Search

Background: Positive T wave in lead aVR (TaVR) has been associated with increased risk of adverse events in patients with various cardiovascular diseases., Objective: The purpose of this study was to investigate the prevalence and prognostic significance of positive TaVR in patients with hypertrophic cardiomyopathy (HCM)., Methods: This study investigated 421 consecutive patients with HCM (177 women; age 51.1 ± 14.9 years). Admission electrocardiogram was examined for the presence of a positive TaVR. The primary endpoint was defined as a composite of major arrhythmic events (MAEs), which included sudden cardiac death, sustained ventricular tachycardia or fibrillation, or appropriate implantable cardioverter-defibrillator therapy. Cardiovascular mortality and all-cause death were evaluated as secondary endpoints., Results: During median follow-up period of 6.0 years (interquartile range 4.0-11.6 years), 53 patients (12.6%) experienced the primary endpoint. On multivariable competing analysis, after adjusting for other confounding factors, the presence of positive TaVR was found to be an independent and strong predictor of the primary composite endpoint. Time-dependent receiver operating characteristic analysis, net reclassification index, and integrated discrimination improvement showed that the addition of positive TaVR to conventional HCM risk factors improved prediction of arrhythmic events. However, in subgroup analysis, a positive TaVR lost statistical significance in patients with apical HCM but remained significant in patients with all other hypertrophy patterns., Conclusion: Positive TaVR is associated with MAE in HCM patients, independent of and incremental to traditional risk factors., (Copyright © 2020 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Background: Noncompaction cardiomyopathy (NCCM) is a relatively rare cardiac abnormality with high rates of mortality and morbidity. T-wave amplitudes during ventricular repolarization in lead aVR (TaVR) have been reported to be associated with the prognosis of various cardiovascular diseases. This study sought to investigate the prevalence and prognostic role of positive TaVR in patients with NCCM., Methods: We evaluated consecutive 161 patients with NCCM (65.8% men, mean age 42.5 ± 15.2 years old). Presentation electrocardiogram was assessed regarding classical parameters as well as T-wave amplitudes in lead aVR. The primary endpoint was defined as composite lethal arrhythmic events, including sudden cardiac death, ventricular fibrillation, or sustained ventricular tachycardia or appropriate implantable cardioverter-defibrillator shock. Heart failure requiring hospitalization, cardiovascular death, and all-cause mortality were also investigated as secondary endpoints., Results: Patients with positive TaVR showed higher rates for arrhythmic events, hospitalization for heart failure, and death compared with patients without it. In multivariate Cox model, after adjusting for other known clinical and electrocardiographic risk factors, the positive TaVR was found to be a strong independent predictor of primary endpoint (HR: 4.8, 95% CI: 1.2-19.3; p = .025) and all-cause death (HR: 3.5, 95% CI: 1.0-12.1; p = .045)., Conclusion: Our findings revealed that positive TaVR is significantly and independently associated with adverse outcomes in NCCM patients. This unique ECG criterion in the often ignored lead provides incremental information beyond what is available with other traditional risk factors., (© 2019 The Authors. Annals of Noninvasive Electrocardiology published by Wiley Periodicals, LLC.)

Background: Fragmented QRS (fQRS) complex, with various morphology, has been recently described as a diagnostic criterion of several cardiac diseases. However, there are little data regarding the prognostic role of fQRS in peripartum cardiomyopathy (PPCM) patients. We aimed to investigate the effect of fQRS on predicting left ventricular (LV) nonrecovery in patients with peripartum cardiomyopathy (PPCM)., Methods: Ninety patients (mean age: 34.7 ± 6.5 years) with the diagnosis of PPCM were analyzed retrospectively. The median follow-up period of was 67.0 (12.0-192.0) months. Fragmented QRS was defined as the presence of various RSR' patterns (QRS duration < 120 ms) with or without Q wave, which include an additional R wave (R' prime) or notching of the R wave or S wave, or the presence of more than one R' (fragmentation) without typical bundle branch block. Recovery of LV function was defined as the presence of LV ejection fraction (EF) >45%., Results: Of the patients, 54 (60%) did not recover LV function at the last follow-up visit (nonrecovery group), while 36 of the patients (40%) exhibited LV recovery (recovery group). LV ejection fraction (EF) and fQRS were identified as independent predictors of LV nonrecovery in patients with PPCM (odds ratio OR: 5.546, 95% confidence interval CI: 0.792-0.979, p = .019 and OR: 5.986, 95% CI: 1.313-11.787, p = .014, respectively)., Conclusion: Our data firstly indicated that presence of fQRS was a significant predictor of LV nonrecovery in patients with PPCM. The fQRS might assist in identifying high-risk patients., (© 2019 The Authors. Annals of Noninvasive Electrocardiology published by Wiley Periodicals, LLC.)

Background: Peripartum cardiomyopathy (PPCM) is an uncommon complication of pregnancy. Clinical courses of PPCM are markedly heterogeneous. Positive T waves in lead aVR (TaVR) are shown to be associated with adverse cardiac events in several cardiovascular diseases. We aimed to investigate the prevalence and prognostic role of positive TaVR in patients with PPCM., Methods: A total of 82 patients (mean age 29.1 ± 6.3 years) with the diagnosis of PPCM were enrolled. Presentation electrocardiogram (ECG) was investigated for presence of a positive TaVR. The median follow-up duration was 67.0 months. The primary endpoint was defined as composite cardiac events, including cardiac death, arrhythmic events, or persistent left ventricular systolic dysfunction., Results: Patients with positive T wave in lead aVR showed higher rates for persistent left ventricular systolic dysfunction, arrhythmic events, and cardiac death compared to patients without it. In multivariate logistic regression analysis, after adjusting for other confounding factors, the presence of positive TaVR was found to be as an independent and strong predictor of primary composite endpoint (odds ratio 6.21, 95% CI 1.45-26.51; p = 0.014). In Kaplan-Meier survival analysis, both primary and secondary endpoints occurred more frequently in the positive TaVR group. Using the cut-off level of 0.25 mV, T-wave amplitude in lead aVR predicted primary endpoint with a sensitivity of 100% and specificity of 100%., Conclusion: Positive T wave in lead aVR, as a simple and feasible electrocardiographic marker, seems to be a novel predictor of adverse cardiovascular outcomes in patients with PPCM., (© 2019 Wiley Periodicals, Inc.)

Ebstein's anomaly is often accompanied by either Wolff-Parkinson-White syndrome or atriofascicular Mahaim. These bypass tracts give rise to antidromic atrioventricular (AV) re-entrant tachycardias, in which the bypass tract serves as the anterograde limb of the circuit and the AV node as the retrograde limb of the reentrant circuit. Since the antidromic AV reentrant tachycardia over a Mahaim fibre has a typically left bundle braunch block (LBBB) morphology, it is easy to make a misdiagnosis of supraventricular tachycardia with functional LBBB or even of ventricular tachycardia particularly in the presence of negative concordance. Some electrocardiographic clues might prevent misdiagnosis of ventricular tachycardia and inadvertent ICD implantation., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Fragmented QRS complex (fQRS) is associated with worse outcomes in several cardiovascular conditions. However, alterations in fQRS in patients with ST elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) and association of fQRS with myocardial blush grade (MBG) has not been investigated until now. In this study, we aimed to investigate the association of MBG after primary PCI with evolution of fQRS., Methods: Our study consisted of 401 consecutive patients with STEMI who underwent primary PCI. Patients were categorized into two subgroups according to persistence or new-onset of fQRS (Group 1) and absence or resolution of fQRS (Group 2) at 48 hours after primary PCI. The evolution of fQRS on pre- and post-PCI ECG and their relation with myocardial reperfusion parameters were investigated., Results: Patients in group 1 showed older age, higher rate of smoking, lower HDL-cholesterol, lower LVEF, higher angina-to-door time, higher TIMI frame count, and high rate of patients with MBG <3 compared to patients with group 2 (P < 0.05). In correlation analysis, LVEF showed positive correlation with MBG (r = 0.448, P < 0.001) and negative correlation with the number of leads with fQRS (r = -0.335, P < 0.001). In multivariate regression analysis, new-onset or persistance of fQRS after primary PCI is significantly associated with MBG <3, peak CK-MB level, pre-PCI fQRS at anterior localization and smoking., Conclusion: Our findings showed that despite complete ST-segment resolution in all patients, fQRS is independently associated with impaired microvascular myocardial perfusion. So, fQRS, as a simple and easily available noninvasive marker, may be useful in stratification of high-risk patients with increased extent of infarcted myocardium who underwent primary PCI., (© 2014 Wiley Periodicals, Inc.)

The article describes the case of a 67-year-old diabetic man with ischemic cardiomyopathy presented with a recurrent defibrillator shock. Topics discussed include medical history of the patient, importance of the introduction of premature ventricular complexes (PVC) during wide complex tachycardias (WCT), and ventriculoatrial (V-A0 responses of the tachycardia.

The article presents a case of a 29-year-old female with repeated paroxysms of palpitations due to rapid narrow QRS complex tachycardia (NCT) to discuss the dynamic changes in atrial activation sequence during supraventricular tachycardia and the mechanism of the tachycardia. Other topics include left atrial tachycardia (AT), premature ventricular complex (PVC), and atrioventricular nodal reentrant tachycardia (AVNRT).

The article presents a case of a 58-year-old male experiencing recurrent episodes of paroxysmal palpitation to discuss the mechanism of a wide QRS tachycardia with short and long ventriculoatrial interval in the presence of atriofascicular (AF) accessory pathway (AP). Also cited are the patient's spontaneous sustained wide complex tachycardia (WCT) with left bundle branch block (LBBB) morphology, and the differential diagnosis of regular WCT like atrial flutter or atrial tachycardia (AT).

The article presents a case study of a 75-year-old man with history of ischemic cardiomyopathy with an ejection fraction referring for ablation of recurrent ventricular tachycardia (VT). Topics include electroanatomic mapping of the endocardium revealing extensive dense scar extending from the base toward the apex along the inferior and lateral walls; and Decanav catheter recording a local V‐shaped diastolic activation pattern.

The article presents a case study of a 28-year-old woman undergoing an electrophysiology study (EPS). Topics include episodes of palpitations with documented narrow (NCT) and wide QRS complex tachycardia (WCT); and dissociation of HB potential from ongoing tachycardia favor AVNRT with BBB aberrancy.

The article presents a case study of a 38-year-old woman with recurrent episodes of tachycardia in the absence of structural heart disease and documented with narrow QRS complex tachycardia (NCT). Topics include first tachycardia diagnosed as typical atrioventricular (AV) nodal reentrant tachycardia (AVNRT) and the radiofrequency ablation of the slow pathway; and attributable to a retrograde atrial activation by the last ventricular stimulus in contrast to ventricular entrainment.

The article presents a case of a 21-year-old male who was rushed to a clinic due to regular palpitations and narrow complex tachycardia (NCT) and wide complex tachycardia (WCT) to discuss the mechanism of tachycardia and the transition from two WCT to narrow QRS tachychardia. Also cited are the observation of two WCTs with both right bundle branch block (RBBB) and left BBB (LBBB) in the patient, and the differential diagnosis of short RP NCT like atrial tachycardia (AT).

The article presents a case study of a 59-year-old man who had rapid palpitations and documented supraventricular tachycardia (SVT) unresponsive to metoprolol therapy. He was diagnosed with an accessory pathway (AP) conduction, with the pathway being a bystander, and as orthodromic tachycardia (ORT) with posteroseptal AP. Also noted is the possibility of resetting even if no change in subsequent cycle length is seen during tachycardia.

The article present a case study of a 33-year old woman with regular palpitations and documented a shortRP narrowQRS complex tachycardia. Topics discussed include the retrograde conduction was decremental and concentric with the earliest activation site at the His bundle region; the presence of anterograde dual AV nodal pathways; and origin of atrial tachycardia (AT) from near the AV node.

The article presents a case study of a 34-year-old man with palpitations and a narrow QRS complex tachycardia. It states that atrial (AT) and atrioventricular reentrant (AVRT) tachycardias were excluded due to the majority presence of ventricular activations. Also noted is the elimination of tachycardia induction via the performance of a slow pathway modification.

A 32‐year‐old woman underwent radiofrequency catheter ablation of narrow QRS tachycardia that was terminated with intravenous adenosine. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 63-year-old man suffering from ischemic ventricular tachycardias (VTs) with recurrent implantable cardioverter-defibrillator (ICD) shocks despite the use of amiodarone, underwent endocardial VT ablation. Using an activation map, an isthmus was located and targeted in the middle of the anteroseptal area of the left ventricle.

The article presents a case study of a 28-year-old woman underwent radiofrequency catheter ablation of narrow QRS tachycardia (NQT) that was terminated with intravenous adenosine. Topics include the main differential diagnosis of an irregular arrhythmia is between the AV nodal reentrant tachycardia (AVNRT) and perinodal atrial tachycardia (AT); and spontaneous changes in the measured intracardiac intervals during tachycardia are useful in determining the mechanism of arrhythmia.

The article presents a case of a 22-year-old male with recurrent episodes of tachycardia who underwent an electrophysiological assessment that induced narrow complex tachycardia (NCT) to discuss the potential mechanism of the transient changes to his QRS morphology during NCT. Also cited are the differential diagnosis of NCT with V-A dissociation including atrioventricular nodel reentrant tachycardia (AVNRT) with block in the upper common pathway (UCP).

The termination of tachycardia may provide important clues toward the mechanism of the tachycardia and that close vigilance may clinch the diagnosis before proceeding to other pacing maneuvers. [ABSTRACT FROM AUTHOR]

The article describes the case of a 21-year-old woman who underwent radiofrequency catheter ablation of narrow QRS tachycardia that was terminated with intravenous adenosine. Highlights include the mechanisms of the unexpected ventriculoatrial block response to the parahisian pacing (PHP) maneuver, demonstration of a retrograde nodal activation pattern during PHP, and the administration of slow pathway ablation to eliminate atrioventricular nodal tachycardia from the patient.

The article presents a case study of a narrow complex tachycardia and sinus rhythm in a 26-year-old woman presented for ablative treatment. The patient was administered with intravenous adenosine and the tachycardia stopped. It states that the electrocardiography (ECG) tracing reveals the disease, and mentions the different diagnosis for atrial tachycardia.