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T-wave inversion (TWI) is not considered useful for diagnosing pediatric arrhythmogenic right ventricular cardiomyopathy (ARVC), because right precordial TWI in ARVC resembles a normal juvenile pattern. The aims of this study were to clarify the electrocardiographic (ECG) characteristics of pediatric ARVC to distinguish those patients from healthy children. Between 1979 and 2017, 11 ARVC patients under 18 years old were registered and compared with school screening ECGs from 48,401 healthy children. The mean age at the first arrhythmic event or diagnosis was 13.3 ± 4.7 years. Nine patients were asymptomatic initially and were found by ECG screening, but 6 developed severe symptoms during the follow-up. Healthy children had a normal juvenile pattern, while ARVC children, especially symptomatic patients, had a significant tendency to have inferior and anterior TWI. The phenomenon of T-wave discontinuity (TWD) in which the TWI became deeper from V1 to V3 and suddenly turned positive in V5 was significantly more frequent in ARVC (60%) than healthy children (0.55%). Anterior TWI and TWD were also significantly more frequent in those who developed severe symptoms. The sensitivity and specificity of TWD were 60% (95% CI, 31–83%), and 99% (95% CI, 99–99%) to distinguish ARVC from healthy children, as well as 100% (95% CI, 71–100%) and 80% (95% CI, 51–80%), respectively, to predict severe symptoms in the future. The ECG is useful to distinguish ARVC children, even in the early phase. Anterior TWI and TWD could detect ARVC children and to predict the possible serious conditions. • This study clarified the frequency of T-wave inversion (TWI) in a large cohort of healthy children. • T-wave discontinuity (TWD), as well as TWI in the inferior and anterior leads could differentiate ARVC children. • TWD and anterior TWI are possible signs to predict a serious prognosis in the future. • ARVC children tend not to have VTs but have PVCs and late potentials. [ABSTRACT FROM AUTHOR]

Takotsubo syndrome (TS) is a life-threatening acute heart failure syndrome. However, little is known about risk factors for worse outcomes in TS and no high-risk ECG criteria have been defined. We sought to identify ECG predictors of life-threatening in-hospital complications in TS. Using the nationwide Swedish Angiography and Angioplasty Registry (SCAAR) we obtained data on all consecutive patients undergoing coronary angiography at Sahlgrenska University Hospital between June 2008 and February 2019. For all patients with TS we conducted in-depth chart reviews to confirm the TS diagnosis. For those with confirmed TS we then evaluated all ECGs obtained during the index hospitalization. The primary endpoint was the occurrence of in-hospital major adverse cardiac event (MACE), defined as the composite of death, ventricular tachycardia or fibrillation (VT/VF), or atrioventricular block ≥2 or asystole ≫10 s. We identified 215 patients with TS (mean age 69 ± 13 years; 93% women). MACE occurred in 34 patients (16%), of whom 20 had VT/VF (9,3%). Patients with MACE were less likely than those without MACE to have sinus rhythm (85% versus 96%, p = 0.025) or T-wave inversion (29% versus 51%, p = 0.025). After propensity score adjustment T-wave inversion was independently associated with lower MACE risk (adjusted odds ratio [AdjOR] 0.28, 95% confidence interval [CI] 0.10–0.76, p = 0.012) and VT/VF (AdjOR 0.24, 95% CI 0.06–0.94, p = 0.041). T-wave inversion is common in TS and is associated with lower risk of MACE, driven by a lower risk of VT/VF. • We analyzed in-depth the presenting ECG for 215 takotsubo syndrome (TS) patients. • T-wave inversion (TWI) was present in 47.4% of the patients. • TWI was independently associated with lower risk of death or malignant arrhythmia. • The only other ECG characteristic associated with the outcome was the rhythm. [ABSTRACT FROM AUTHOR]

Background The diagnostic work-up to reveal etiology in a young ischemic stroke (IS) patient includes evaluation for high-risk source of cardioembolism (HRCE), since this subtype associates with high early recurrence rate and mortality. We investigated the association of ECG findings with a final etiologic subgroup of HRCE in a cohort of young patients with first-ever IS. Methods The Helsinki Young Stroke Registry includes IS patients aged 15 to 49 years admitted between 1994 and 2007. Blinded to other clinical data, we analyzed a 12-lead resting ECG obtained 1–14 days after the onset of stroke symptoms in 690 patients. We then compared the ECG findings between a final diagnosis of HRCE (n = 78) and other/undetermined causes (n = 612). We used multivariate logistic regression to study the association between ECG parameters and HRCE. Results Of our cohort (63% male), 35% showed ECG abnormality, the most common being T-wave inversion (16%), left ventricular hypertrophy (14%), prolonged P-wave (13%), and prolonged QTc (12%). 3% had atrial fibrillation (AF), and 4% P-terminal force (PTF). Of the continuous parameters, longer QRS-duration, QTc, and wider QRS-T-angle independently associated with HRCE. After AF, PTF had the strongest independent association with HRCE (odds ratio = 44.32, 95% confidence interval = [10.51–186.83]), followed by a QRS-T angle > 110° (8.29 [3.55–19.32]), T-wave inversion (5.06, 2.54–10.05), and prolonged QTc (3.02 [1.39–6.56]). Conclusion Routine ECG provides useful information for directing the work-up of a young IS patient. In addition to AF, PTF in particular showed a strong association with etiology of HRCE. [ABSTRACT FROM AUTHOR]

Abstract: Takotsubo syndrome (TTS) is characterized by electrocardiogram (ECG) diffuse ST-segment elevations (+ST), and T-wave inversions with prolongation of the QTc interval. Thus ECG-wise, TTS is not different from acute coronary syndromes (ACSs). However unlike acute ST-elevation myocardial infarction, one type of ACS, a rapid conversion of+ST to T-wave inversion with prolongation of the QTc interval is seen in TTS. The author hypothesizes that this conversion is paralleled by a change of segmental myocardial dyskinesis to akinesis, development of myocardial edema, and reversion of the cardioinhibitory ß-2 adrenergic receptor function, to its cardiostimulatory normal status. This hypothesis does not negate the plausibility that the ECG changes in TTS are due to myocardial ischemia/injury as traditionally perceived in ACSs. The reasons of the counterintuitive concurrence of the cardiac contractility to normal, or previous baseline status, while myocardial edema and T-wave inversions persist for several weeks in patients with TTS, are still elusive. [Copyright &y& Elsevier]

Abstract: Electrocardiographic changes mimicking an acute coronary event with T-wave inversion have been reported in the resting electrocardiogram in patients without ischemic heart disease but with acute ischemic stroke, or subarachnoid hemorrhage, or intracerebral hemorrhage, or a severe head injury. We present a case of T-wave inversion in a 73-year-old Italian woman admitted to the Emergency Department following a severe head injury. Pericarditis, pericardial effusion, and acute coronary event were excluded. Ischemic stroke, subarachnoid hemorrhage, and intracerebral hemorrhage were also excluded. Also this case focuses attention on T-wave inversion after a severe head injury without ischemic heart disease. [Copyright &y& Elsevier]