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Early repolarisation

Oruganti Sai Satish, K Sashikanth Srivastav
Till recently, ST segment elevation in the absence of conduction abnormalities or chest pain occurring particularly in young bradycardia individuals has been considered a normal variant called early repolarisation (ER). However, recent studies suggest a more worrisome picture as patients with history of idiopathic ventricular fibrillation showed increased prevalence of ER in ECG. ER is an ECG pattern characterised by elevation of the QRS-ST junction (J point) ≥ 2 mv from baseline in the inferior (II, III, aVF) or lateral (I, aVL, V4-V6) leads manifested as QRS slurring or notching...
July 2016: Journal of the Association of Physicians of India
Deniz Akdis, Corinna Brunckhorst, Firat Duru, Ardan M Saguner
This overview gives an update on the molecular mechanisms, clinical manifestations, diagnosis and therapy of arrhythmogenic cardiomyopathy (ACM). ACM is mostly hereditary and associated with mutations in genes encoding proteins of the intercalated disc. Three subtypes have been proposed: the classical right-dominant subtype generally referred to as ARVC/D, biventricular forms with early biventricular involvement and left-dominant subtypes with predominant LV involvement. Typical symptoms include palpitations, arrhythmic (pre)syncope and sudden cardiac arrest due to ventricular arrhythmias, which typically occur in athletes...
August 2016: Arrhythmia & Electrophysiology Review
Giulio Conte, Maria Luce Caputo, François Regoli, Tiziano Moccetti, Pedro Brugada, Angelo Auricchio
Brugada and early repolarisation (ER) syndromes are currently considered two distinct inherited electrical disorders with overlapping clinical and electrocardiographic features. A considerable number of patients diagnosed with ER syndrome have a genetic mutation related to Brugada syndrome (BrS). Due to the high variable phenotypic manifestation, patients with BrS may present with inferolateral repolarisation abnormalities only, resembling the ER pattern. Moreover, the complex genotype-phenotype interaction in BrS can lead to the occurrence of mixed phenotypes with ER syndrome...
August 2016: Arrhythmia & Electrophysiology Review
Bram B Bessem, Matthijs M C de Bruijn, Wybe W Nieuwland
OBJECTIVES: Gender-related differences are frequently used in medicine. Electrocardiograms are also subject to such differences. This study evaluated gender differences in ECG parameters of young athletes, discussing the possible implications of these differences for ECG criteria used in the cardiovascular screening of young athletes. DESIGN: Observational cross-sectional study. METHODS: In 2013 and 2014 all the ECGs from the cardiovascular screenings performed at University Sports Medical Centre in Groningen of the student athletes who wanted to participate in a college sports program were collected...
July 6, 2016: Journal of Science and Medicine in Sport
K G Madhu, Vijo George, T G Binu, R Ranjith, Subair Kunju, R Baiju, K S Mohanan, R Jayaram, V V Radhakrishnan
BACKGROUND: Early repolarisation (ER) on ECG, which was initially believed to be benign, has of late been considered otherwise. Brugada syndrome has recently been thought to be an extension of the ER spectrum, and the familial tendency of the ER pattern is being highlighted. With attention being drawn to ER's association with idiopathic ventricular fibrillation (VF), the prognosis and lineage of patients with an ER pattern are under scrutiny. AIMS: To analyse ER patterns on ECG, their presence in first-degree relatives and their association with structural heart disease...
2014: Heart Asia
Woo Seok Lee, Gi-Byoung Nam, Sung-Hwan Kim, Jin Hee Choi, Uk Jo, Won Young Kim, Yong-Seog Oh, Kyu Nam Park, Guang-Won Seo, Ki-Hun Kim, Eun-Sun Jin, Kyoung-Suk Rhee, Laeyoung Jung, Ki-Won Hwang, Yoo Ri Kim, Chang Hee Kwon, Jun Kim, Kee-Joon Choi, You-Ho Kim
OBJECTIVE: Hypothermia can induce ECG J waves. Recent studies suggest that J waves may be associated with ventricular fibrillation (VF) in patients with structurally normal hearts. However, little is known about the ECG features, clinical significance or arrhythmogenic potentials of therapeutic hypothermia (TH)-induced J waves. METHODS: We analysed ECGs from 240 patients who underwent TH at six major university hospitals in Korea between August 2010 and December 2013...
October 1, 2016: Heart: Official Journal of the British Cardiac Society
Demosthenes G Katritsis, Bernard J Gersh, A John Camm
New concepts regarding early repolarisation syndrome are presented. Genetics and epidemiology data, as well as new evidence on the potential clinical significance of early repolarisation patterns, are discussed.
December 2015: Arrhythmia & Electrophysiology Review
Manoj N Obeyesekere, Andrew D Krahn
The early repolarisation (ER) pattern is a common ECG finding. Most individuals with the ER pattern are at minimal risk for arrhythmic events. In others, ER increases the arrhythmic risk of underlying cardiac pathology. Rarely ER syndrome will manifest as a primary arrhythmogenic disorder causing ventricular fibrillation (VF). ER syndrome is defined as syncope attributed to ventricular arrhythmias or cardiac arrest attributed to ER following systematic exclusion of other etiologies. Some ECG features associated with ER portend a higher risk...
August 2015: Arrhythmia & Electrophysiology Review
Ashok J Shah, Meleze Hocini, Patrizio Pascale, Laurent Roten, Yuki Komatsu, Matthew Daly, Khaled Ramoul, Arnaud Denis, Nicolas Derval, Frederic Sacher, Remi Dubois, Ryan Bokan, Sandra Eliatou, Maria Strom, Charu Ramanathan, Pierre Jais, Philippe Ritter, Michel Haissaguerre
The authors describe a novel three-dimensional, 252-lead electrocardiography (ECG) and computed tomography (CT)-based non-invasive cardiac imaging and mapping modality. This technique images potentials, electrograms and activation sequences (isochrones) on the epicardial surface of the heart. This tool has been investigated in the normal cardiac electrophysiology and various tachyarrhythmic, conduction and anomalous depo-repolarisation disorders. The clinical application of this system includes a wide range of electrical disorders like atrial arrhythmias (premature atrial beat, atrial tachycardia, atrial fibrillation), ventricular arrhythmias (premature ventricular beat, ventricular tachycardia) and ventricular pre-excitation (Wolff-Parkinson-White syndrome)...
April 2013: Arrhythmia & Electrophysiology Review
Marcin Konopka, Krystyna Burkhard-Jagodzińska, Krystyna Anioł-Strzyżewska, Wojciech Król, Andrzej Klusiewicz, Jolanta Chwalbińska, Andrzej Pokrywka, Dariusz Sitkowski, Mirosław Dłużniewski, Wojciech Braksator
BACKGROUND: The prevalence and significance of the early repolarisation (ER) pattern in the general population has raised a number of questions. Even less data are available on athletes. AIM: To determine the prevalence and determinants of ER in a group of young high endurance athletes. METHODS: We studied 117 rowers (46% women, mean age 17.5 ± 1.5 years, mean training duration 4.3 ± 1.8 years). On 12-lead electrocardiogram (ECG), we evaluated inferolateral leads for the presence of the ER pattern, defined as at least 0...
2016: Kardiologia Polska
Michael K Pugsley, Michael J Curtis, Eric S Hayes
Cardiac safety pharmacology is a continuously evolving discipline that uses the basic principles of pharmacology in a regulatory-driven process to generate data to inform risk/benefit assessment of a new chemical entity (NCE). The aim of cardiac safety pharmacology is to characterise the pharmacodynamic/pharmacokinetic (PK/PD) relationship of a drug's adverse effects on the heart using continuously evolving methodology. Unlike Toxicology, safety pharmacology includes within its remit a regulatory requirement to predict the risk of rare cardiotoxic (potentially lethal) events such as torsades de pointes (TdP), which is statistically associated with drug-induced changes in the QT interval of the ECG due to blockade of I Kr or K v11...
2015: Handbook of Experimental Pharmacology
Abdulrahman Naseef, Elijah R Behr, Velislav N Batchvarov
The Brugada syndrome (BrS) is a malignant, genetically-determined, arrhythmic syndrome manifesting as syncope or sudden cardiac death (SCD) in individuals with structurally normal hearts. The diagnosis of the BrS is mainly based on the presence of a spontaneous or Na + channel blocker induced characteristic, electrocardiographic (ECG) pattern (type 1 or coved Brugada ECG pattern) typically seen in leads V1 and V2 recorded from the 4th to 2nd intercostal (i.c.) spaces. This pattern needs to be distinguished from similar ECG changes due to other causes (Brugada ECG phenocopies)...
April 2015: Journal of the Saudi Heart Association
Hitesh B Mistry, Mark R Davies, Giovanni Y Di Veroli
There is currently a strong interest in using high-throughput in-vitro ion-channel screening data to make predictions regarding the cardiac toxicity potential of a new compound in both animal and human studies. A recent FDA think tank encourages the use of biophysical mathematical models of cardiac myocytes for this prediction task. However, it remains unclear whether this approach is the most appropriate. Here we examine five literature data-sets that have been used to support the use of four different biophysical models and one statistical model for predicting cardiac toxicity in numerous species using various endpoints...
2015: Frontiers in Pharmacology
Sebastian Stankala, Jerzy Sacha, Jarosław Bugajski, Andrzej Wester
No abstract text is available yet for this article.
2015: Kardiologia Polska
A O Verkerk, H L Tan, T Baartscheer, J H Ravesloot
OBJECTIVES: The proarrhythmic, early afterdepolarisations during phase two of the action potential (phase-2 EADs) are associated with secondary Ca(2+) release from the sarcoplasmic reticulum. This makes it probable that the Ca(2+)-activated Cl(-) current (ICl(Ca)) may contribute to phase-2 EADs. Activation of ICl(Ca) during phase two of the action potential will result in a repolarising current and may thus be expected to prevent excessive depolarisation of phase-2 EADs. The present study was designed to test this hypothesis...
December 2002: Netherlands Heart Journal
Meagan M Wasfy, James DeLuca, Francis Wang, Brant Berkstresser, Kathryn E Ackerman, Aaron Eisman, Gregory D Lewis, Adolph M Hutter, Rory B Weiner, Aaron L Baggish
BACKGROUND/AIM: The international governing body for competitive rowing recently mandated the inclusion of 12-lead ECG during preparticipation screening. We therefore sought to describe normative ECG characteristics and to examine the prevalence of abnormal ECG findings as defined by contemporary athlete ECG interpretation criteria among competitive rowers. METHODS: Competitive rowers (n=330, 56% male) underwent standard 12-lead ECG at the time of collegiate preparticipation screening...
February 2015: British Journal of Sports Medicine
Kamal K Sethi, Kabir Sethi, Surendra K Chutani
J wave syndrome has emerged as a significant cause of Idiopathic ventricular fibrillation (IVF) responsible for sudden cardiac death. A large body of data is now available on genesis, genetics and ionic mechanisms of J wave syndromes. Two of these viz., Early repolarization syndrome (ER) and Brugada syndrome (BrS) are fairly well characterized enabling correct diagnosis in most patients. The first part of repolarization of ventricular myocardium is governed by Ito current i.e., rapid outward potassium current...
July 2014: Indian Heart Journal
Gary R Mirams, Mark R Davies, Stephen J Brough, Matthew H Bridgland-Taylor, Yi Cui, David J Gavaghan, Najah Abi-Gerges
INTRODUCTION: Detection of drug-induced pro-arrhythmic risk is a primary concern for pharmaceutical companies and regulators. Increased risk is linked to prolongation of the QT interval on the body surface ECG. Recent studies have shown that multiple ion channel interactions can be required to predict changes in ventricular repolarisation and therefore QT intervals. In this study we attempt to predict the result of the human clinical Thorough QT (TQT) study, using multiple ion channel screening which is available early in drug development...
November 2014: Journal of Pharmacological and Toxicological Methods
Malcolm C Finlay, Akbar K Ahmed, Alan Sugrue, Justine Bhar-Amato, Giovanni Quarta, Antonis Pantazis, Edward J Ciaccio, Petros Syrris, Srijita Sen-Chowdhry, Ron Ben-Simon, Anthony W Chow, Martin D Lowe, Oliver R Segal, William J McKenna, Pier D Lambiase
AIMS: The concealed phase of arrhythmogenic right ventricular cardiomyopathy (ARVC) may initially manifest electrophysiologically. No studies have examined dynamic conduction/repolarization kinetics to distinguish benign right ventricular outflow tract ectopy (RVOT ectopy) from ARVC's early phase. We investigated dynamic endocardial electrophysiological changes that differentiate early ARVC disease expression from RVOT ectopy. METHODS: 22 ARVC (12 definite based upon family history and mutation carrier status, 10 probable) patients without right ventricular structural anomalies underwent high-density non-contact mapping of the right ventricle...
2014: PloS One
Peter Taggart, Michele Orini, Ben Hanson, Martin Hayward, Richard Clayton, Halina Dobrzynski, Joseph Yanni, Mark Boyett, Pier D Lambiase
Understanding the mechanisms of fatal ventricular arrhythmias is of great importance. In view of the many electrophysiological differences that exist between animal species and humans, the acquisition of basic electrophysiological data in the intact human heart is essential to drive and complement experimental work in animal and in-silico models. Over the years techniques have been developed to obtain basic electrophysiological signals directly from the patients by incorporating these measurements into routine clinical procedures which access the heart such as cardiac catheterisation and cardiac surgery...
August 2014: Progress in Biophysics and Molecular Biology
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