Absence of ST elevation in ECG leads V7, V8, V9 in ischaemia of non-occlusive aetiologies

Background Early repolarization in the anterior ECG leads (ERV2–4) is considered to be a sign of right ventricular (RV) remodeling, but its etiology and importance are unclear. Methods A total of 243 top-level endurance-trained athletes (ETA; 183 men and 60 women, weekly training hours: 15–20) and 120 leisure-time athletes (LTA; 71 men and 49 women, weekly training hours: 5–6) were investigated. The ERV2–4 sign was evaluated concerning type of sport, gender, transthoracic echocardiographic parameters, and ECG changes, which can indicate elevated RV systolic pressure [left atrium enlargement (LAE), right atrium enlargement (RAE), RV conduction defect (RVcd)]. Results Stroke volume and left ventricular mass were higher in ETAs vs. LTAs in both genders (p < 0.01). Prevalence of the ERV2–4 sign was significantly higher in men than in women [p = 0.000, odds ratio (OR) = 36.4] and in ETAs than in LTAs (p = 0.000). The highest ERV2–4 prevalence appeared in the most highly trained triathlonists and canoe and kayak paddlers (OR = 13.8 and 5.2, respectively). Within the ETA group, the post-exercise LAE, RAE, and RVcd changes developed more frequently in cases with than without ERV2–4 (LAE: men: p < 0.05, females: p < 0.005; RAE: men: p < 0.05, females: p < 0.005; RVcd: N.S.). These post-exercise appearing LAE, RAE, and RVcd are associated with the ERV2–4 sign (OR = 4.0, 3.7, and 3.8, respectively). Conclusions According to these results, ERV2–4 develops mainly in male ETAs due to long-lasting and repeated endurance training. The ERV2–4 sign indicates RV’s adaptation to maintain higher compensatory pulmonary pressure and flow during exercise but its danger regarding malignant arrhythmias is unclear.

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Interpretation of the ECG during Exercise and Recovery

Ellestad's Stress Testing ◽

10.1093/med/9780190225483.003.0009 ◽

2018 ◽

pp. 160-198 ◽

Cited By ~ 1

Author(s):

Gregory S. Thomas ◽

Sonia R. Samtani ◽

Myrvin H. Ellestad

Keyword(s):

Coronary Artery ◽

Myocardial Ischemia ◽

Exercise Testing ◽

Exercise Test ◽

P Wave ◽

St Depression ◽

St Segment ◽

Electrocardiographic Changes ◽

St Elevation ◽

Ecg Leads

The chapter Interpretation of the ECG During Stress Testing reviews the electrocardiographic changes of ischemia during exercise testing. Normal ECG changes during exercise are reviewed and include the Ta wave of atrial repolarization which is directed in the opposite direction of the P wave. Its duration extends into the ST segment, resulting in a false positive exercise test in some patients. The type, severity and duration of ST depression predicts CAD severity and outcome. Downsloping ST depression is more ominous than horizontal which is worse than upsloping. As Ellestad has long posited, an abnormal ST segment response is >1 mm of downsloping and horizontal and >1.5 mm of upsloping ST depression. The 12 lead ECG leads most predictive of myocardial ischemia are leads V4-6, I, and aVR. ST elevation in leads without Q waves occurs secondary to transmural ischemia and localizes to the stenotic coronary artery.

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Site of Transmural Late Gadolinium Enhancement on the Cardiac MRI Coincides With the ECG Leads Exhibiting Terminal QRS Distortion in Patients With ST-Elevation Myocardial Infarctions

International Heart Journal ◽

10.1536/ihj.53.270 ◽

2012 ◽

Vol 53 (5) ◽

pp. 270-275 ◽

Cited By ~ 7

Author(s):

Asami Nimura ◽

Naka Sakamoto ◽

Naoki Nakagawa ◽

Hisanobu Ota ◽

Yasuko Tanabe ◽

...

Keyword(s):

Late Gadolinium Enhancement ◽

Cardiac Mri ◽

Myocardial Infarctions ◽

Gadolinium Enhancement ◽

St Elevation ◽

Ecg Leads

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Prevalence, characteristics, and prognosis role of type 1 ST elevation in the peripheral ECG leads in patients with Brugada syndrome

Heart Rhythm ◽

10.1016/j.hrthm.2013.03.001 ◽

2013 ◽

Vol 10 (7) ◽

pp. 1012-1018 ◽

Cited By ~ 40

Author(s):

A. Rollin ◽

F. Sacher ◽

J.B. Gourraud ◽

J.L. Pasquié ◽

F. Raczka ◽

...

Keyword(s):

Brugada Syndrome ◽

St Elevation ◽

Ecg Leads

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P6585Number of ECG leads and prognosis of spontaneous type 1 Brugada syndrome

European Heart Journal ◽

10.1093/eurheartj/ehz746.1173 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

V Probst ◽

M Arnaud ◽

N Behar ◽

P Mabo ◽

B Guyomarch ◽

...

Keyword(s):

Brugada Syndrome ◽

Ventricular Arrhythmias ◽

Icd Therapy ◽

St Elevation ◽

Group 3 ◽

Group 2 ◽

Ecg Leads ◽

Group 1

Abstract Introduction Brugada syndrome (BrS) is an inherited arrhythmia syndrome with an increased risk of sudden cardiac death (SCD). The recent single lead-based diagnosis of Brugada syndrome recommended criterion may lead to overdiagnosis of Brugada syndrome and overestimation of the risk of SCD. Objective We aim to investigate the value of a single lead diagnosis in spontaneous type 1 ECG Brugada patient and to investigate the association between the number of ECG leads with a spontaneous type 1 ST elevation and the arrhythmic risk. Methods Consecutive patients affected with BrS were recruited in a multicentric prospective registry in France (15 centers) between 1994 and 2016. A total of 1613 patients affected by the Brugada syndrome were enrolled. For this specific study, only patient with a spontaneous type 1 BrS were enrolled (n=505). Data were prospectively collected with an average follow-up of 6.5±4.7 years. ECGs were reviewed by 2 physicians blinded to clinical status. Type 1 ST elevation was defined by ≥2 mm J-point elevation with coved ST segment and negative T wave. Results A total of 505 patients with a spontaneous type 1 BrS (mean age 46±15 years, 398 males, 79%) were enrolled. 117 patients (23%) were symptomatic at baseline (32 (6%) aborted SCD, 85 (17%) syncope). Implantable cardiac defibrillator (ICD) was implanted in 191 patients (38%). Brugada ECG pattern was found in 1 lead in 250 patients (50%, group 1), in 2 leads in 227 patients (45%, group 2) and in 3 leads in 28 patients (5%, group 3). Groups were comparable in term of clinical presentation except for group 3 who presented more frequently an early repolarization pattern (n=19 (8%) in group 1, n=15 in group 2 (6%) and n=7 (25%) in group 3, p=0.02) and more frequently QRS fragmentation (n=6 (2%) in group 1, n=3 in group 2 (1%) and n=3 (11%) in group 3, p=0.03). During follow-up, 46 (9%) patients presented an arrhythmic event: 22 (9%) in group 1 (4 SCD, 14 appropriate ICD therapy, 4 ventricular arrhythmias), 22 (10%) in group 2 (6 SCD, 11 appropriate ICD therapy, 5 ventricular arrhythmias) and 2 (7%) in group 3 (1 SCD, 1 appropriate ICD therapy). Patients with type 1 BrS pattern in 2 or 3 ECG leads had not a significantly higher rate of arrhythmic events than patients with type 1 BrS pattern in only 1 ECG lead (HR: 1.1; 95% CI: 0.6–1.9 for group 2 and HR: 0.7; 95% CI: 0.2–3 for group 2; p=0,087). Conclusion In the largest cohort of BrS patients ever described, the prognosis of Brugada syndrome with a spontaneous ECG pattern does not appear to be affected by the number of leads required for diagnostic.

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