Analysis of the Early Repolarization in Competitive Athletes: Comparison Between the Notch and The Slur

2021 ◽  
Author(s):  
A. Djellaoudji
Keyword(s):  
Heart Rate ◽  
Ventricular Hypertrophy ◽  
Early Repolarization ◽  
Bundle Branch Block ◽  
St Segment Elevation ◽  
Current Definition ◽  
St Segment ◽  
Competitive Athletes ◽  
Definition Of ◽  
Electrocardiographic Parameters

Early repolarization is currently defined by the presence of notch or slur, at the end of QRS complex, greater ≥ than 0.1 mV in two contiguous leads, and the ST-segment elevation is not necessary for diagnosis. Several studies have confirmed that early repolarization on the electrocardiogram has been associated with an increased risk of sudden arrhythmic death either in the general population or in athletes. However, no study has evaluated the prevalence of this anomaly, using the current definition of early repolarization, in the population of Algerian or North African athletes, no study analyzed notches and slurs separately, and no study compared them. The main objective of our study is to determine the prevalence of ER in an Algerian population of competitive athletes. The secondary objective was to compare the end-QRS Notching and Slurring, and to determine the influence on this prevalence of certain clinical and electrocardiographic parameters, to establish an epidemiological profile of this anomaly. Methods: In our study, we used the current definition of early repolarization. The study population is represented by 621 athletes participating in the various sports competitions organized in the region of Sétif, having undergone a cardiological examination, at the level of the cardiology service of Setif university hospital center, as part of the establishment of a medical certificate of no contraindication to the practice of the sport. Athletes also benefited from a clinical examination (weight, height, cardiac auscultation, functional signs (angina, palpitation, loss of awareness and dyspnea), palpation of the pulse, and measurement of the blood pressure). The electrocardiograms were collected at rest and away from any sporting activity. And in addition to the analysis of ER (prevalence, notch, slur, amplitude, and topography), criteria for ventricular hypertrophy (Sokolow-Lyon index and Cornell index), heart rate, and right bundle branch block were sought and analyzed. Results: The ECG was normal in 29.3% of the athletes, while the majority of athletes (66.3%) had adaptative electrocardiographic abnormalities to regular physical training (minimum of 4 h per week) and competition, 4.3% of athletes had abnormal electrocardiographic patterns suggesting underlying heart disease. The prevalence of ER in our athletes according to the new diagnostic criteria is 26.1%, with a clear male predominance. This prevalence increases with age, peaking in the third decade and then declines. The prevalence of ER is higher in bradycardic athletes and those with a Sokolow-Lyon index greater than 35 mm; for the Cornell index, no relationship was found. Moreover, ER is significantly lower in athletes with incomplete right Branch Block. In our series, ER is predominant in the inferior leads (40.7%) than lateral ones (34.6%), and the double location is found in 24.7%. This distribution of topographies is not influenced by age and gender. 31.8% of ER has an amplitude ≥ of 2 mm. 30.9% of ER is associated with ST-segment elevation. Notch is the predominant pattern whatever the topography of ER is (notch, 57.4%; slur, 18.5%; notch+slur, 24.1%); notch predominates in lateral leads (52.3%) while slur is predominant in inferior leads (68.0%).1%); only the notch has a significant relationship with male sex (23.8% vs 5.7%, p<0.001) with bradycardia (41.4% vs 16%, P<0.001) and with physical training. The prevalence of notches and slurs is significantly higher in athletes with a Sokolow-Lyon index greater than 35 mm. Conclusion: The pattern of ER is frequent in athletes; its prevalence is influenced by age, sex, heart rate, left ventricular hypertrophy, and incomplete right bundle branch block, type of sport, and intensity of the dynamic and static component of sports activity. The inferior topography (considered as a criterion of the high risk of ER) is found the most in our athletes; the notch is the most frequent pattern. It has been found that the two patterns "notch" and "slur", which are the basis of the definition of ER, are not influenced in the same way by the other clinical and electrocardiographic parameters.

Intraventricular conduction defects in patients with st-segment elevation myocardial infarction – the paradox of right bundle branch block

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Fernandes ◽  
F Montenegro ◽  
M Cabral ◽  
R Carvalho ◽  
L Santos ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Right Bundle Branch Block ◽  
Independent Predictor ◽  
Left Ventricular Ejection ◽  
Bundle Branch Block ◽  
Hospital Outcomes ◽  
St Segment Elevation ◽  
Intraventricular Conduction ◽  
St Segment ◽  
Worse Prognosis

Abstract   Intraventricular conduction defects (IVCD) in patients with acute myocardial infarct (AMI) are predictors of a worse prognosis. When acquired they can be the result of an extensive myocardial damage. Purpose To assess the impact of IVCD, regardless of being previously known or presumed new, on in-hospital outcomes of patients with AMI with ST segment elevation (STEMI) or undetermined location. Methods From a series of patients included in the National Registry of Acute Coronary Syndrome between 10/1/2010 and 9/1/2019, were selected patients with STEMI or undetermined AMI, undergoing coronary angiography. Results 7805 patients were included: 461 (5.9%) presenting left bundle branch block (LBBB), 374 (4.8%) with right bundle branch block (RBBB) and 6970 (89.3%) with no IVCD. Clinical characteristics as well as in-hospital outcomes are described in the table 1. An unexpected worse prognosis in patients with RBBB has motivated a multivariate analysis. RBBB remained an independent predictor of in-hospital mortality (OR 1.91, 95% CI 1.04–3.50, p=0.038), along with female gender (OR 1.73, 95% CI 1.11–2.68, p=0.015), Killip Class&gt;1 (OR 2.26, 95% CI 1.45–3.53, p&lt;0.001), left ventricular ejection fraction &lt;50% (OR 3.93, 95% CI 2.19–7.05, p&lt;0.001) and left anterior descending artery as the culprit lesion (OR 1.85, 95% CI 1.16–2.91, p=0.009). Conclusion In spite of an apparent better clinical profile, in the current large series of unselected STEMI patients, the presence of RBBB is associated with the worst in-hospital outcome. RBBB doubles the risk of death, being an independent predictor of in-hospital mortality. Funding Acknowledgement Type of funding source: None

Electrocardiographic characteristics and associated outcomes in patients with Takotsubo syndrome. Insights from the RETAKO registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Martin-Demiguel ◽  
I Nunez-Gil ◽  
A Perez-Castellanos ◽  
O Vedia ◽  
A Uribarri ◽  
...  
Keyword(s):  
Heart Rate ◽  
Primary Endpoint ◽  
Qt Interval ◽  
Protective Factor ◽  
Independent Predictor ◽  
Prognostic Significance ◽  
Takotsubo Syndrome ◽  
St Segment Elevation ◽  
Corrected Qt Interval ◽  
St Segment

Abstract Background Our aim was to describe the prevalence and prognostic significance of electrocardiographic features in patients with Takotsubo syndrome (TTS). Methods Our data come from the Spanish Multicenter REgistry of TAKOtsubo syndrome (RETAKO). All patients with complete electrocardiogram were included. Results 246 patients were studied, mean age was 71.3±11.5 and 215 (87.4%) were women. ST-segment elevation was seen in 143 patients (59.1%) and was present in ≥2 wall leads in 97 (39.8%). Exclusive elevation in inferior leads was infrequent (5 - 2.0%). After 48 hours, 198 patients (88.0%) developed negative T-waves in a median of 8 leads with a mean amplitude of 0.7±0.5 mV. Mean corrected QT interval was 520±72 ms and it was independently associated with the primary endpoint of all-cause death and nonfatal cardiovascular events (p=0.002) and all-cause death (p=0.008). A higher heart rate at admission was also an independent predictor of the primary endpoint (p=0.001) and of developing acute pulmonary edema (p=0.04). ST-segment elevation with reciprocal depression was an independent predictor of all-cause death (p=0.04). Absence of ST-segment deviation was a protective factor (p=0.005) for the primary endpoint. Arrhythmias were independently associated with cardiogenic shock (p&lt;0.001). Conclusion Prolonged corrected QT interval, arrhythmia, heart rate at admission and broader repolarization alterations are associated with a poor outcome in TTS. Typical ECG at admission and after 48h. Funding Acknowledgement Type of funding source: None

scholarly journals Right Bundle Branch Block, Right Precordial ST-Segment Elevation, and Sudden Death in Young People

Circulation ◽  
2001 ◽  
Vol 103 (5) ◽  
pp. 710-717 ◽  
Author(s):  
Domenico Corrado ◽  
Cristina Basso ◽  
Gianfranco Buja ◽  
Andrea Nava ◽  
Lino Rossi ◽  
...  
Keyword(s):  
Young People ◽  
Sudden Death ◽  
Right Bundle Branch Block ◽  
Bundle Branch Block ◽  
St Segment Elevation ◽  
St Segment

Characteristics of heart rate variability in patients with acute coronary syndrome without ST segment elevation in comparison with clinical and biochemical parameters

2021 ◽  
Vol 29 (3) ◽  
pp. 369-378
Author(s):  
Aleksej A. Nizov ◽  
Aleksej I. Girivenko ◽  
Mihail M. Lapkin ◽  
Aleksej V. Borozdin ◽  
Yana A. Belenikina ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Acute Coronary Syndrome ◽  
Creatine Phosphokinase ◽  
Spectral Power ◽  
Low Frequency ◽  
Heart Rhythm ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

BACKGROUND: The search for rational methods of primary, secondary, and tertiary prevention of coronary heart disease. To date, there are several publications on heart rate variability in ischemic heart disease. AIM: To study the state of the regulatory systems in the organism of patients with acute coronary syndrome without ST segment elevation based on the heart rhythm, and their relationship with the clinical, biochemical and instrumental parameters of the disease. MATERIALS AND METHODS: The open comparative study included 76 patients (62 men, 14 women) of mean age, 61.0 0.9 years, who were admitted to the Emergency Cardiology Department diagnosed of acute coronary syndrome without ST segment elevation. On admission, cardiointervalometry was performed using Varicard 2.51 apparatus, and a number of clinical and biochemical parameters were evaluated RESULTS: Multiple correlations of parameters of heart rate variability and clinical, biochemical and instrumental parameters were observed. From this, a cluster analysis of cardiointervalometry was performed, thereby stratifying patients into five clusters. Two extreme variants of dysregulation of the heart rhythm correlated with instrumental and laboratory parameters. A marked increase in the activity of the subcortical nerve centers (maximal increase of the spectral power in the very low frequency range with the underlying reduction of SDNN) in cluster 1 was associated with reduction of the left ventricular ejection fraction: cluster 147.0 [40.0; 49.0], cluster 260.0 [58.0; 64.0], cluster 360.0 [52.5; 64.5] % (the data are presented in the form of median and interquartile range; Me [Q25; Q75], p 0,05). Cluster 5 showed significant reduction in SDNN (monotonous rhythm), combined with increased level of creatine phosphokinase (CPC): cluster 5446,0 [186.0; 782.0], cluster 4141.0 [98.0; 204.0] IU/l; Me [Q25; Q75], p 0.05) and MВ-fraction of creatine phosphokinase; cluster 532.0 [15.0; 45.0], 4 cluster 412.0 [9.0; 18.0] IU/l; Me [Q25; Q75], p 0.05). CONCLUSIONS: In patients with acute coronary syndrome without ST segment elevation, cluster analysis of parameters of heart rate variability identified different peculiarities of regulation of the heart rhythm. Pronounced strain of the regulatory systems of the body was found to be associated with signs of severe pathology: the predominance of VLF (spectral power of the curve enveloping a dynamic range of cardiointervals in the very low frequency range) in spectral analysis with an underlying reduced SDNN is characteristic of patients with a reduced ejection fraction, and a monotonous rhythm is characteristic of patients with an increased level of creatine phosphokinase and MB-fraction of creatine phosphokinase.

scholarly journals P982 Correlation between electrocardiographic and imaging data in patients with acute myocarditis: a single centre retrospective analysis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Caretta ◽  
L A Leo ◽  
V L Paiocchi ◽  
G M Viani ◽  
S A Schlossbauer ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Wall Motion ◽  
Acute Myocarditis ◽  
Left Ventricular Ejection ◽  
Imaging Data ◽  
Bundle Branch Block ◽  
St Segment Elevation ◽  
St Segment ◽  
Wall Motion Abnormalities ◽  
Ecg Abnormalities

Abstract Funding Acknowledgements None Background Acute myocarditis is a clinical and pathological condition defined as an inflammation of the myocardium. Its diagnosis is often challenging and requires multiple information derived from different diagnostic modalities. Purpose The aim of the study is to evaluate the correlation between electrocardiographic and imaging data in patients with acute myocarditis. Methods We made a retrospective analysis of 102 patients admitted to our Centre between January 2012 and April 2019 for suspected acute myocarditis. Diagnosis was confirmed with cardiac magnetic resonance (CMR) by identification of myocardial edema in T2-weighted images and/or typical subepicardial or midwall pattern of late gadolinium enhancement (LGE). Significant coronary artery disease was ruled out with coronary angiography. Electrocardiogram (ECG) was analysed on admission - in order to evaluate the presence of ST segment abnormalities, atrio-ventricular or bundle-branch block and heart rhythm disorders - and at the time of discharge. Every patient underwent echocardiography and CMR: from both these exams we reported the presence of regional wall motion abnormalities and left ventricular ejection fraction (LVEF). Results Mean age of our population was 39 ± 18 years; 92 people (90%) were males. At admission, 85 patients (83%) presented ECG abnormalities; the most frequent was ST-segment elevation (65 cases). Conduction or rhythm disorders were observed in 26 cases (25%). At the time of discharge, 41 out of 85 patients had complete regression of ECG changes. Mean value of LVEF measured with echocardiography was 56.4 ± 7.6%. In patients with normal ECG on admission it was 59.9 ± 3.1%, whereas in patients with abnormal ECG 55.7 ± 7.9% (p = 0.045). Considering CMR, mean LVEF in the population was 58.5 ± 8.6%, varying between 64.0 ± 8.9% in the group with normal ECG and 57.4 ± 10.1% in the group with ECG abnormalities (p = 0.02). Moreover, subjects with altered ECG on admission had a higher prevalence of wall motion abnormalities both in echocardiography (47/85 – 55% vs 3/17 – 18%, p &lt; 0.01) and in CMR (45/85 – 53% vs 3/17 – 18%, p &lt; 0.01). Patients with ECG normalization at discharge had a higher prevalence of ST-segment elevation (88 vs 66%, p = 0.02), while the group with persistent ECG alterations had a higher incidence of AV or bundle-branch block (23 vs 7%, p = 0.048). No statistical difference was noted between these two groups regarding echocardiographic or CMR values. Conclusion In our experience evaluation of ECG at admission in patients with suspected acute myocarditis identifies a subgroup of individuals with lower values of LVEF and a higher prevalence of wall motion abnormalities both in echocardiography and in CMR, while data derived by imaging techniques had no significant predictive value on ECG evolution at the time of discharge.

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