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Journal of Electrocardiology

Gopi Dandamudi, Pugazhendhi Vijayaraman
Chronic right ventricular (RV) pacing has been shown over the years to exert detrimental physiological changes including increased risk for heart failure and atrial fibrillation. His bundle pacing offers the promise of physiological activation of the ventricular tissue, with the potential for reducing the detrimental effects of RV pacing. We describe His bundle pacing in a historical context and briefly highlight several clinical trials that have helped shape the landscape of permanent His bundle pacing.
September 24, 2016: Journal of Electrocardiology
Bryce Alexander, Samantha Britton, Raimundo Barbosa-Barros, Andrés R Pérez-Riera, Izabel Carminda de Mourão Matos, Przemyslaw Guzik, Adrian Baranchuk
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.
September 24, 2016: Journal of Electrocardiology
Pasquale Crea, Giuseppe Picciolo, Teresa Crea, Francesco Luzza
An 80-year-old male, who previously received a dual chamber pacemaker, was referred to our ambulatory for dizziness and fatigue. The ECG obtained showed sinus rhythm, highly variable atrioventricular (AV) interval and alternation between spontaneous and paced ventricular complexes. A spike on the ascending part of the T wave was observed, suggesting ventricular undersensing. However, telemetry-supported pacemaker control showed inconstant atrial undersensing.
September 24, 2016: Journal of Electrocardiology
George S Waits, Elsayed Z Soliman
The paper electrocardiogram (ECG) has been widely used for cardiac assessment for well over a century. ECGs can be obtained quickly and cheaply. For this reason, an ever-growing amount of paper ECG records continue to accumulate, some of which are stored into a paper-only format. Converting paper ECGs into digital form has been proposed as the most efficient means to store and analyze an otherwise cumbersome paper archive. In this article, a literature review was conducted for conversion algorithms, criticisms of said algorithms, applications, and standardization efforts...
September 12, 2016: Journal of Electrocardiology
Venu Velagapudi, John C O'Horo, Anu Vellanki, Stephen P Baker, Rahul Pidikiti, Jeffrey S Stoff, Dennis A Tighe
BACKGROUND: We sought to develop an improved 12 lead ECG model to diagnose hyperkalemia by use of traditional and novel parameters. METHODS: We retrospectively analyzed ECGs in consecutive hyperkalemic patients (serum potassium (K)>5.3mEq/L) by blinded investigators with normokalemic ECGs as internal controls. Potassium levels were modeled using general linear mixed models followed by refit with standardized variables. Optimum sensitivity and specificity were determined using cut point analysis of ROC-AUC...
September 9, 2016: Journal of Electrocardiology
Raimundo Barbosa-Barros, Andrés Ricardo Pérez-Riera, Luiz Carlos de Abreu, Ricardo Paulo de Sousa-Rocha, Danielli Oliveira da Costa Lino, Adrian Baranchuk, Li Zhang
Left ventricular involvement in the advanced stage of arrhythmogenic cardiomyopathy (AC) is an evolution of this desmosomopathy. Mutation in intercalated discs explains the phenotypic variability. Abnormal trafficking of the intercalated discs at the site of end-to-end contacts between cardiomyocytes and the canonical Wnt/β-catenin and Hippo signaling pathways have been implicated. In AC, T-wave inversion in lateral leads is the hallmark of left ventricular (LV) involvement. We herein report a case of isolated LV AC in which the initial ECG has typical features: fragmented QRS (fQRS), Twave inversion (TWI) in lateral leads, and ventricular tachycardia from inferobasal LV wall...
September 8, 2016: Journal of Electrocardiology
Marlieke L A Haeck, Gijsbert F L Kapel, Roderick W C Scherptong, Cees A Swenne, Arie C Maan, Jeroen J Bax, Martin J Schalij, Hubert W Vliegen
BACKGROUND: The aim was to assess the diagnostic value of the Inverse Dower (INVD)-derived vectorcardiogram (VCG) and the Kors-derived VCG to detect elevated systolic pulmonary artery pressure (SPAP) in suspected pulmonary hypertension (PH). METHODS: In 132 patients, morphologic variables were evaluated by comparing the VCG parameters synthesized by INVD and Kors matrix. Comparison of the diagnostic accuracy of detecting SPAP ≥50mmHg between the matrices was performed by ROC curve analysis and logistic regression analysis...
September 8, 2016: Journal of Electrocardiology
Thomas M Roston, Wenting Guo, Andrew D Krahn, Ruiwu Wang, Filip Van Petegem, Shubhayan Sanatani, S R Wayne Chen, Anna Lehman
BACKGROUND: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an ion channelopathy usually caused by gain-of-function mutations ryanodine receptor type-2 (RyR2). Left ventricular non-compaction (LVNC) is an often genetic cardiomyopathy. A rare LVNC-CPVT overlap syndrome may be caused by exon 3 deletion in RyR2. We sought to characterize the phenotypic spectrum and molecular basis of a novel RyR2 mutation identified in a family with both conditions. METHODS: Several members of an affected family underwent clinical and genetic assessments...
September 8, 2016: Journal of Electrocardiology
Ahmet Ilker Tekkesin, Göksel Çinier, Yasin Cakilli, Mert İlker Hayıroğlu, Ahmet Taha Alper
BACKGROUND: Interatrial block which is defined as P wave duration longer than 120 milliseconds is underappreciated but highly prevalent electrocardiographic abnormality and associated with atrial tachyarrhythmias and ischemic stroke. Impaired left atrial mechanics and atrial fibrillation are potential mechanisms contributing to the embolic events associated with interatrial block. Detection of atrial high rate episodes by cardiac implantable electronic devices provides clinicians to diagnose asymptomatic atrial fibrillation...
September 8, 2016: Journal of Electrocardiology
Christian Paludan-Müller, Jesper H Svendsen, Morten S Olesen
This review focuses on the genetic basis of atrial fibrillation (AF) and the role of variants in the susceptibility of developing the disease. AF is the most common cardiac arrhythmia affecting 1-2% of the general population. Studies in the last decade have demonstrated that AF, and in particular lone AF, has a substantial genetic component. A number of genome-wide association studies (GWAS) have indicated that common genetic variants, more precisely the so called single-nucleotide polymorphisms (SNPs) are associated with AF...
August 26, 2016: Journal of Electrocardiology
Michele M Pelter, Denise Loranger, Teri M Kozik, Richard Fidler, Xiao Hu, Mary G Carey
BACKGROUND: Most patients presenting with suspected acute coronary syndrome (ACS) are admitted to telemetry units. While telemetry is an appropriate level of care, acute complications requiring a higher level of care in the intensive care unit (ICU) occur. PURPOSE: Among patients admitted to telemetry for suspected ACS, we determine the frequency of unplanned ICU transfer, and examine whether ECG changes indicative of myocardial ischemia, and/or symptoms preceded unplanned transfer...
August 26, 2016: Journal of Electrocardiology
Joachim Seegers, Leonard Bergau, Tobias Tichelbäcker, Marek Malik, Markus Zabel
BACKGROUND AND RATIONALE: In patients with ischemic or non-ischemic cardiomyopathy and impaired left ventricular ejection fraction, treatment with implantable cardioverter-defibrillator (ICD) has been shown to improve survival and guidelines recommend their use for primary prevention of sudden cardiac death. Experts disagree regarding the validity of decade-old trial results as the basis for this recommendation, therefore, reconsideration of prophylactic ICD treatment is needed. EU-CERT-ICD, DANISH-ICD AND DO-IT: In order to update the evidence on prophylactic ICD treatment, several prospective studies are underway in Europe...
August 26, 2016: Journal of Electrocardiology
Óscar Cano, Ana Andrés, Pau Alonso, Joaquín Osca, María-José Sancho-Tello, Joaquín Rueda, Ana Osa, Luis Martínez-Dolz
The prevalence of adults with congenital heart disease has dramatically increased during the last decades due to significant advances in the surgical correction of these conditions. As a result, patient's survival has been prolonged and arrhythmias have become one of the principal causes of morbidity and mortality for these patients. The surface 12-lead ECG may play a critical role in the identification of the underlying heart disease of the patient, the recognition of the arrhythmia mechanism and may also help in the planification of the ablation procedure in this setting...
August 21, 2016: Journal of Electrocardiology
Jessica K Zègre-Hemsey, David Pickham, Michele M Pelter
INTRODUCTION: The American Heart Association recommends individuals with symptoms suggestive of acute coronary syndrome (ACS) activate the Emergency Medical Services' (EMS) 911 system for ambulance transport to the emergency department (ED), which enables treatment to begin prior to hospital arrival. Despite this recommendation, the majority of patients with symptoms suspicious of ACS continue to self-transport to the ED. The IMMEDIATE AIM study was a prospective study that enrolled individuals who presented to the ED with ischemic symptoms...
August 20, 2016: Journal of Electrocardiology
Enrique Velázquez-Rodríguez, Horacio Rodríguez-Piña, Alex Pacheco-Bouthillier, Marcelo Paz Jiménez-Cruz
BACKGROUND: Typical diagnostic, coved-type 1, Brugada ECG patterns fluctuate spontaneously over time with a high proportion of non-diagnostic ECG patterns. Insulin modulates ion transport mechanisms and causes hyperpolarization of the resting potential. We report our experience with unmasking J-ST changes in response to a dextrose-insulin test. METHODS: Nine patients, mean age 40.5±19.4years (range: 15-65years), presented initially with a non-diagnostic ECG pattern, which was suggestive of Brugada syndrome (group I)...
August 19, 2016: Journal of Electrocardiology
John J Wang, Olle Pahlm, Galen S Wagner, James W Warren, B Milan Horáček, John L Sapp
BACKGROUND: Existing criteria recommended by ACC/ESC for identifying patients with ST elevation myocardial infarction (STEMI) from the 12-lead ECG perform with high specificity (SP) but low sensitivity (SE). In our previous studies, we found that the SE of acute ischemia detection can be markedly improved without any loss of SP by calculating, from the 12-lead ECG, ST deviation in 3 "optimal" vessel-specific leads (VSLs). To further validate the method, we evaluated the SP performance using a dataset with non-ischemic ST-segment changes...
August 18, 2016: Journal of Electrocardiology
Raymond R Bond, Dewar D Finlay, James McLaughlin, Daniel Guldenring, Andrew Cairns, Alan Kennedy, Robert Deans, Albert L Waldo, Aaron Peace
INTRODUCTION: The CardioQuick Patch® (CQP) has been developed to assist operators in accurately positioning precordial electrodes during 12-lead electrocardiogram (ECG) acquisition. This study describes the CQP design and assesses the device in comparison to conventional electrode application. METHODS: Twenty ECG technicians were recruited and a total of 60 ECG acquisitions were performed on the same patient model over four phases: (1) all participants applied single electrodes to the patient; (2) all participants were then re-trained on electrode placement and on how to use the CQP; (3) participants were randomly divided into two groups, the standard group applied single electrodes and the CQP group used the CQP; (4) after a one day interval, the same participants returned to carry out the same procedure on the same patient (measuring intra-practitioner variability)...
August 18, 2016: Journal of Electrocardiology
Jan Němec
Repolarization alternans precedes certain types of ventricular arrhythmias and its presence may be prognostically useful, but some ventricular arrhythmias are not preceded by repolarization alternans. Nonalternans changes of ventricular repolarization occur in patients with coronary artery disease and in subjects with congenital long QT syndrome. In animal experiments, nonalternans repolarization lability occurs in a canine model of chronic AV block with propensity to polymorphic ventricular tachycardia, in the perfused rabbit heart exposed to IKr block, and in a murine model of catecholaminergic polymorphic ventricular tachycardia...
August 17, 2016: Journal of Electrocardiology
Alan Kennedy, Dewar D Finlay, Daniel Guldenring, Raymond R Bond, Kieran Moran, James McLaughlin
Automated detection of AF from the electrocardiogram (ECG) still remains a challenge. In this study, we investigated two multivariate-based classification techniques, Random Forests (RF) and k-nearest neighbor (k-nn), for improved automated detection of AF from the ECG. We have compiled a new database from ECG data taken from existing sources. R-R intervals were then analyzed using four previously described R-R irregularity measurements: (1) the coefficient of sample entropy (CoSEn), (2) the coefficient of variance (CV), (3) root mean square of the successive differences (RMSSD), and (4) median absolute deviation (MAD)...
August 12, 2016: Journal of Electrocardiology
Pavel Leinveber, Josef Halamek, Pavel Jurak
Ambulatory monitoring represents an effective tool for the assessment of silent and transient myocardial ischemia during routine daily activities. Incidence of silent ischemia can provide important prognostic information about patients with coronary artery disease or acute coronary syndrome, as well as about post-myocardial infarction patients. The current technological progress enables development of powerful and miniaturized wearable devices for Holter monitoring. Higher sampling rates, dynamic range, and extended computational and storage capacity allow for considering of more complex methodological solutions such as high-frequency QRS analysis for diagnosing myocardial ischemia...
August 5, 2016: Journal of Electrocardiology
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