ECG Handbook of Contemporary Challenges
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A state-of-the-art reference on contemporary and challenging issues in electrocardiography.
Amazingly, over a century after the first use of the electrocardiogram, new ECG patterns are being discovered. And in the last few decades, several new electrocardiographic phenomena and markers have emerged that are challenging to physicians and allied professionals who read and interpret ECGs such as early repolarization, ECGs of athletes, Brugada Syndrome, short and long QT syndrome, various channelopathies, and cardiomyopathies.
Internationally recognized experts discuss the most recent evidence-based information on these new observations, complemented with detailed ECG tracings, to provide essential guidance for the optimal interpretation of ECGs in the 21st century.
the AV node is usually the weakest link for the initiation and maintenance of reentry.22,83 Thus, during ORT initiation by premature V impulse, the site of retrograde block in the HPS is more likely to permit ORT to occur than if the AV node was the site of CC.84,85 On the other hand, in duction of ART by A2 usually requires a proximal AV nodal block. Therefore, by the time the impulse has completed its course over the AP, V muscle, the HPS, and the distal AV node, the proximal AV node would
compared to 74% in patients with normal P wave. Padeletti et al115 Coh ort 660 Mean follow-up: 19 mon th s P-dur >100 ms ( the median for this cohort) is independently associated with AF-related hospitalization s an d more frequen t cardioversion s in patients that receive a dual-chamber PPM. Sn oeck et al114 Coh ort 320 Follow-up: 5 years P-dur in lead V1 at th e time of a PPM implan tation is associated with higher 5-year AF incidence, in patients that received a PPM for sick sinus
morphology was primarily utilized for the diagnosis of atrial enlargement. In the modern era of cardiovascular medicine, there is an increasing understanding that PR interval and P-wave morphology have provided important, noninvasive insight on atrial electrical function. The current literature-driven prototype around PR interval and PWIs is that genetic substrate and acquired AF risk factors result in atrial electro-anatomical adaptation that can be captured in abnormal PWIs. Abnormal PWIs
History of cardiac arrest or syncope. Family history of ARVD/ C or unexplained SCD. Extensive RV dysfunction and right HF. LV involvement. • • • • • • Intolerable or pleomorphic VT. Syncope. Endurance exercise. Unsuccessful antiarrhythmic drug treatmen t. Epsilon wave or late potential ( signal-averaged ECG) . QRS dispersion ( >40 ms) . Chapter 6: Electrocardiograph ic Markers of Sudden Cardiac Death in Differen t Substrates 95 Figure 6.9. Risk-stratification model of patients with ARVD/C.
ICD needs to be individualized; antiarrhythmic drug therapy (including β-blockers) and/or catheter ablation seems to be a reasonable first-line therapy. Whether, in the absence of syncope or significant VAs, severe dilation and/or dysfunction of the RV, LV or both, as well as early-onset structurally severe disease (age <35 years) require prophylactic ICD remains to be determined. Modified with permission.122 • • • • • fQRS. T-wave inversion beyond V3 ≥120 ms. History of CHF. Young age at