- Echocardiography for the management of patients with biventricular pacing: Possible roles in cardiac resynchronization therapy implementation. [Review]
- HJHellenic J Cardiol 2018 Feb 13
- Cardiac Resynchronization Therapy (CRT) is an established therapeutic option for the subset of patients with heart failure (HF), reduced ejection fraction (EF) and dyssynchrony evidenced by electroca...
Cardiac Resynchronization Therapy (CRT) is an established therapeutic option for the subset of patients with heart failure (HF), reduced ejection fraction (EF) and dyssynchrony evidenced by electrocardiography. Benefit from CRT has been proven in many clinical trials, yet a sizeable proportion of these patients with wide QRS do not respond to this intervention, despite the updated practice guidelines. Several echocardiographic indices, targeting mechanical rather than electrical dyssynchrony, have been suggested to address this issue, but research so far has not succeeded in providing a single and simple measurement with adequate sensitivity and specificity for identification of responders. While there is still ongoing research in this field, echocardiography proves helpful in other aspects of CRT implementation, such as site selection for left ventricular (LV) lead pacing and optimization of pacing parameters during follow up visits.
- Impaired Recovery of Left Ventricular Function in Patients With Cardiomyopathy and Left Bundle Branch Block. [Journal Article]
- JACCJ Am Coll Cardiol 2018 Jan 23; 71(3):306-317
- CONCLUSIONS: LBBB is associated with a smaller degree of LVEF improvement compared with other QRS morphologies, even with GDMT. Some patients with LBBB may benefit from CRT earlier than guidelines currently recommend.
- R-Wave Peak Time at Lead II in Adults With Ventricular Premature Beats, Bundle Branch Block and Left Anterior Fascicular Block. [Journal Article]
- AJAm J Med Sci 2018; 355(1):44-47
- CONCLUSIONS: Our study showed that there is a significant difference in the RWPT at lead II between groups with left BBB, ventricular premature beat, right BBB and LAFB. A RWPT of 50ms may be optimal to differentiate between ventricular tachycardia and supraventricular tachycardia with right left BBB and LAFB, but not with left BBB.
- Relation between electrical and mechanical dyssynchrony in patients with left bundle branch block: An electro- and vectorcardiographic study. [Journal Article]
- ANAnn Noninvasive Electrocardiol 2017 Dec 18
- CONCLUSIONS: In LBBB patients, large QRS areas correlate better with mechanical dyssynchrony compared to wide QRSD intervals. However, the overall accuracy to predict mechanical dyssynchrony by electrocardiographic dyssynchrony markers, even when using complex vectorcardiographic parameters, remains low.
- Severe cardiac toxicity following alcohol intake in a patient using therapeutic dose of propafenone. [Journal Article]
- TKTurk Kardiyol Dern Ars 2017; 45(8):752-754
- An unconscious, 25-year-old, male patient was brought to the emergency department. The patient's electrocardiography demonstrated a wide QRS interval and first-degree atrioventricular block. He was b...
An unconscious, 25-year-old, male patient was brought to the emergency department. The patient's electrocardiography demonstrated a wide QRS interval and first-degree atrioventricular block. He was being treated with propafenone twice daily (450 mg) for paroxysmal atrial fibrillation. The patient had consumed a substantial amount of alcohol the day before. He recovered after supportive management with sodium bicarbonate and inotropic therapy. In the presently described case, treatment resulted in quick normalization of QRS interval and stabilization of hemodynamic status.
- Electrocardiographic Predictors of Morbidity and Mortality in Patients With Acute Myocarditis: The Importance of QRS-T Angle. [Journal Article]
- JCJ Card Fail 2018; 24(1):3-8
- CONCLUSIONS: QRS-T angle is a predictor of increased morbidity and mortality in acute myocarditis.
- The development and validation of an easy to use automatic QT-interval algorithm. [Journal Article]
- PlosPLoS One 2017; 12(9):e0184352
- CONCLUSIONS: Our automated algorithm provides reliable beat-to-beat QT-interval assessment, robust to heart axis and T-wave morphology.
- General Approach to a Wide QRS Complex. [Review]
- CECard Electrophysiol Clin 2017; 9(3):461-485
- Wide QRS complex is present when the normal activation pattern is modified by various mechanisms and clinical conditions. Correct interpretation is crucial for appropriate decision making. When appro...
Wide QRS complex is present when the normal activation pattern is modified by various mechanisms and clinical conditions. Correct interpretation is crucial for appropriate decision making. When approaching an electrocardiogram (ECG) with wide complex tachycardia, one must differentiate between ventricular tachycardia and supraventricular tachycardia conducted with aberrancy. ECG criteria are used and algorithms developed to aid in differential diagnosis. They are based on finding ECG signs of ventriculoatrial dissociation and QRS morphologies inconsistent with classic bundle branch block. The conditions able to modify structurally the normal activation of the heart may alter spontaneous ventricular activation during supraventricular tachycardia, creating differential diagnosis problems.
- General Introduction, Classification, and Electrocardiographic Diagnosis of Cardiac Arrhythmias. [Review]
- CECard Electrophysiol Clin 2017; 9(3):345-363
- The conduction system includes a primary pacemaker, the internodal tracts, the atrioventricular node, and the His bundle with the right and left branches. In "emergency" conditions, accessory pacemak...
The conduction system includes a primary pacemaker, the internodal tracts, the atrioventricular node, and the His bundle with the right and left branches. In "emergency" conditions, accessory pacemakers may be triggered. The conduction system produces very low-intensity currents; a surface electrocardiogram (ECG) detects only the big myocardial masses. Electrogenetic mechanisms are reduced automaticity and/or impaired conduction at the base of bradycardias. An increased automaticity and/or reentry phenomenon are at the base of ectopic beats and tachycardias. A "wide QRS" is a ventricular activation time of 120 milliseconds or more. The "laddergram" helps in the fast and reliable ECG interpretation.
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- Successful Catheter Ablation as a Substitute for Cardiac Resynchronization Therapy in Patient with an Accessory Pathway-induced Cardiomyopathy. [Case Reports]
- IMIntern Med 2017 Aug 15; 56(16):2165-2169
- A 50-year-old man presented with exertional dyspnea and orthopnea. An electrocardiogram showed a delta wave and a wide QRS complex, similar to left bundle branch block. Cardiac echocardiography revea...
A 50-year-old man presented with exertional dyspnea and orthopnea. An electrocardiogram showed a delta wave and a wide QRS complex, similar to left bundle branch block. Cardiac echocardiography revealed diffuse severe hypokinesis and dyssynchrony. The patient was diagnosed with congestive heart failure. We considered that the patient's condition was caused by an accessory pathway-induced cardiomyopathy after heart failure compensation with guideline-oriented medical therapy. We therefore performed catheter ablation for right-sided pre-excitation syndrome as cardiac resynchronization therapy. The left ventricular dyssynchrony was resolved immediately after the procedure, and the patient's ventricular contraction improved, with a reduced cardiac volume at 6 months after the procedure-thus suggesting that the accessory pathway had affected the patient's cardiac function.