European Heart Journal (2001) 22, doi: /euhj , available online at on

Size: px
Start display at page:

Download "European Heart Journal (2001) 22, 2290 2296 doi:10.1053/euhj.2001.2691, available online at http://www.idealibrary.com on"

Transcription

1 European Heart Journal (00), doi:0.053/euhj.00.69, available online at on New electrocardiographic leads and the procainamide test for the detection of the in sudden unexplained death syndrome survivors and their relatives S. Sangwatanaroj, S. Prechawat, B. Sunsaneewitayakul, S. Sitthisook, P. Tosukhowong and K. Tungsanga 3 Division of Cardiology, Division of Nephrology, Department of Medicine, 3 Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Aims Sudden unexplained death syndrome occurs in previously healthy South-east Asian young adults without any structural cause of death. The common electrocardiographic (ECG) change in sudden unexplained death syndrome survivors is right bundle branch block and ST elevations in leads V to V 3, which are similar to the ECG pattern in the Brugada syndrome (). It is difficult to diagnose the -lead ECG in sudden unexplained death syndrome survivors and their family members because the ECG could be transiently normalized. We proposed using the higher intercostal space V to V 3 lead ECG, together with procainamide to detect the. Methods and Results Among 0 ventricular fibrillation cardiac arrest patients, 3 sudden unexplained death syndrome survivors and their relatives (n=88) were studied using the single standard -lead ECG and the new six higher intercostal space V to V 3 lead ECG ( V to V 3 and V to V 3 ). Ten sudden unexplained death syndrome survivors and relatives (n=48) who had a normalized ECG were also infused with procainamide (0 mg. kg i.v.) to unmask the and both ECG methods were recorded. Forty healthy individuals and 3 spouses served as the control group. Prior to the procainamide infusion, the could be detected in nine sudden unexplained death syndrome survivors (69 %) and three (3 4%) relatives standard ECG and in (9 3%) and nine (0 %) new six-lead ECG. After the procainamide infusion, the could be demonstrated in seven sudden unexplained death syndrome survivors (70%) and seven (4 6%) relatives with the standard ECG and in nine (90%) (P=0 6) and 3 (47 9%) (P=0 0004) new six-lead ECG, respectively. All the controls were negative for the. Conclusions Our data suggest that the new higher intercostal space lead ECG, with or without the procainamide test is helpful in detecting the in sudden unexplained death syndrome survivors and their relatives. (Eur Heart J 00; : 90 96, doi:0.053/euhj ) 00 The European Society of Cardiology Key Words: Sudden unexplained death syndrome, the Brugada syndrome, the, electrocardiographic leads, procainamide. See page 3, doi: 0.053/euhj for the Editorial comment on this article Introduction Manuscript submitted December 000, accepted 6 March 00, and published online 4 August 00. Correspondence: Somkiat Sangwatanaroj, MD, Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama 4 Road, Patumwan, Bangkok 0330, Thailand X/0/90+07 $35.00/0 Sudden unexplained death syndrome is one of the major causes of death in Thai young men. It has been defined (by the US-CDC in 984) as any unexpected death in a person at least years of age, born in, or with at least one parent born in Vietnam, Cambodia, Laos, Thailand, the Philippines or other South-east Asian country, and a post-mortem examination revealing no underlying 00 The European Society of Cardiology

2 Electrocardiography in the Brugada syndrome 9 cause of death []. In probable or presumptive sudden unexplained death syndrome (PSUDS) the victim would have at least four of the following criteria for a witnessed case, and at least three for a non-witnessed case: () age 0 50 years; () event taking place during sleep or a short nap; (3) victim known to be healthy until immediately before the event; (4) agonal respiration or difficulty in breathing before death; (5) waking is difficult or unsuccessful; (6) no necropsy is performed []. Therefore a PSUDS survivor, whose cause of arrest cannot be identified after intensive investigations, is called a sudden unexplained death syndrome survivor or near sudden unexplained death syndrome (NSUDS). The majority of NSUDS had documented ventricular fibrillation, cardiac arrest and the characteristic ECG pattern of the Brugada syndrome (): right bundle branch block and ST-segment elevation in leads V to V [3,4] 3. Transient normalization of this ECG pattern in Brugada syndrome patients may lead to under-diagnosis [5]. However, sodium channel blockers such as ajmaline, procainamide and flecainide can unmask the in many Brugada syndrome patients [6]. We hypothesized that higher intercostal space leads V to V 3 ( V to V 3 and V to V 3 )(Fig. ) should be helpful in detecting the because () the was a reflection of conduction delay localized in the right ventricular anterior wall and the right ventricular outflow tract by isochrone mapping [7]. The ECG lead position could be extended to cover the sites where abnormal repolarization prevails; () the recent report of improved detection of coronary artery disease by exercise ECG use of right precordial leads along standard six left precordial leads [8] gave us the idea that the more ECG leads we utilized, the greater the chance of detecting the in highly suspect cases; (3) one of our patients Brugada syndrome who survived his second idiopathic ventricular fibrillation cardiac arrest did not have an ECG characteristic of the in the conventional -lead ECG of his immediate post-cardiac arrest tracing, but did have it in leads V, V and V and similar manifestations were also found in other NSUDS patients (Fig. ) and their family members [9]. Shimizu et al. [0] also recently reported that recordings of leads V to V 3 in the -lead ECG in the parasternal second or third intercostal space would be helpful in the diagnosis of the Brugada syndrome in Japanese patients, and that the sodium channel blocker (disopyramide) could accentuate ST segment elevation not associated with a shift of location of the maximum ST segment elevation in Brugada syndrome patients. Very few ECG data for NSUDS patients and none of their families are available. The purpose of this study is to determine the usefulness of the higher intercostal space V to V 3 lead ECG, by comparing the ECG patterns of NSUDS and their relatives using the standard -lead and the new six higher intercostal space lead ECG ( V to V 3 and V to V 3 ) with and without intravenous procainamide. MAL AAL MCL V V V V V Methods V 3 V We define an NSUDS patient as a survivor of cardiac arrest from documented/witnessed ventricular fibrillation or as a PSUDS survivor in whom polymorphic ventricular tachycardia/ventricular fibrillation could be induced by electrophysiology. The subjects were previously healthy Thais, and extensive investigations, including biochemical study, echocardiography, coronary angiography, left and right ventriculography and electrophysiology, could reveal no cause of cardiac arrest. The NSUDS patient who has not undergone extensive investigation and has no structural heart disease/conditions to explain the cause of ventricular tachycardia/ventricular fibrillation is known as a presumptive near sudden unexplained death syndrome (PNSUDS) patient. From June 997 to November 000, we studied ventricular tachycardia/ventricular fibrillation cardiac arrest victims who were referred, or admitted, to the Department of Medicine, King Chulalongkorn Memorial Hospital. The standard V 3 V 3 MCL V 4 AAL MAL Figure The standard precordial positions of conventional chest leads V to V 6 (open circles) and the higher intercostal space ECG leads: V to V 3 and V to V 3 (open squares) are shown. The lead V is just to the right of the sternum in the third intercostal space; the lead V to the left of the sternum in the third intercostal space; the lead V 3 is one intercostal space higher than standard lead V 3 ; the lead V and V are just to the right and left, respectively, of the sternum in the second intercostal space; the lead V 3 is two intercostal spaces higher than standard lead V 3. MAL=mid-auxillary line; AAL=anterior auxillary line; MCL=mid-clavicular line. V 5 V 6 Eur Heart J, Vol., issue 4, December 00

3 V V V 9 S. Sangwatanaroj et al. V V V V 3 V 3 V 3 Figure The initial standard ECG leads V to V 3 of a near sudden unexplained death syndrome (NSUDS) showed no typical right bundle branch block or ST elevation typical of the Brugada syndrome (Brugada sign) but when the new higher intercostal space ECG leads ( V to V 3 and V to V 3 ) were employed, the coved types of the Brugada syndrome were revealed in lead V and the saddle-back type in leads V and V. -lead ECG and new six higher intercostal space lead ECG ( V to V 3 and V to V 3 )(Fig. ) were recorded after resuscitation. The other investigations, including complete blood count, urinary analysis, blood chemistry, electrolyte, chest X-ray, echocardiography with Doppler study, left- and right-sided cardiac catheterization with coronary angiography and left/right ventriculography were also performed to exclude organic heart disease and other causes of ventricular tachycardia/ventricular fibrillation. Those who had no known causes of malignant ventricular arrhythmia were included. We performed the electrophysiological study and programmed electrical stimulation at the right ventricular apex and outflow tract in three cycle-lengths in all NSUDS and PSUDS survivors who gained consciousness and were able to sign the informed consent. The PSUDS survivors in whom ventricular tachycardia/ ventricular fibrillation could not be induced with programmed electrical stimulation were excluded from the study. The NSUDS patients were treated with either beta-blocker or implantable cardioverter defibrillator. We define the as an ECG with right bundle branch block and ST-segment elevation in the right precordial leads, and looking similar to the ECGs in publications by Brugada [3]. A questionable Brugada sign is defined as an ECG tracing of QRS abnormalities and ST-segment elevation in the right precordial leads whose abnormality was of a lesser degree than the abnormal ECG shown in the original publications by Brugada [3]. It is consistent with (but not a definite). We define a negative as a normal ECG, or an ECG with minor ST-T changes dissimilar to those shown in the original publications by Brugada [3]. If the standard -lead ECG showed no or a questionable in leads V to V 3, 0 mg.kg of procainamide was intravenously administered in 0 min, patient being continuously monitored in the intensive care unit. The procainamide test was positive when the post-procainamide ECG demonstrated a greater than 0 mv down-sloping ST-segment elevation in any of the leads V to V 3, V to V 3 and V to V 3 in the immediate post-procainamide ECG compared with baseline ECG. We performed the standard -lead and new six higher intercostal space lead ECGs in the healthy relatives of NSUDS patients, together procainamide test (0 mg. kg intravenously in 0 min) in the emergency room or intensive care unit where cardiopulmonary resuscitation facilities were available, if the ECG showed questionable or negative. The relatives of NSUDS with symptomatic heart disease or evidence of coronary artery disease were excluded from the procainamide test. The pedigree of sudden Eur Heart J, Vol., issue 4, December 00

4 Electrocardiography in the Brugada syndrome 93 Table Comparison of the rate of detection of the by the conventional -lead ECG new six higher intercostal space lead ECG ( V to V 3 and V to V 3 ) in near sudden unexplained death syndrome patients, their relatives and normal controls -lead ECG unexplained death syndrome families was drawn using the as the phenotype and the genetic mode of transmission was determined. The protocol was approved by the Faculty of Medicine Ethical Committee and informed consent was obtained from all subjects before the study. Statistical analysis was made for the chi-squared test for the difference between the two ECG methods and a P value <0 05 was considered as statistically significant. Results six higher intercostal space lead ECG NSUDS, no. (%) (n=3) 9 (69 ) (9 3) Relatives, no. (%) (n=88) 3 (3 4) 9 (0 ) Controls, no. (%) (n=53) 0 (0) 0 (0) NSUDS=near sudden unexplained death syndrome. Twenty patients with unexplained ventricular fibrillation cardiac arrest were admitted to hospital. All but one were males and the mean age was years. Seven patients were excluded because invasive cardiovascular studies to elucidate the aetiologies of ventricular fibrillation were incomplete. Thirteen patients were diagnosed as NSUDS after extensive investigations according to the protocol. These and their 88 relatives were studied, together with 53 healthy adults and spouses of the first degree relatives, who served as controls. Procainamide tests were performed in 0 (out of 3) NSUDS patients who had transient normalization of the, in 48 relatives who had negative or questionable on the standard -lead and new six higher intercostal space lead ECG (Fig. 3), and in 3 healthy controls. The was detected in nine (69 %) of the NSUDS patients by the conventional -lead ECG compared with (9 3%) by the new six-lead ECG (P=0 3). Of the relatives, three (3 4%) were revealed to have the by the -lead ECG and nine (0 %) by new six-lead ECG (P=0 07) (Table ). There were similar findings in the procainamide groups: seven NSUDS patients (70%) by the -lead ECG compared with nine (90%) by the new six-lead ECG (P=0 6), seven (4 6%) relatives by the -lead ECG and 3 (47 9%) by new six-lead ECG (P=0 0004) (Table ). None of the controls or spouses had a positive by both methods Table Comparison of the rate of detection of the by the conventional -lead ECG new six higher intercostal space lead ECG ( V to V 3 and V to V 3 ) after intravenous injection of 0 mg. kg of procainamide in near sudden unexplained death syndrome patients, their relatives and normal controls -lead ECG with or without procainamide. No ventricular arrhythmia or serious side-effects were observed during the procainamide test. In one eight-member NSUDS family (SSR), the - lead ECG alone, the -lead post-procainamide ECG and the six higher intercostal space lead ECG alone, showed a positive in one and a questionable in another (Fig. 4(a)). However, five positive s were detected by the new six-lead post-procainamide ECG (Fig. 4(b)). Individuals I. and II.5 were healthy until they suddenly unexpectedly died in their sleep in the fourth decade of life without any obvious cause of death (PSUDS). Using presumptive sudden unexplained death and the as the phenotype, the pedigree of the SSR family clearly demonstrates the mode of transmission of autosomal dominance with complete penetrance, as reported in the Brugada syndrome []. Discussions six higher intercostal space lead ECG NSUDS, no. (%) (n=0) 7 (70 0) 9 (90 0) Relatives, no. (%) (n=48) 7 (4 6) 3 (47 9)* Controls, no. (%) (n=3) 0 (0) 0 (0) NSUDS=near sudden unexplained death syndrome. *P<0 00. In this study we demonstrate that the higher intercostal space V to V 3 lead ECG ( V to V 3 and V to V 3 ) is superior to the conventional -lead ECG in the detection of the in both sudden unexplained death syndrome survivors (NSUDS) and their relatives. Moreover, intravenous procainamide administration plus the higher intercostal space leads ECG was able to unmask the in 0 more relatives (n=48) when compared higher leads alone, and in two more NSUDS patients (n=0) when compared post-procainamide -lead ECG. Our data show that the post-procainamide six higher intercostal space lead ECG is the most sensitive method for detecting the in both NSUDS patients and the relatives. It was suggested that flecainide administration is a sensitive and specific test for detecting the among patients carrying genetic mutations for the Eur Heart J, Vol., issue 4, December 00

5 94 S. Sangwatanaroj et al. Baseline Post-procainamide V to V 3 V to V 3 V to V 3 V to V 3 (a) (b) (c) (d) Figure 3 The pre- and post-procainamide ECGs of a relative of a near sudden unexplained death syndrome patient. (a) Baseline ECG leads V to V 3 showed no right bundle branch block or ST elevation typical of the Brugada syndrome (); (b) baseline higher intercostal space ECG leads V to V 3 (Fig. ) indicate a questionable (arrow) in lead V ; (c) post-procainamide ECG leads V to V 3 showed a positive ; (d) post-procainamide ECG leads V to V 3 also showed a positive (arrow) at lead V. Brugada syndrome []. Even through procainamide is less potent than flecainide, utilization of the higher intercostal space leads could increase the power to detect the. With the method of procainamide administration (0 mg intravenously in 0 min) recommended by Brugada et al. [3], no serious side-effects from procainamide have been reported in the Brugada syndrome; however, one patient developed ventricular fibrillation during ajmaline administration []. Flecainide can be safely used to maintain sinus rhythm in patients with ventricular arrhythmia and no structural heart disease. It has recently been reported that flecainide can induce ventricular tachycardia and fibrillation in patients treated for atrial fibrillation [4]. The efficacy and safety of sodium channel blockers in this condition should be elucidated in future investigations new six higher intercostal space ECG. Our data confirm the recent Japanese study on the 87-lead body surface map in Brugada syndrome patients [0]. The study indicated that the second and third intercostal space V to V 3 lead ECG, alone or with sodium channel blockers, would be helpful in the detection of the. For the first time, we have extended the study to relatives and have found that the new six-lead ECG is more sensitive than the conventional ECG in the detection of the. The difference is significant procainamide test in the relatives group (P<0 00), but is not significant in the NSUDS group, possibly due to the small number of the latter. The ECG findings in the SSR family members demonstrated that the conventional -lead ECG, plus the procainamide test and new six-leads alone are not enough to detect the in healthy relatives of sudden unexplained death syndrome patients. Therefore it is mandatory to perform the procainamide test new six-lead ECG to identify the phenotype of the family members Brugada syndrome. The lack of phenotype genotype correlation in some family members of Brugada syndrome patients [5] or incomplete penetrance and variable responses to sodium channel blockade [6] maybe due to inadequate efficacy of procainamide, ajmaline or the flecainide test conventional -lead ECG to unmask the. Moreover it is conceivable to expect a higher prevalence of the in an apparently healthy population by using the new six higher intercostal space lead ECG [7 9] as well as in idiopathic ventricular fibrillation patients. Study limitations The diagnosis of the in our patients was exclusively based on an ECG only, without genotype analysis. The only gene associated Brugada syndrome is the cardiac sodium channel gene (SCN5A) []. At least three mutations of this gene cause Brugada syndrome and sodium channel mutation might Eur Heart J, Vol., issue 4, December 00

6 Electrocardiography in the Brugada syndrome 95 (a) (b) I II III? IV Figure 4 A pedigree of one near sudden unexplained death syndrome patient (NSUDS) (SSR). Circles indicate females; squares, male; open symbol, unaffected status; open symbol with question mark, questionable ; closed symbol, NSUDS; stippled, positive ; stippled with slash, presumptive sudden unexplained death syndrome (PSUDS). (a) Pedigree phenotype of the by the -lead ECG with procainamide, and the new six-lead ECG alone. (b) The same pedigree with phenotypes of a positive by the new six-lead ECG procainamide test and PSUDS clearly demonstrate the autosomal dominant mode of transmission. be present in only a small proportion of patients Brugada syndrome [0]. We still have to rely on this ECG marker () for the diagnosis of the Brugada syndrome in survivors of idiopathic polymorphic ventricular tachycardia or ventricular fibrillation arrest and their healthy relatives although the specificity of the is questionable [0,]. In subjects without documented or suspected ventricular tachycardia/ ventricular fibrillation, the specificity of ST elevation following administration of a class I drug is still not clear [,3]. Clinical implications The new six-lead ECG ( V to V 3 and V to V 3 ) with procainamide is safe, easy to perform and should be helpful in the detection of the in sudden unexplained death syndrome, especially in the relatives of the NSDUS patients. We propose this method as a screening tool for the Brugada syndrome in sudden unexplained death syndrome survivors from polymorphic ventricular tachycardia/ventricular fibrillation cardiac arrest and their healthy relatives. It could also be used as a surrogate marker to assess therapeutic efficacy of antiarrhythomogenic intervention. We thank Professor Chitr Sitthi-Amorn for his excellent advice and support. This work has been supported by Thailand Research Fund (RTA/08/540). References [] Parrisk RG, Tucker M, Ing R, Encamacion C, Ebergardt M. Sudden unexplained death syndrome in Southeast Asian refugees: A review of CDC surveillance. MMWR CDC Surveil Summ 987; 36: 43SS 53SS. [] Tatsanavivat P, Chirawatkul A, Klungboonkrong V et al. Sudden and unexplained deaths in sleep (Lai Tai) of young men in rural north-eastern Thailand. Int J Epidemiol 99; : [3] Brugada P, Brugada J. Right bundle-branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol 99; 0: Eur Heart J, Vol., issue 4, December 00

7 96 S. Sangwatanaroj et al. [4] Nademanee K, Veerakul G, Nimmannit S et al. Arrhythmogenic marker for the sudden unexplained death syndrome in Thai men. Circulation 997; 96: [5] Bjerregaard P, Gussak I, Antzelevitch C. The enigmatic ECG manifestation of Brugada syndrome. J Cardiovasc Electrophysiol 998; 9: 09. [6] Antzelevitch C, Nesterenko VV, Yan GX. Ionic processes underlying the action potential. In: Liebman J., ed. Electrocardiology 996: From the cell to the body surface. Singapore: World Scientific Publishing Co. Pte. Ltd., 996: 9 9. [7] Michaelides AP, Psomadaki ZD, Dilaveris PE et al. Improved detection of coronary artery disease by exercise electrocardiography use of right precordial leads. N Engl J Med 999; 340: [8] Bezzina C, Veldkamp MW, van den Berg MP et al. A single Na + channel mutation causing both long QT and Brugada syndromes. Circ Res 999; 85: [9] Sangwatanaroj S, Prechawat S, Sunsaneewitayakul B et al. The Right Ventricular Electrocardiographic Leads for Detection of Brugada Syndrome in Sudden Unexplained Death Syndrome Survivors and Their Relatives. Clin Cardiol (in press). [0] Shimizu W, Matsuo K, Takagi M et al. Body surface distribution and response to drugs of ST segment elevation in Brugada syndrome: Clinical implication of eighty-seven-lead body surface potential mapping and its application to twelvelead electrocardiograms. J Cardiovasc Electrophysiol 000; : [] Chen Q, Kirsch GE, Zhang D et al. Genetic basis and molecular mechanism for idiopathic ventricular fibrillation. Nature 998; 39: [] Brugada R, Brugada J, Antzelevitch C et al. Sodium channel blockers identify risk for sudden death in patients with ST-segment elevation and right bundle branch block but structurally normal hearts. Circulation 000; 0: [3] Brugada P, Brugada R, Brugada J. Sudden death in patients and relatives syndrome of right bundle branch block, ST segment elevation in the precordial leads V to V 3 and sudden death. Eur Heart J 000; : 3 6. [4] Falk RH. Flecainide-induced ventricular tachycardia and fibrillation in patients treated with atrial fibrillation. Ann Intern Med 989; : 07. [5] Kasanuki H, Ohnishi S, Ohtuka M et al. Idiopathic ventricular fibrillation induced with vagal activity in patients without obvious heart disease. Circulation 997; 95: [6] Priori SG, Napolitano C, Gasparini M et al. Clinical and genetic heterogeneity of right bundle branch block and STsegment elevation syndrome. Circulation 000; 0: [7] Hermida J, Lemoine J, Aoun FB, Jarry G, Rey J, Quiret J. Prevalence of the Brugada syndrome in an apparently healthy population. Am J Cardiol 000; 86: 9 4. [8] Viskin S, Fish R, Eldar M et al. Prevalence of the Brugada sign in idiopathic ventricular fibrillation and healthy controls. Heart 000; 84: 3 6. [9] Tohyou Y, Nakazawa K, Ozawa A. A survey in the incidence of right bundle branch block with ST elevation among normal population. Jpn J Electrocardiol 995; 5: 3 6. [0] Farre J. The Brugada syndrome: do we need more than the -lead ECG? Eur Heart J 000; : [] Tarin N, Farre J, Rubio JM, Tunon J, Castro-Dorticos J. Brugada-like electrocardiographic pattern in a patient with a mediastinal tumor. PACE 999; : [] Roden DM, Wilde AAM. Drug-induced J-point elevation: a marker for genetic risk of sudden death or ECG curiosity? J Cardiovasc Electrophysiol 999; 0: 9 3. [3] Fujiki A, Usui M, Nagasawa H, Mizumaki K, Hayashi H, Inoue H. ST segment elevation in the right precordial leads induced with class C antiarrhythmic drugs: insight into the mechanism of Brugada syndrome. J Cardiovasc Electrophysiol 999; 0: 4 8. Eur Heart J, Vol., issue 4, December 00

How to read the ECG in athletes: distinguishing normal form abnormal

How to read the ECG in athletes: distinguishing normal form abnormal How to read the ECG in athletes: distinguishing normal form abnormal Antonio Pelliccia, MD Institute of Sport Medicine and Science www.antoniopelliccia.it Cardiac adaptations to Rowing Vagotonia Sinus

More information

January 14-15, 2011 SCA Conference 2

January 14-15, 2011 SCA Conference 2 Electrical Abnormalities: Long QT and Beyond Yaniv Bar-Cohen, M.D. Assistant Professor of Pediatrics Division of Cardiology / Electrophysiology Childrens Hospital Los Angeles Keck School of Medicine Genetic

More information

Diagnostic Scoring System for LQTS

Diagnostic Scoring System for LQTS Medical Coverage Policy Genetic Testing: Congenital Long QT Syndrome Device/Equipment Drug Medical Surgery Test Other Effective Date: 2/15/2011 Policy Last Updated: 2/21/2012 Prospective review is recommended/required.

More information

Guidelines for the diagnosis and management of Brugada Syndrome

Guidelines for the diagnosis and management of Brugada Syndrome The Cardiac Society of Australia and New Zealand Guidelines for the diagnosis and management of Brugada Syndrome Development of these guidelines was co-ordinated ordinated by A/Prof Jitendra Vohra and

More information

Life Threatening EKG s In The Office. Joseph A Manfredi, MD, FACC, FHRS GHS Cardiovascular Symposium

Life Threatening EKG s In The Office. Joseph A Manfredi, MD, FACC, FHRS GHS Cardiovascular Symposium Life Threatening EKG s In The Office Joseph A Manfredi, MD, FACC, FHRS GHS Cardiovascular Symposium January 24 th, 2015 Disclosures Speaker Honorariums: STJM, Boston Scientific Advisory role: Medtronic

More information

Sudden Arrhythmia Death Syndrome: Importance of the Long QT Syndrome

Sudden Arrhythmia Death Syndrome: Importance of the Long QT Syndrome Sudden Arrhythmia Death Syndrome: Importance of the Long QT Syndrome JOHN S. MEYER, M.D., St. Luke s Hospital, Chesterfield, Missouri ALI MEHDIRAD, M.D., Midwest Heart Rhythm, St. Louis, Missouri BAKR

More information

A Case of Long QT Syndrome Type 3 Aggravated by Beta-Blockers and Alleviated by Mexiletine: The Role of Epinephrine Provocation Test

A Case of Long QT Syndrome Type 3 Aggravated by Beta-Blockers and Alleviated by Mexiletine: The Role of Epinephrine Provocation Test Case Report http://dx.doi.org/10.3349/ymj.2013.54.2.529 pissn: 0513-5796, eissn: 1976-2437 Yonsei Med J 54(2):529-533, 2013 A Case of Long QT Syndrome Type 3 Aggravated by Beta-Blockers and Alleviated

More information

Electrocardiographic Issues in Williams Syndrome

Electrocardiographic Issues in Williams Syndrome Electrocardiographic Issues in Williams Syndrome R. Thomas Collins II, MD Assistant Professor, Pediatrics and Internal Medicine University of Arkansas for Medical Sciences Arkansas Children s Hospital

More information

Cardiopatie Aritmogene nel Giovane

Cardiopatie Aritmogene nel Giovane Firenze, 16 Novembre 2012 Cardiopatie Aritmogene nel Giovane Prof. Luigi Padeletti Università degli Studi di Firenze 1) Long QT Syndrome 2) Short QT Syndrome 3) J wave Syndrome: Early Repolarization Syndrome

More information

Adding IV Amiodarone to the EMS Algorithm for Cardiac Arrest Due to VF/Pulseless VT

Adding IV Amiodarone to the EMS Algorithm for Cardiac Arrest Due to VF/Pulseless VT Adding IV Amiodarone to the EMS Algorithm for Cardiac Arrest Due to VF/Pulseless VT Introduction Before the year 2000, the traditional antiarrhythmic agents (lidocaine, bretylium, magnesium sulfate, procainamide,

More information

Innovation Platform: Sudden Cardiac Death

Innovation Platform: Sudden Cardiac Death Innovation Platform: Sudden Cardiac Death Prof. dr. Bart Loeys CRC Antwerp General Assembly VzW Board of Directors Strategic Advisory Board Staff: 1 executive director 1 ICT manager 1 financial administration

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Genetic Testing for Cardiac Ion Channelopathies File Name: Origination: Last CAP Review: Next CAP Review: Last Review: genetic_testing_for_cardiac_ion_channelopathies 10/2008 4/2015

More information

Natural History of Early Repolarization in the Inferior Leads

Natural History of Early Repolarization in the Inferior Leads ORIGINAL ARTICLE Natural History of Early Repolarization in the Inferior Leads Ricardo Stein, M.D., Karim Sallam, M.D., Chandana Adhikarla, M.D., Madhavi Boga, M.D., Alexander D. Wood, B.Sc., and Victor

More information

Københavns Universitet

Københavns Universitet university of copenhagen Københavns Universitet Automatic J-point Location in Subjects with Electrocardiographic Early Repolarization Melgaard, Jacob; Struijk, Johannes J.; Hansen, John; Kanters, Jørgen

More information

Potential Causes of Sudden Cardiac Arrest in Children

Potential Causes of Sudden Cardiac Arrest in Children Potential Causes of Sudden Cardiac Arrest in Children Project S.A.V.E. When sudden death occurs in children, adolescents and younger adults, heart abnormalities are likely causes. These conditions are

More information

Treating AF: The Newest Recommendations. CardioCase presentation. Ethel s Case. Wayne Warnica, MD, FACC, FACP, FRCPC

Treating AF: The Newest Recommendations. CardioCase presentation. Ethel s Case. Wayne Warnica, MD, FACC, FACP, FRCPC Treating AF: The Newest Recommendations Wayne Warnica, MD, FACC, FACP, FRCPC CardioCase presentation Ethel s Case Ethel, 73, presents with rapid heart beating and mild chest discomfort. In the ED, ECG

More information

The QT interval: Too long, too short or just right

The QT interval: Too long, too short or just right CONTEMPORARY REVIEW The QT interval: Too long, too short or just right Sami Viskin, MD From Tel-Aviv Sourasky Medical Center, Sackler-School of Medicine, Tel Aviv, Israel. The hallmark of the congenital

More information

Hypertrophic and Dilated Cardiomyopathy. Rahul Deo, MD PHD Assistant Professor Division of Cardiology, UCSF Principal Investigator, CVRI

Hypertrophic and Dilated Cardiomyopathy. Rahul Deo, MD PHD Assistant Professor Division of Cardiology, UCSF Principal Investigator, CVRI Hypertrophic and Dilated Cardiomyopathy Rahul Deo, MD PHD Assistant Professor Division of Cardiology, UCSF Principal Investigator, CVRI Outline Definitions Epidemiology: the scope of the problem Genetics

More information

The Emerging Atrial Fibrillation Epidemic: Treat It, Leave It or Burn It?

The Emerging Atrial Fibrillation Epidemic: Treat It, Leave It or Burn It? The Emerging Atrial Fibrillation Epidemic: Treat It, Leave It or Burn It? Indiana Chapter-ACC 17 th Annual Meeting Indianapolis, Indiana October 19, 2013 Deepak Bhakta MD FACC FACP FAHA FHRS CCDS Associate

More information

RATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY. Charles Jazra

RATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY. Charles Jazra RATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY Charles Jazra NO CONFLICT OF INTEREST TO DECLARE Relationship Between Atrial Fibrillation and Age Prevalence, percent

More information

Electrocardiography Review and the Normal EKG Response to Exercise

Electrocardiography Review and the Normal EKG Response to Exercise Electrocardiography Review and the Normal EKG Response to Exercise Cardiac Anatomy Electrical Pathways in the Heart Which valves are the a-v valves? Closure of the a-v valves is associated with which heart

More information

Methods SOO G. KIM, MD, FACC, STEVEN W. SEIDEN, MD, JEFFREY A. MATOS, MD, LAWRENCE E. WASPE, MD, FACC, JOHN D. FISHER, MD, FACC

Methods SOO G. KIM, MD, FACC, STEVEN W. SEIDEN, MD, JEFFREY A. MATOS, MD, LAWRENCE E. WASPE, MD, FACC, JOHN D. FISHER, MD, FACC lacc Vol. 6, No.3 539 Discordance Between Ambulatory Monitoring and Programmed Stimulation in Assessing Efficacy of Class IA Antiarrhythmic Agents in Patients With Ventricular Tachycardia SOO G. KIM, MD,

More information

Acquired, Drug-Induced Long QT Syndrome

Acquired, Drug-Induced Long QT Syndrome Acquired, Drug-Induced Long QT Syndrome A Guide for Patients and Health Care Providers Sudden Arrhythmia Death Syndromes (SADS) Foundation 508 E. South Temple, Suite 202 Salt Lake City, Utah 84102 800-STOP

More information

REFERRAL HOSPITAL. The Importance of Door In Door Out Time DIDO

REFERRAL HOSPITAL. The Importance of Door In Door Out Time DIDO REFERRAL HOSPITAL The Importance of Door In Door Out Time DIDO Time to Treatment is critical for STEMI patients For patients with ST-segment elevation myocardial infarction (STEMI), percutaneous coronary

More information

Genetic Long QT Syndrome GENETIC TESTING FOR LONG QT SYNDROME HS-148. Policy Number: HS-148. Original Effective Date: 1/21/2010

Genetic Long QT Syndrome GENETIC TESTING FOR LONG QT SYNDROME HS-148. Policy Number: HS-148. Original Effective Date: 1/21/2010 Harmony Behavioral Health, Inc. Harmony Behavioral Health of Florida, Inc. Harmony Health Plan of Illinois, Inc. HealthEase of Florida, Inc. Ohana Health Plan, a plan offered by WellCare Health Insurance

More information

Introduction to Electrocardiography. The Genesis and Conduction of Cardiac Rhythm

Introduction to Electrocardiography. The Genesis and Conduction of Cardiac Rhythm Introduction to Electrocardiography Munther K. Homoud, M.D. Tufts-New England Medical Center Spring 2008 The Genesis and Conduction of Cardiac Rhythm Automaticity is the cardiac cell s ability to spontaneously

More information

8 Peri-arrest arrhythmias

8 Peri-arrest arrhythmias 8 Peri-arrest arrhythmias Introduction Cardiac arrhythmias are relatively common in the peri-arrest period. They are common in the setting of acute myocardial infarction and may precipitate ventricular

More information

Long QT. Long QT Syndrome. A Guide for

Long QT. Long QT Syndrome. A Guide for Long QT Long QT Syndrome A Guide for Introduction Long QT syndrome (LQTS) is a genetic heart disorder due to the malfunction of cardiac ion channels that results in 4,000 deaths annually in the United

More information

Tips and Tricks to Demystify 12 Lead ECG Interpretation

Tips and Tricks to Demystify 12 Lead ECG Interpretation Tips and Tricks to Demystify 12 Lead ECG Interpretation Mission: Lifeline North Dakota Regional EMS and Hospital Conference Samantha Kapphahn, DO Essentia Health- Interventional Cardiology June 5th, 2014

More information

Purpose To guide registered nurses who may manage clients experiencing sudden or unexpected life-threatening cardiac emergencies.

Purpose To guide registered nurses who may manage clients experiencing sudden or unexpected life-threatening cardiac emergencies. Emergency Cardiac Care: Decision Support Tool #1 RN-Initiated Emergency Cardiac Care Without Cardiac Monitoring/Manual Defibrillator or Emergency Cardiac Drugs Decision support tools are evidence-based

More information

Signal-averaged electrocardiography late potentials

Signal-averaged electrocardiography late potentials SIGNAL AVERAGED ECG INTRODUCTION Signal-averaged electrocardiography (SAECG) is a special electrocardiographic technique, in which multiple electric signals from the heart are averaged to remove interference

More information

LAST NAME VAT NUMBER. PHONE (Important for possible case discussion)

LAST NAME VAT NUMBER. PHONE (Important for possible case discussion) Long QT Panel CUSTOMER INFORMATION FIRST NAME LAST NAME ORGANIZATION VAT NUMBER BILLING ADDRESS 1ST LINE BILLING ADDRESS 2ND LINE POST CODE CITY COUNTRY EMAIL (Required) PHONE (Important for possible case

More information

Usefulness of Epinephrine Test in the Congenital Long QT Syndrome

Usefulness of Epinephrine Test in the Congenital Long QT Syndrome Usefulness of Epinephrine Test in the Congenital Long QT Syndrome Wataru Shimizu M.D., Ph.D. CASE PRESENTATION A 14-year old Japanese boy was successfully resuscitated from cardiac arrest (near drowning)

More information

ACLS PHARMACOLOGY 2011 Guidelines

ACLS PHARMACOLOGY 2011 Guidelines ACLS PHARMACOLOGY 2011 Guidelines ADENOSINE Narrow complex tachycardias or wide complex tachycardias that may be supraventricular in nature. It is effective in treating 90% of the reentry arrhythmias.

More information

PRACTICAL APPROACH TO SVT. Graham C. Wong MD MPH Division of Cardiology Vancouver General Hospital University of British Columbia

PRACTICAL APPROACH TO SVT. Graham C. Wong MD MPH Division of Cardiology Vancouver General Hospital University of British Columbia PRACTICAL APPROACH TO SVT Graham C. Wong MD MPH Division of Cardiology Vancouver General Hospital University of British Columbia CONDUCTION SYSTEM OF THE HEART SA node His bundle Left bundle AV node Right

More information

Diagnosis Code Crosswalk : ICD-9-CM to ICD-10-CM Cardiac Rhythm and Heart Failure Diagnoses

Diagnosis Code Crosswalk : ICD-9-CM to ICD-10-CM Cardiac Rhythm and Heart Failure Diagnoses Diagnosis Code Crosswalk : to 402.01 Hypertensive heart disease, malignant, with heart failure 402.11 Hypertensive heart disease, benign, with heart failure 402.91 Hypertensive heart disease, unspecified,

More information

Atrial Fibrillation An update on diagnosis and management

Atrial Fibrillation An update on diagnosis and management Dr Arvind Vasudeva Consultant Cardiologist Atrial Fibrillation An update on diagnosis and management Atrial fibrillation (AF) remains the commonest disturbance of cardiac rhythm seen in clinical practice.

More information

Automatic External Defibrillators

Automatic External Defibrillators Last Review Date: May 27, 2016 Number: MG.MM.DM.10dC2 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth

More information

Ngaire has Palpitations

Ngaire has Palpitations Ngaire has Palpitations David Heaven Cardiac Electrophysiologist/Heart Rhythm Specialist Middlemore, Auckland City and Mercy Hospitals Auckland Heart Group MCQ Ms A is 45, and a healthy marathon runner.

More information

Wide-Complex Tachycardias in the ED: Myths and Pitfalls

Wide-Complex Tachycardias in the ED: Myths and Pitfalls Wide-Complex Tachycardias in the ED: Myths and Pitfalls, FACEP, FAAEM Professor and Vice Chair Director, Emergency Cardiology Fellowship Department of Emergency Medicine University of Maryland School of

More information

Supraventricular Tachycardia

Supraventricular Tachycardia Supraventricular Tachycardia Supraventricular tachycardia (SVT) is a rapid heart rate that originates in the top chambers of the heart called the atria. This is a relatively common entity that effects

More information

Cardiovascular Genetics Center

Cardiovascular Genetics Center B r i g h a m a n d W o m e n s H o s p i t a l Cardiovascular Genetics Center Hypertrophic Cardiomyopathy Clinic The HCM Clinic at Brigham and Women s Hospital applies the latest scientific discoveries

More information

Ablation The removal, isolation or destruction of cardiac tissue or conduction pathways involved in arrhythmias.

Ablation The removal, isolation or destruction of cardiac tissue or conduction pathways involved in arrhythmias. Glossary of Cardiology Terms Ablation The removal, isolation or destruction of cardiac tissue or conduction pathways involved in arrhythmias. Algorithm A set of precise rules or procedures programmed into

More information

Overview of Inherited Heart Rhythm Disorders for Patients

Overview of Inherited Heart Rhythm Disorders for Patients Introduction Overview of Inherited Heart Rhythm Disorders for Patients Inherited heart rhythm disorders affect a small portion of the population, presenting as palpitations, fainting, heart arrest and

More information

Recurrent AF: Choosing the Right Medication.

Recurrent AF: Choosing the Right Medication. In the name of God Shiraz E-Medical Journal Vol. 11, No. 3, July 2010 http://semj.sums.ac.ir/vol11/jul2010/89015.htm Recurrent AF: Choosing the Right Medication. Basamad Z. * Assistant Professor, Department

More information

Cardiac Arrest Pediatric Ventricular Fibrillation / Pulseless Ventricular Tachycardia Protocol revised October 2008

Cardiac Arrest Pediatric Ventricular Fibrillation / Pulseless Ventricular Tachycardia Protocol revised October 2008 Cardiac Arrest Pediatric Ventricular Fibrillation / Pulseless Ventricular Tachycardia Protocol revised October 2008 Preamble In contrast to cardiac arrest in adults, cardiopulmonary arrest in pediatric

More information

UnitedHealthcare, UnitedHealthcare of the River Valley and Neighborhood Health Partnership Cardiology Notification and Prior Authorization Program:

UnitedHealthcare, UnitedHealthcare of the River Valley and Neighborhood Health Partnership Cardiology Notification and Prior Authorization Program: UnitedHealthcare, UnitedHealthcare of the River Valley and Neighborhood Health Partnership Cardiology Notification and Prior Authorization Program: Electrophysiology Implant Code Classification Table The

More information

Chest Pain in Young Athletes. Christopher Davis, MD, PhD Pediatric Cardiology Rady Children s Hospital San Diego cdavis@rchsd.

Chest Pain in Young Athletes. Christopher Davis, MD, PhD Pediatric Cardiology Rady Children s Hospital San Diego cdavis@rchsd. Chest Pain in Young Athletes Christopher Davis, MD, PhD Pediatric Cardiology Rady Children s Hospital San Diego cdavis@rchsd.org 858-966-5855 None Disclosures Chest Pain: the good news and the bad news:

More information

GUIDELINE 11.9 MANAGING ACUTE DYSRHYTHMIAS. (To be read in conjunction with Guideline 11.7 Post-Resuscitation Therapy in Adult Advanced Life Support)

GUIDELINE 11.9 MANAGING ACUTE DYSRHYTHMIAS. (To be read in conjunction with Guideline 11.7 Post-Resuscitation Therapy in Adult Advanced Life Support) AUSTRALIAN RESUSCITATION COUNCIL GUIDELINE 11.9 MANAGING ACUTE DYSRHYTHMIAS (To be read in conjunction with Guideline 11.7 Post-Resuscitation Therapy in Adult Advanced Life Support) The term cardiac arrhythmia

More information

Medical Policy Manual. Topic: Genetic Testing for Cardiac Ion Channelopathies Date of Origin: December 2012

Medical Policy Manual. Topic: Genetic Testing for Cardiac Ion Channelopathies Date of Origin: December 2012 Medical Policy Manual Topic: Genetic Testing for Cardiac Ion Channelopathies Date of Origin: December 2012 Section: Genetic Testing Last Reviewed Date: December 2015 Policy No: 07 Effective Date: January

More information

Heart Attack: What You Need to Know

Heart Attack: What You Need to Know A WorkLife4You Guide Heart Attack: What You Need to Know What is a Heart Attack? The heart works 24 hours a day, pumping oxygen and nutrient-rich blood to the body. Blood is supplied to the heart through

More information

Atrial Fibrillation and Cardiac Device Therapy RAKESH LATCHAMSETTY, MD DIVISION OF ELECTROPHYSIOLOGY UNIVERSITY OF MICHIGAN HOSPITAL ANN ARBOR, MI

Atrial Fibrillation and Cardiac Device Therapy RAKESH LATCHAMSETTY, MD DIVISION OF ELECTROPHYSIOLOGY UNIVERSITY OF MICHIGAN HOSPITAL ANN ARBOR, MI Atrial Fibrillation and Cardiac Device Therapy RAKESH LATCHAMSETTY, MD DIVISION OF ELECTROPHYSIOLOGY UNIVERSITY OF MICHIGAN HOSPITAL ANN ARBOR, MI Outline Atrial Fibrillation What is it? What are the associated

More information

Cardiac Rhythm Disorders

Cardiac Rhythm Disorders Cardiac Rhythm Disorders EP Laboratory Procedures (N = 4,65) Cleveland Clinic electrophysiologists use specialized approaches to diagnose and treat a wide variety of arrhythmias. In, we performed more

More information

How should we treat atrial fibrillation in heart failure

How should we treat atrial fibrillation in heart failure Advances in Cardiac Arrhhythmias and Great Innovations in Cardiology Torino, 23/24 Ottobre 2015 How should we treat atrial fibrillation in heart failure Matteo Anselmino Dipartimento Scienze Mediche Città

More information

TOP 5. The term cardiac arrhythmia encompasses all cardiac. Arrhythmias in Dogs & Cats. Sinus Arrhythmia. TOP 5 Arrhythmias Seen in Dogs & Cats

TOP 5. The term cardiac arrhythmia encompasses all cardiac. Arrhythmias in Dogs & Cats. Sinus Arrhythmia. TOP 5 Arrhythmias Seen in Dogs & Cats Top 5 ardiology Peer reviewed TOP 5 rrhythmias in Dogs & ats shley Jones, DVM mara Estrada, DVM, DVIM (ardiology) University of Florida The term cardiac arrhythmia encompasses all cardiac rhythms other

More information

E C C. American Heart Association. ACLS Provider. Written Examinations. August 2006

E C C. American Heart Association. ACLS Provider. Written Examinations. August 2006 E C C American Heart Association ACLS Provider Written Examinations Contents: Examination Memo Version A Answer Sheet Version A Exam Version A Answer Key Version A Annotations Version B Answer Sheet Version

More information

Implantable Cardioverter Defibrillator Treatment: Benefits and Pitfalls in the Currently Indicated Population. Carel Jan Willem Borleffs

Implantable Cardioverter Defibrillator Treatment: Benefits and Pitfalls in the Currently Indicated Population. Carel Jan Willem Borleffs Implantable Cardioverter Defibrillator Treatment: Benefits and Pitfalls in the Currently Indicated Population Carel Jan Willem Borleffs The studies described in this thesis were performed at the Department

More information

How to control atrial fibrillation in 2013 The ideal patient for a rate control strategy

How to control atrial fibrillation in 2013 The ideal patient for a rate control strategy How to control atrial fibrillation in 2013 The ideal patient for a rate control strategy L. Pison, MD Advances in Cardiac Arrhythmias and Great Innovations in Cardiology - Torino, September 28 th 2013

More information

BASIC STANDARDS FOR RESIDENCY TRAINING IN CARDIOLOGY

BASIC STANDARDS FOR RESIDENCY TRAINING IN CARDIOLOGY BASIC STANDARDS FOR RESIDENCY TRAINING IN CARDIOLOGY American Osteopathic Association and the American College of Osteopathic Internists Specific Requirements For Osteopathic Subspecialty Training In Cardiology

More information

ATRIAL FIBRILLATION (RATE VS RHYTHM CONTROL)

ATRIAL FIBRILLATION (RATE VS RHYTHM CONTROL) ATRIAL FIBRILLATION (RATE VS RHYTHM CONTROL) By Prof. Dr. Helmy A. Bakr Mansoura Universirty 2014 AF Classification: Mechanisms of AF : Selected Risk Factors and Biomarkers for AF: WHY AF? 1. Atrial fibrillation

More information

ACLS Cardiac Arrest Algorithm Neumar, R. W. et al. Circulation 2010;122:S729-S767

ACLS Cardiac Arrest Algorithm Neumar, R. W. et al. Circulation 2010;122:S729-S767 ACLS Cardiac Arrest Algorithm Neumar, R. W. et al. Circulation 2010;122:S729-S767 Copyright 2010 American Heart Association ACLS Cardiac Arrest Circular Algorithm Neumar, R. W. et al. Circulation 2010;122:S729-S767

More information

Cardiac Arrest VF/Pulseless VT Learning Station Checklist

Cardiac Arrest VF/Pulseless VT Learning Station Checklist Cardiac Arrest VF/Pulseless VT Learning Station Checklist VF/VT 00 American Heart Association Adult Cardiac Arrest Shout for Help/Activate Emergency Response Epinephrine every - min Amiodarone Start CPR

More information

510(k) Summary May 7, 2012

510(k) Summary May 7, 2012 510(k) Summary Medicalgorithmics 510(k) Premarket Notification 510(k) Summary May 7, 2012 1. Submitter Name and Address Medicalgorithmics LLC 245 West 107th St., Suite 11A New York, NY 10025, USA Contact

More information

BIPOLAR LIMB LEADS UNIPOLAR LIMB LEADS PRECORDIAL (UNIPOLAR) LEADS VIEW OF EACH LEAD INDICATIVE ECG CHANGES

BIPOLAR LIMB LEADS UNIPOLAR LIMB LEADS PRECORDIAL (UNIPOLAR) LEADS VIEW OF EACH LEAD INDICATIVE ECG CHANGES BIPOLAR LIMB LEADS Have both a distinctive positive and negative pole. Lead I LA (positive) RA (negative) Lead II LL (positive) RA (negative) Lead III LL (positive) LA (negative) UNIPOLAR LIMB LEADS Have

More information

Equine Cardiovascular Disease

Equine Cardiovascular Disease Equine Cardiovascular Disease 3 rd most common cause of poor performance in athletic horses (after musculoskeletal and respiratory) Cardiac abnormalities are rare Clinical Signs: Poor performance/exercise

More information

Long QT Syndrome Genetic Testing for Inherited Arrhythmias. patient guide

Long QT Syndrome Genetic Testing for Inherited Arrhythmias. patient guide Long QT Syndrome Genetic Testing for Inherited Arrhythmias patient guide What is Long QT Syndrome? Arrhythmias are problems with the electrical system in the heart that controls the heartbeat s regular

More information

Clinical Glidepath TM Tools Syncope Frail Life expectancy less than five years or significant functional impairment

Clinical Glidepath TM Tools Syncope Frail Life expectancy less than five years or significant functional impairment Robust Elderly greater ALL GROUPS 1 SYMPTOMS a) wth, nausea b) postural symptoms c) chest pain, dyspnea, post-exercise, dizziness, history of heart disease, palpitations, family history (prolonged QT)

More information

Automated External Defibrillator (AED) Program

Automated External Defibrillator (AED) Program FINANCE & OPERATIONS POLICY LIBRARY Revised: 01.17.07 TABLE OF CONTENTS Automated External Defibrillator (AED) Program I. INTRODUCTION...2 II. PURPOSE...2 III. POLICY...2 IV. REFERENCES...2 V. DEFINITIONS...3

More information

What Are Arrhythmias?

What Are Arrhythmias? What Are Arrhythmias? Many people have questions about what the word arrhythmia means, and arrhythmias can be a difficult subject to understand. The text below should give you a better understanding of

More information

PERI ARREST ARRHYTHMIAS Anu Roy

PERI ARREST ARRHYTHMIAS Anu Roy PERI ARREST ARRHYTHMIAS Anu Roy BACKGROUND The term peri arrest arrhythmias are used to describe cardiac rhythm disorders that may precede cardiac arrest or follow initial resuscitation from a cardiac

More information

How do you decide on rate versus rhythm control?

How do you decide on rate versus rhythm control? Heart Rhythm Congress 2014 How do you decide on rate versus rhythm control? Dr Ed Duncan Consultant Cardiologist & Electrophysiologist Define Rhythm Control DC Cardioversion Pharmacological AFFIRM study

More information

Medical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South

Medical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South Medical management of CHF: A New Class of Medication Al Timothy, M.D. Cardiovascular Institute of the South Disclosures Speakers Bureau for Amgen Background Chronic systolic congestive heart failure remains

More information

Review of Important ECG Findings in Patients with Syncope Joseph Toscano, MD

Review of Important ECG Findings in Patients with Syncope Joseph Toscano, MD 92 Review of Important ECG Findings in Patients with Syncope Joseph Toscano, MD Abstract Guidelines recommend 12-lead ECG as an important test to perform in patients with syncope. Though the incidence

More information

Tachyarrhythmias (fast heart rhythms)

Tachyarrhythmias (fast heart rhythms) Patient information factsheet Tachyarrhythmias (fast heart rhythms) The normal electrical system of the heart The heart has its own electrical conduction system. The conduction system sends signals throughout

More information

COVERAGE GUIDANCE: ABLATION FOR ATRIAL FIBRILLATION

COVERAGE GUIDANCE: ABLATION FOR ATRIAL FIBRILLATION COVERAGE GUIDANCE: ABLATION FOR ATRIAL FIBRILLATION Question: How should the EGBS Coverage Guidance regarding ablation for atrial fibrillation be applied to the Prioritized List? Question source: Evidence

More information

ACLS Chapter 3 Rhythm Review Instructor Lesson Plan to Accompany ACLS Study Guide 3e

ACLS Chapter 3 Rhythm Review Instructor Lesson Plan to Accompany ACLS Study Guide 3e ACLS Chapter 3 Rhythm Review Lesson Plan Required reading before this lesson: ACLS Study Guide 3e Textbook Chapter 3 Materials needed: Multimedia projector, computer, ACLS Chapter 3 Recommended minimum

More information

Appropriate Use Criteria for ICD/CRT Online Appendix Guideline Mapping and References Document

Appropriate Use Criteria for ICD/CRT Online Appendix Guideline Mapping and References Document Appropriate Use Criteria for ICD/CRT Online Appendix Guideline Mapping and References Document Section 1: Secondary Prevention Table 1.1 CAD: VF or Hemodynamically Unstable VT Associated With Acute (

More information

EXPERIMENTAL AND THERAPEUTIC MEDICINE 8: 201-206, 2014

EXPERIMENTAL AND THERAPEUTIC MEDICINE 8: 201-206, 2014 EXPERIMENTAL AND THERAPEUTIC MEDICINE 8: 201-206, 2014 Feasibility and efficacy of a remote real time wireless ECG monitoring and stimulation system for management of ventricular arrhythmia in rabbits

More information

LQTS: Long QT Syndrome. Inherited Heart Disease Clinic

LQTS: Long QT Syndrome. Inherited Heart Disease Clinic 2011 LQTS: Long QT Syndrome Inherited Heart Disease Clinic What is LQTS? LQTS is a rare heart rhythm disorder. It causes a disruption of the electrical signal that stimulates your heart to beat. It occurs

More information

Cardiac Arrest - Ventricular Fibrillation / Pulseless Ventricular Tachycardia Protocol revised October 2008

Cardiac Arrest - Ventricular Fibrillation / Pulseless Ventricular Tachycardia Protocol revised October 2008 Cardiac Arrest - Ventricular Fibrillation / Pulseless Ventricular Tachycardia Protocol revised October 2008 Preamble Survival from cardiorespiratory arrest for patients who present with ventricular fibrillation

More information

Atrial Fibrillation in the ICU: Attempting to defend 4 controversial statements

Atrial Fibrillation in the ICU: Attempting to defend 4 controversial statements Atrial Fibrillation in the ICU: Attempting to defend 4 controversial statements Salmaan Kanji, Pharm.D. The Ottawa Hospital The Ottawa Hospital Research Institute Conflict of Interest No financial, proprietary

More information

ACLS Provider Manual Comparison Sheet Based on 2010 AHA Guidelines for CPR and ECC. BLS Changes

ACLS Provider Manual Comparison Sheet Based on 2010 AHA Guidelines for CPR and ECC. BLS Changes ACLS Provider Manual Comparison Sheet Based on 2010 AHA Guidelines for CPR and ECC CPR Chest compressions, Airway, Breathing (C-A-B) BLS Changes New Old Rationale New science indicates the following order:

More information

UNITED STATES PATENT AND TRADEMARK OFFICE BEFORE THE PATENT TRIAL AND APPEAL BOARD. Ex parte VINOD SHARMA and DANIEL C. SIGG

UNITED STATES PATENT AND TRADEMARK OFFICE BEFORE THE PATENT TRIAL AND APPEAL BOARD. Ex parte VINOD SHARMA and DANIEL C. SIGG UNITED STATES PATENT AND TRADEMARK OFFICE BEFORE THE PATENT TRIAL AND APPEAL BOARD Ex parte VINOD SHARMA and DANIEL C. SIGG Appeal 2012-000284 Technology Center 1600 Before ERIC GRIMES, FRANCISCO C. PRATS,

More information

ECG may be indicated for patients with cardiovascular risk factors

ECG may be indicated for patients with cardiovascular risk factors eappendix A. Summary for Preoperative ECG American College of Cardiology/ American Heart Association, 2007 A1 2002 A2 European Society of Cardiology and European Society of Anaesthesiology, 2009 A3 Improvement,

More information

Thrombolytics (Reteplase, Tenecteplase) Rpa/Tnk and Adjunctive Heparin

Thrombolytics (Reteplase, Tenecteplase) Rpa/Tnk and Adjunctive Heparin PRESENTATION Vials of reteplase 10 units for reconstitution with 10ml water for injection. Vials of tenecteplase 10,000 units for reconstitution with 10ml water for injection, or 8,000 units for reconstitution

More information

Il loop recorder esterno. Roberto Maggi

Il loop recorder esterno. Roberto Maggi Il loop recorder esterno Roberto Maggi ECG monitoring and syncope In-hospital monitoring Holter Monitoring Event recorder External loop recorder Remote (at home) telemetry Implantable loop recorder External

More information

ST-Segment Elevation in Conditions Other Than Acute Myocardial Infarction

ST-Segment Elevation in Conditions Other Than Acute Myocardial Infarction The new england journal of medicine review article current concepts ST-Segment Elevation in Conditions Other Than Acute Myocardial Infarction From the Hennepin County Medical Center, University of Minnesota,

More information

Assessment, diagnosis and specialist referral of adults (>16 years) with an episode of transient loss of consciousness (TLoC) or a blackout.

Assessment, diagnosis and specialist referral of adults (>16 years) with an episode of transient loss of consciousness (TLoC) or a blackout. Assessment, diagnosis and specialist referral of adults (>16 years) with an episode of transient loss of consciousness (TLoC) or a blackout. TLoC is common huge variation in management range of clinicians

More information

CARDIOLOGY Delineation of Privileges

CARDIOLOGY Delineation of Privileges CARDIOLOGY Delineation of Privileges APPLICANT: INITIAL APPOINTMENT REQUIREMENTS: BASIC EDUCATION: M.D. or D.O. from an accredited school of medicine or osteopathy. Successful completion of an ACGME or

More information

TREATMENT IN BRADYCARDIA

TREATMENT IN BRADYCARDIA TREATMENT IN BRADYCARDIA DEFINITION OF BRADYCARDIA 12- LEAD ECG 24-hour ambulatory monitoring DEFINITION OF BRADYCARDIA 12- LEAD ECG 0-3 years:

More information

INTRODUCTORY GUIDE TO IDENTIFYING ECG IRREGULARITIES

INTRODUCTORY GUIDE TO IDENTIFYING ECG IRREGULARITIES INTRODUCTORY GUIDE TO IDENTIFYING ECG IRREGULARITIES NOTICE: This is an introductory guide for a user to understand basic ECG tracings and parameters. The guide will allow user to identify some of the

More information

Atrial Fibrillation During an Exploration Class Mission. Mark Lipsett MD, PhD Douglas Hamilton MD, PhD Jay Lemery MD James Polk DO

Atrial Fibrillation During an Exploration Class Mission. Mark Lipsett MD, PhD Douglas Hamilton MD, PhD Jay Lemery MD James Polk DO Atrial Fibrillation During an Exploration Class Mission Mark Lipsett MD, PhD Douglas Hamilton MD, PhD Jay Lemery MD James Polk DO Disclosure Information 82nd Annual Scientific and Human Performance Meeting

More information

Inherited Cardiomyopathies: Genetics and Scientific Research Advances

Inherited Cardiomyopathies: Genetics and Scientific Research Advances Inherited Cardiomyopathies: Genetics and Scientific Research Advances Adam Helms, MD Inherited Cardiomyopathy Program University of Michigan Health System Outline How are HCM and DCM heritable? Does genetic

More information

CARDIOVASCULAR DISORDERS

CARDIOVASCULAR DISORDERS Acute Decompensated Heart Failure: Time Critical Interventions MO-51 / 1 Hour Faculty: Matthew Strehlow, MD, FACEP Monday, 10/26/2015 / 3:30 PM - 4:20 PM The treatment of congestive heart failure (CHF)

More information

Cardiac Arrhythmias. Many different types of cardiac arrhythmias. Management of. Atrial Fibrillation/Atrial Flutter

Cardiac Arrhythmias. Many different types of cardiac arrhythmias. Management of. Atrial Fibrillation/Atrial Flutter Focus on CME at the University of Calgary Management of Cardiac Arrhythmias With many types of cardiac arrhythmias presenting in the clinical setting, family physicians must be able to distinguish each

More information

Author's Accepted Manuscript

Author's Accepted Manuscript Author's Accepted Manuscript Adjusting voltage criteria can unmask conducting channels in a patient with arrhythmogenic right ventricular cardiomyopathy and ventricular tachycardia Prabhat Kumar MBBS,

More information

Application for a Marketing Authorisation: Requirements and Criteria for the Assessment of QT Prolonging Potential

Application for a Marketing Authorisation: Requirements and Criteria for the Assessment of QT Prolonging Potential Application for a Marketing Authorisation: Requirements and Criteria for the Assessment of QT Prolonging Potential Bundesinstitut für Arzneimittel Dr. med. Clemens Mittmann Bundesinstitut für Arzneimittel

More information

Clinical Genetics in Heart Function Services

Clinical Genetics in Heart Function Services Clinical Genetics in Heart Function Services Dhavendra Kumar Consultant/ Hon. Professor Clinical Geneticist & Lead- Cardiovascular Genetics Institute of Medical Genetics University Hospital of Wales Cardiff

More information

Genetic analysis of Brugada syndrome and congenital long- QT syndrome type 3 in the Chinese

Genetic analysis of Brugada syndrome and congenital long- QT syndrome type 3 in the Chinese JCDR Original Paper Genetic analysis of Brugada syndrome and congenital long- QT syndrome type 3 in the Chinese Peng Liang, Wenling Liu 1, Cuilan Li 1, Wuhua Tao 2, Lei Li 1, Dayi Hu 1 Heart Center, Beijing

More information

Familial clustering of lone atrial fibrillation in patients with saddleback-type ST-segment elevation in right precordial leads

Familial clustering of lone atrial fibrillation in patients with saddleback-type ST-segment elevation in right precordial leads European Heart Journal (2007) 28, 463 468 doi:10.1093/eurheartj/ehl474 Clinical research Arrhythmia/electrophysiology Familial clustering of lone atrial fibrillation in patients with saddleback-type ST-segment

More information