first and then try to correlate the findings with clinical pathologies. Furthermore, the ECG is an integral part of the screening model for a variety of conditions such as channelopathies, athletes, preoperative risk profile, and remains the cardiologist's best friend.
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Design of Studies and Scientific Writing Laboratory in the ABC School of Medicine, ABC Foundation, Av. Príncipe de Gales, 821 - Vila Principe de Gales, Santo André, São Paulo 09060-650, Brazil; Ambulatorio de cardiologia do Hospital do Coração, R. Des. Eliseu Guilherme, 147 - Paraiso, São Paulo, São Paulo 04004-030, Brazil
| | - Raimundo Barbosa-Barros
- Coronary Center of the Hospital de Messejana Dr Carlos Alberto Studart Gomes, Av. Frei Cirilo, 3480, Fortaleza, Ceará 60840-285, Brazil
| | - Mohammad Shenasa
- Department of Cardiovascular Services, Heart and Rhythm Medical Group, O'Connor Hospital, 105 North Bascom Avenue, Suite 204, San Jose, CA 95128, USA.
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Laboratório de Delineamento de Estudos e Escrita Científica da Faculdade de Medicina do André Bernardo Caetano (ABC), Santo André, São Paulo, Brazil (A.R.P.-R., R.D.R., L.C.d.A.)
| | - Raimundo Barbosa-Barros
- Centro Coronariano do Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil (R.B.-B.)
| | - Rodrigo Daminello-Raimundo
- Laboratório de Delineamento de Estudos e Escrita Científica da Faculdade de Medicina do André Bernardo Caetano (ABC), Santo André, São Paulo, Brazil (A.R.P.-R., R.D.R., L.C.d.A.)
| | - Luiz Carlos de Abreu
- Laboratório de Delineamento de Estudos e Escrita Científica da Faculdade de Medicina do André Bernardo Caetano (ABC), Santo André, São Paulo, Brazil (A.R.P.-R., R.D.R., L.C.d.A.)
| | - Adrian Baranchuk
- Division of Cardiology, Queen’s University, Kingston, Canada (A.B.)
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Pérez-Riera AR, Barbosa-Barros R, de Rezende Barbosa MPC, Daminello-Raimundo R, de Lucca AA, de Abreu LC. Catecholaminergic polymorphic ventricular tachycardia, an update. Ann Noninvasive Electrocardiol 2017; 23:e12512. [PMID: 29048771 DOI: 10.1111/anec.12512] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 09/20/2017] [Indexed: 12/11/2022] Open
Abstract
Catecholaminergic polymorphic ventricular tachycardia is a rare devastating lethal inherited disorder or sporadic cardiac ion channelopathy characterized by unexplained syncopal episodes, and/or sudden cardiac death (SCD), aborted SCD (ASCD), or sudden cardiac arrest (SCA) observed in children, adolescents, and young adults without structural heart disease, consequence of adrenergically mediated arrhythmias: exercise-induced, by acute emotional stress, atrial pacing, or β-stimulant infusion, even when the electrocardiogram is normal. The entity is difficult to diagnose in the emergency department, given the range of presentations; thus, a familiarity with and high index of suspicion for this pathology are crucial. Furthermore, recognition of the characteristic findings and knowledge of the management of symptomatic patients are necessary, given the risk of arrhythmia recurrence and SCA. In this review, we will discuss the concept, epidemiology, genetic background, genetic subtypes, clinical presentation, electrocardiographic features, diagnosis criteria, differential diagnosis, and management.
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Affiliation(s)
- Andrés R Pérez-Riera
- Design of Studies and Scientific Writing Laboratory in the ABC Medicine Faculty, Santo André, São Paulo, Brazil
| | - Raimundo Barbosa-Barros
- Coronary Center of the Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | | | - Rodrigo Daminello-Raimundo
- Design of Studies and Scientific Writing Laboratory in the ABC Medicine Faculty, Santo André, São Paulo, Brazil
| | - Augusto A de Lucca
- Design of Studies and Scientific Writing Laboratory in the ABC Medicine Faculty, Santo André, São Paulo, Brazil
| | - Luiz C de Abreu
- Design of Studies and Scientific Writing Laboratory in the ABC Medicine Faculty, Santo André, São Paulo, Brazil
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Pérez-Riera AR, Barbosa-Barros R, Daminello-Raimundo R, de Abreu LC. Main artifacts in electrocardiography. Ann Noninvasive Electrocardiol 2017; 23:e12494. [PMID: 28940924 DOI: 10.1111/anec.12494] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 07/16/2017] [Indexed: 11/27/2022] Open
Abstract
Electrocardiographic artifacts are defined as electrocardiographic alterations, not related to cardiac electrical activity. As a result of artifacts, the components of the electrocardiogram (ECG) such as the baseline and waves can be distorted. Motion artifacts are due to shaking with rhythmic movement. Examples of motion artifacts include tremors with no evident cause, Parkinson's disease, cerebellar or intention tremor, anxiety, hyperthyroidism, multiple sclerosis, and drugs such as amphetamines, xanthines, lithium, benzodiazepines, or shivering (due to hypothermia, fever (rigor due to shaking), cardiopulmonary resuscitation by chest compression (oscillations of great amplitude) and patients who move their limbs during the test, causing sudden irregularities in the ECG baseline that may resemble premature contractions or interfere with ECG wave shapes, or other supraventricular and ventricular arrhythmias. When the skeletal muscles experience shaking, the ECG is "bombarded" by apparently random electrical activity.
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Design of Studies and Scientific Writing Laboratory at the ABC School of Medicine, Santo André, São Paulo, Brazil
| | - Raimundo Barbosa-Barros
- Coronary Center of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceara, Brazil
| | - Rodrigo Daminello-Raimundo
- Design of Studies and Scientific Writing Laboratory at the ABC School of Medicine, Santo André, São Paulo, Brazil
| | - Luiz Carlos de Abreu
- Design of Studies and Scientific Writing Laboratory at the ABC School of Medicine, Santo André, São Paulo, Brazil
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Pérez-Riera AR, Barbosa-Barros R, Penachini da Costa de Rezende Barbosa M, Daminello-Raimundo R, de Abreu LC. Transient left septal and anterior fascicular block associated with type 1 electrocardiographic Brugada pattern. J Electrocardiol 2017; 51:145-149. [PMID: 28919216 DOI: 10.1016/j.jelectrocard.2017.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Indexed: 11/19/2022]
Abstract
The left septal fascicular block (LSFB) or blockage of the middle fibers of the left bundle branch is probably caused mainly by - in the developed world - the proximal obstruction of the left anterior descending artery (LAD) before its first anterior septal perforator branch (S1). The association of transient LSFB and left anterior fascicular block (LAFB) - left bifascicular block - and the electrocardiographic type 1 Brugada pattern (BrP) has not been described in the literature yet.
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Design of Studies and Scientific Writing Laboratory in the Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil.
| | - Raimundo Barbosa-Barros
- Coronary Center of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | | | - Rodrigo Daminello-Raimundo
- Design of Studies and Scientific Writing Laboratory in the Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
| | - Luiz Carlos de Abreu
- Design of Studies and Scientific Writing Laboratory in the Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
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Pérez-Riera AR, Baranchuk A, Zhang L, Barbosa-Barros R, de Abreu LC, Brugada P. Myotonic dystrophy and Brugada syndrome: A common pathophysiologic pathway? J Electrocardiol 2017; 50:513-517. [PMID: 28389016 DOI: 10.1016/j.jelectrocard.2017.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Indexed: 11/18/2022]
Abstract
Type 1 myotonic dystrophy (DM1) is a hereditary neuromuscular disease affecting multiple organs in human adults. Here we report a 42-year-old man diagnosed with DM1. Having a history of progressive muscular weakness and gradual loss of visual acuity, he was referred to us by his ophthalmologist for risk assessment of undergoing cataract surgery. Cardiology workup revealed type 1 Brugada ECG pattern, positive late potentials and inducible ventricular fibrillation in an electrophysiology study. Literature review revealed that those ECG changes may be observed in DM1, suggesting that DM1 and Brugada syndrome may share a common pathophysiologic pathway.
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Design of Studies and Scientific Writing Laboratory at the ABC School of Medicine, Santo André, São Paulo, Brazil.
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Li Zhang
- Lankenau Medical Center and Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Raimundo Barbosa-Barros
- Coronary Center of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, CE, Brazil
| | - Luiz Carlos de Abreu
- Design of Studies and Scientific Writing Laboratory at the ABC School of Medicine, Santo André, São Paulo, Brazil
| | - Pedro Brugada
- Department of Cardiology, Heart Rhythm Management Center, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Barbosa-Barros R, Alexander B, Baranchuk A. Interatrial Block in Brugada Syndrome. ACTA ACUST UNITED AC 2017; 70:1005. [PMID: 28130006 DOI: 10.1016/j.rec.2016.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Raimundo Barbosa-Barros
- Department of Medicine, Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Bryce Alexander
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Department of Medicine, Queen's University, Kingston, Ontario, Canada.
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Barbosa-Barros R, Pérez-Riera AR, de Abreu LC, de Sousa-Rocha RP, Oliveira da Costa Lino D, Baranchuk A, Zhang L. Isolated left ventricular arrhythmogenic cardiomyopathy: A case report. J Electrocardiol 2017; 50:144-147. [DOI: 10.1016/j.jelectrocard.2016.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Indexed: 11/25/2022]
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Pérez-Riera AR, Barbosa-Barros R, de Lucca AA, Viana MJ, de Abreu LC. Mid-ventricular Hypertrophic Obstructive Cardiomyopathy with Apical Aneurysm Complicated with Syncope by Sustained Monomorphic Ventricular Tachycardia. Ann Noninvasive Electrocardiol 2016; 21:618-621. [PMID: 27422472 DOI: 10.1111/anec.12377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Mid-ventricular hypertrophic obstructive cardiomyopathy with secondary formation of apical aneurysm is a rare variant of hypertrophic cardiomyopathy. They have a unique behavior because unlike other variants it causes sustained monomorphic ventricular tachycardia, which makes it particularly severe.
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Affiliation(s)
| | - Raimundo Barbosa-Barros
- Coronary Center of the Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, CE, Brazil
| | | | - Mujimbi Jose Viana
- ABC Faculty of Medicine - ABC Foundation, Santo André, São Paulo, Brazil
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Pérez-Riera AR, de Abreu LC, Barbosa-Barros R, Grindler J, Fernandes-Cardoso A, Baranchuk A. P-wave dispersion: an update. Indian Pacing Electrophysiol J 2016; 16:126-133. [PMID: 27924760 PMCID: PMC5197451 DOI: 10.1016/j.ipej.2016.10.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/20/2016] [Indexed: 11/30/2022] Open
Abstract
P-wave dispersion (PWD, Pd or Pdis) is a noninvasive electrocardiographic (ECG) marker for atrial remodeling and predictor for atrial fibrillation (AF). PWD is defined as the difference between the widest and the narrowest P-wave duration recorded from the 12 ECG leads. Increased P-wave duration and PWD reflect prolongation of intraatrial and interatrial conduction time with lack of a well-coordinated conduction system within the atrial muscles, with inhomogeneous, asynchronic, pro-inflammatory and anti-inflammatory effect mediated by interleukin-6 (IL-6) in patients with the CG + GG genotype IL-6 -634C/G polymorphism [1] and discontinuous propagation of sinus impulses mainly between the left and right atria, interstitial/extracellular fibroblast activation and collagen deposition with fibrosis (via TGF-β) in atrial tissue, insufficient blood supply, significant not isotropic myoelectric activity, and thin wall thickness and consequent expansion tendency all well-known electrophysiological characteristics in patients with atrial arrhythmias and especially paroxysmal atrial fibrillation (PAF) [2].
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Design of Studies and Scientific Writing Laboratory in the ABC Medicine Faculty, Santo André, São Paulo, Brazil.
| | - Luiz Carlos de Abreu
- Design of Studies and Scientific Writing Laboratory in the ABC Medicine Faculty, Santo André, São Paulo, Brazil; Program in Molecular and Integrative Physiological Sciences (MIPS), Department of Environmental Health, Harvard T.H. Chan School of Public Health, USA
| | - Raimundo Barbosa-Barros
- Coronary Center of the Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - José Grindler
- Electrocardiology Sector, Central Institute of Clínicas Hospital, Faculty of Medicine, University of São Paulo (HCFMUSP), Brazil
| | - Acácio Fernandes-Cardoso
- Electrocardiology Sector, Central Institute of Clínicas Hospital, Faculty of Medicine, University of São Paulo (HCFMUSP), Brazil
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
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Alexander B, Britton S, Barbosa-Barros R, Pérez-Riera AR, de Mourão Matos IC, Guzik P, Baranchuk A. Massive J-waves in the context of intracranial hemorrhage. J Electrocardiol 2016; 50:142-143. [PMID: 27717572 DOI: 10.1016/j.jelectrocard.2016.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Indexed: 11/18/2022]
Abstract
Transient ST-segment elevation may be caused by conditions other than myocardial ischemia, among them intracranial hemorrhage. Recognition of the underlying etiology of these ST-segment changes is key because of the vastly different therapies used to treat them. We describe the case of a patient with massive transient J-waves and ST-segment elevation in the context of an intracranial hemorrhage.
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Affiliation(s)
- Bryce Alexander
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Samantha Britton
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Andrés R Pérez-Riera
- Cardiology Discipline, ABC Faculty, ABC Foundation, Santo André, São Paulo, Brazil
| | | | - Przemyslaw Guzik
- Department of Cardiology-Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Adrian Baranchuk
- Department of Medicine, Queen's University, Kingston, Ontario, Canada.
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Britton S, Barbosa-Barros R, Alexander B, Baranchuk A. Progressive interatrial block associated with atrial fibrillation in a patient with hypertrophic cardiomyopathy. Ann Noninvasive Electrocardiol 2016; 22. [PMID: 27615799 DOI: 10.1111/anec.12403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Progressive interatrial block is a clinically significant condition that has previously been reported in various patient populations. It is a manifestation of progressive fibrosis affecting the Bachmann region. This report presents a case of progressive interatrial block associated with atrial fibrillation in the context of hypertrophic cardiomyopathy.
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Affiliation(s)
- Samantha Britton
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | | | - Bryce Alexander
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Adrian Baranchuk
- Department of Medicine, Queen's University, Kingston, ON, Canada
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Pérez-Riera AR, de Abreu LC, Barbosa-Barros R, Nikus KC, Baranchuk A. R-Peak Time: An Electrocardiographic Parameter with Multiple Clinical Applications. Ann Noninvasive Electrocardiol 2015; 21:10-9. [PMID: 26523751 DOI: 10.1111/anec.12323] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In the 12-lead electrocardiogram (ECG), the time from the onset of the QRS complex (Q or R wave) to the apex or peak of R or to R' (when present), using indirect or semidirect surface unipolar precordial leads, bipolar limb leads or unipolar limb leads, is called ventricular activation time (VAT), R wave peak time (RWPT), R-peak time or intrinsicoid deflection (ID). The R-peak time in a specific ECG lead is the interval from the earliest onset of the QRS complex, preferably determined from multiple simultaneously recorded leads, to the peak (maximum) of the R wave or R' if present. Irrespective of the relative height of the R and R' waves, the R-peak time is measured to the second peak. The parameter corresponds to the time of the electrical activation occurring from the endocardium to the epicardium as reflected by the recording electrode located at a variable distance on the body surface, depending on the lead type: a unipolar precordial lead, a bipolar or unipolar limb lead. In normal conditions, the R-peak time for the thinner-walled right ventricle is measured from lead V1 or V2 and its upper limit of normal is 35 ms. The R-peak time for the left ventricle (LV) is measured from leads V5 to V6 and 45 ms is considered the upper limit of normal. In this manuscript, we review the clinical applications of this parameter.
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Laboratory Design of Studies and Scientific Writing, ABC Faculty of Medicine, ABC Foundation, Santo André, São Paulo, Brazil
| | - Luiz Carlos de Abreu
- Laboratory Design of Studies and Scientific Writing, ABC Faculty of Medicine, ABC Foundation, Santo André, São Paulo, Brazil
| | - Raimundo Barbosa-Barros
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA.,Coronary Center of the Messejana's Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Cear, Brazil
| | - Kjell C Nikus
- Heart Center, Tampere University Hospital and School of Medicine, University of Tampere, Finland
| | - Adrian Baranchuk
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston ON, Canada
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Pérez-Riera AR, Nadeau-Routhier C, Barbosa-Barros R, Baranchuk A. Transient Left Septal Fascicular Block: An Electrocardiographic Expression of Proximal Obstruction of Left Anterior Descending Artery? Ann Noninvasive Electrocardiol 2015; 21:206-9. [PMID: 25940584 DOI: 10.1111/anec.12271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Andrés R Pérez-Riera
- Cardiology Discipline, ABC Faculty, ABC Foundation, Santo André, São Paulo, Brazil
| | | | - Raimundo Barbosa-Barros
- Coronary Center of the Hospital of Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Brazil
| | - Adrian Baranchuk
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Canada
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Baranchuk A, Barbosa-Barros R, Pérez-Riera AR. Brugada ECG pattern obscured by right bundle branch block: how to resolve the enigma? Pacing Clin Electrophysiol 2014; 37:1071-2. [PMID: 24665941 DOI: 10.1111/pace.12388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 02/06/2014] [Accepted: 02/14/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Adrian Baranchuk
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
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Pérez-Riera AR, de Lucca AA, Barbosa-Barros R, Yanowitz FG, de Cano SF, Cano MN, Palandri-Chagas AC. Value of electro-vectorcardiogram in hypertrophic cardiomyopathy. Ann Noninvasive Electrocardiol 2014; 18:311-26. [PMID: 23879271 DOI: 10.1111/anec.12067] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The electrocardiogram is an important tool for the initial diagnostic suspicion of hypertrophic cardiomyopathy in any of its forms, both in symptomatic and in asymptomatic patients because it is altered in more than 90 percent of the cases. Electrocardiographic anomalies are more common in patients carriers of manifest hypertrophic cardiomyopathy and the electrocardiogram alterations are earlier and more sensitive than the increase in left ventricular wall thickness detected by the echocardiogram. Nevertheless, despite being the leading cause of sudden death among young competitive athletes there is no consensus over the need to include the method in the pre-participation screening. In apical hypertrophic cardiomyopathy the electrocardiographic hallmarks are the giant negative T waves in anterior precordial leads. In the vectorcardiogram, the QRS loop is located predominantly in the left anterior quadrant and T loop in the opposite right posterior quadrant, which justifies the deeply negative T waves recorded. The method allows estimating the left ventricular mass because it relates to the maximal spatial vector voltage of the left ventricle in the QRS loop. The recording on electrocardiogram or Holter monitoring of nonsustained monomorphic ventricular tachycardia in patients with syncope, recurrent syncope in young patient, hypotension induced by strain, bradyarrhythmia, or concealed conduction are markers of poor prognosis. The presence of rare sustained ventricular tachycardia is observed in mid-septal obstructive HCM with apical aneurysm. The presence of complete right bundle branch block pattern is frequent after the percutaneous treatment and complete left bundle branch block is the rule after myectomy.
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Gottschalk B, Gysel M, Barbosa-Barros R, De Sousa Rocha RP, Pérez-Riera AR, Zhang L, Fontaine G, Baranchuk A. The use of fontaine leads in the diagnosis of arrhythmogenic right ventricular dysplasia. Ann Noninvasive Electrocardiol 2014; 19:279-84. [PMID: 24597934 DOI: 10.1111/anec.12153] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
We report a case of a 68-year-old man admitted to the emergency department with syncope preceded by rapid palpitations. His admission ECG demonstrated a sustained ventricular tachycardia (VT) originating from the right ventricular outflow tract (RVOT). This report highlights the importance of distinguishing ventricular tachycardia caused by arrhythmogenic right ventricular dysplasia (ARVD) from the more benign idiopathic RVOT-VT. Furthermore, we demonstrate the utility of the Fontaine leads placement in increasing the sensitivity for uncovering epsilon waves, a highly specific electrocardiographic feature that increases diagnostic accuracy in patients with ARVD.
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Affiliation(s)
- Byron Gottschalk
- Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
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