- Beyond the length and look of repolarization: Defining the non-QTc electrocardiographic profiles of patients with congenital long QT syndrome. [Journal Article]
- HRHeart Rhythm 2018 Apr 30
- CONCLUSIONS: Beyond the QT interval and bradycardia, ECG abnormalities are uncommon in LQTS patients, and patients almost never have concomitant bundle branch block. Notably, 19% of LQTS patients overall and 27% of LQTS type 2 patients exhibit anterior TWI that would satisfy a diagnostic criterion for arrhythmogenic right ventricular cardiomyopathy, thus creating the potential for diagnostic miscues.
- Distinct ECG Phenotypes Identified in Hypertrophic Cardiomyopathy Using Machine Learning Associate With Arrhythmic Risk Markers. [Journal Article]
- FPFront Physiol 2018; 9:213
- Aims: Ventricular arrhythmia triggers sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM), yet electrophysiological biomarkers are not used for risk stratification. Ou...
Aims: Ventricular arrhythmia triggers sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM), yet electrophysiological biomarkers are not used for risk stratification. Our aim was to identify distinct HCM phenotypes based on ECG computational analysis, and characterize differences in clinical risk factors and anatomical differences using cardiac magnetic resonance (CMR) imaging.Methods:High-fidelity 12-lead Holter ECGs from 85 HCM patients and 38 healthy volunteers were analyzed using mathematical modeling and computational clustering to identify phenotypic subgroups. Clinical features and the extent and distribution of hypertrophy assessed by CMR were evaluated in the subgroups.Results:QRS morphology alone was crucial to identify three HCM phenotypes with very distinct QRS patterns. Group 1 (n= 44) showed normal QRS morphology, Group 2 (n= 19) showed short R and deep S waves in V4, and Group 3 (n= 22) exhibited short R and long S waves in V4-6, and left QRS axis deviation. However, no differences in arrhythmic risk or distribution of hypertrophy were observed between these groups. Including T wave biomarkers in the clustering, four HCM phenotypes were identified: Group 1A (n= 20), with primary repolarization abnormalities showing normal QRS yet inverted T waves, Group 1B (n= 24), with normal QRS morphology and upright T waves, and Group 2 and Group 3 remaining as before, with upright T waves. Group 1A patients, with normal QRS and inverted T wave, showed increased HCM Risk-SCD scores (1A: 4.0%, 1B: 1.8%, 2: 2.1%, 3: 2.5%,p= 0.0001), and a predominance of coexisting septal and apical hypertrophy (p< 0.0001). HCM patients in Groups 2 and 3 exhibited predominantly septal hypertrophy (85 and 90%, respectively).Conclusion:HCM patients were classified in four subgroups with distinct ECG features. Patients with primary T wave inversion not secondary to QRS abnormalities had increased HCM Risk-SCD scores and coexisting septal and apical hypertrophy, suggesting that primary T wave inversion may increase SCD risk in HCM, rather than T wave inversion secondary to depolarization abnormalities. Computational ECG phenotyping provides insight into the underlying processes captured by the ECG and has the potential to be a novel and independent factor for risk stratification.
- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- One of the key steps in interpreting an electrocardiogram (EKG) is determining the electrical axis of the heart. Being able to determine the electrical axis can give insight into underlying disease s...
One of the key steps in interpreting an electrocardiogram (EKG) is determining the electrical axis of the heart. Being able to determine the electrical axis can give insight into underlying disease states and help steer the differential diagnosis towards or away from certain diagnoses. Herein, we will discuss what makes up the electrical axis, ventricular (QRS) axis, axis classifications, various approaches to determining the electrical axis, and causes of axis deviation.
- [Clinical and electrocardiographic aspect of pulmonary embolism masking aortic dissection revealed by thoracic CT angiography]. [Case Reports]
- PAPan Afr Med J 2017; 28:3
- We here report the case of a 52-year old hypertensive, obese woman (BMI 32,46 kg/m2) with a past history of smoking and without evidence-based risk factors of venous thromboembolism, hospitalized for...
We here report the case of a 52-year old hypertensive, obese woman (BMI 32,46 kg/m2) with a past history of smoking and without evidence-based risk factors of venous thromboembolism, hospitalized for left chest pain radiating to the dorsolumbar region associated with dyspnoea. Clinical examination on hopitalization showed left blood pressure 100/60 mmHg, tachycardia 100/min, oxygen desaturation index at 88% with the patient breathing ambient air, normal cardiopulmonary auscultation, peripheral pulses palpable and no symptoms of phlebitis of the lower limbs. The ECG showed right axis deviation, S1Q3 pattern, right ventricular hypertrophy and right bundle branch block (A, B, C). The patient underwent emergency thoracic CT angiography objectifying aortic dissection from the origin of the aorta to the iliac bifurcation (Stanford A). Our patient received medical care based on blood pressure and heart rate control as well as on analgesics, with good evolution in the absence of surgical means.
- Prevalence and predictive value of electrocardiographic abnormalities in pulmonary hypertension: evidence from the Pan-African Pulmonary Hypertension Cohort (PAPUCO) study. [Journal Article]
- CJCardiovasc J Afr 2017 Nov/Dec 23; 28(6):370-376
- CONCLUSIONS: When present, signs of PH on ECG strongly indicated disease, but a normal ECG cannot rule out disease. ECG patterns focusing on the R and S amplitude in V1 and right-axis deviation had good specificity and negative predictive values for PH, and warrant further investigation with echocardiography.
- Incidence rates, correlates, and prognosis of electrocardiographic P-wave abnormalities - a nationwide population-based study. [Journal Article]
- JEJ Electrocardiol 2017 Nov - Dec; 50(6):925-932
- CONCLUSIONS: Modifiable risk factors associate with P-wave abnormalities that are common and may represent intermediate steps of atrial cardiomyopathy on a pathway leading to AF.
- Accuracy of the ECG for differential diagnosis between hypertrophic cardiomyopathy and athlete's heart: comparison between the European Society of Cardiology (2010) and International (2017) criteria. [Journal Article]
- BJBr J Sports Med 2018; 52(10):667-673
- CONCLUSIONS: The use of 2017 International criteria is associated with a substantial increase in specificity and a marginal decrease in sensitivity for differential diagnosis between HCM and athlete's heart.
- Mahaim Tachycardia Induced Cardiomyopathy. [Case Reports]
- JCJ Coll Physicians Surg Pak 2016; 26(11):S80-S82
- We present the case report of a 22-year man, with incessant palpitations, chest pain, shortness of breath, and pulsations in his neck for the past 7 months. He was referred to the cardiology unit for...
We present the case report of a 22-year man, with incessant palpitations, chest pain, shortness of breath, and pulsations in his neck for the past 7 months. He was referred to the cardiology unit for workup of wide complex tachycardia (WCT). His echocardiography, 6 months earlier, had demonstrated severe left ventricular (LV) systolic dysfunction, severe global hypokinesia, mild tricuspid regurgitation (TR), and mild mitral regurgitation (MR) which resolved with medical therapy including beta-blockers. He underwent electrophysiological study, which revealed a decremental right sided atriofascicular pathway causing a WCT with left bundle branch block (LBBB) morphology and left axis deviation (LAD, Mahaim tachycardia). This was successfully ablated by radiofrequency ablation (RF) with abolition of the tachycardia. This case report highlights Mahaim tachycardia induced cardiomyopathy, a rare but curable cause of cardiomyopathy.
- Electrocardiogeriatrics: ECG in advanced age. [Review]
- JEJ Electrocardiol 2017 Sep - Oct; 50(5):698-700
- The electrocardiogram (ECG) presents substantial changes associated with aging. In fact, the likelihood of having a "normal" ECG decreases with age. The most common findings are left ventricular hype...
The electrocardiogram (ECG) presents substantial changes associated with aging. In fact, the likelihood of having a "normal" ECG decreases with age. The most common findings are left ventricular hypertrophy pattern, leftward axis deviation and QRS widening. Interatrial block (IAB) is frequently present, mainly partial IAB. Atrial fibrillation prevalence raises from 6-7% in those aged 65-74years to 13-17% in those >75years.
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- Electrocardiographic Predictors of Heart Failure With Reduced Versus Preserved Ejection Fraction: The Multi-Ethnic Study of Atherosclerosis. [Multicenter Study]
- JAJ Am Heart Assoc 2017 May 25; 6(6)
- CONCLUSIONS: Markers of ventricular repolarization and delayed ventricular activation are able to distinguish between the future risk of HFrEF and HFpEF. These findings suggest a role for ECG markers in the personalized risk assessment of heart failure subtypes.