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Publisher: John Wiley and Sons   (Total: 1580 journals)

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Showing 1 - 200 of 1580 Journals sorted alphabetically
Abacus     Hybrid Journal   (Followers: 13, SJR: 0.48, h-index: 22)
About Campus     Hybrid Journal   (Followers: 5)
Academic Emergency Medicine     Hybrid Journal   (Followers: 65, SJR: 1.385, h-index: 91)
Accounting & Finance     Hybrid Journal   (Followers: 47, SJR: 0.547, h-index: 30)
ACEP NOW     Free   (Followers: 1)
Acta Anaesthesiologica Scandinavica     Hybrid Journal   (Followers: 52, SJR: 1.02, h-index: 88)
Acta Archaeologica     Hybrid Journal   (Followers: 158, SJR: 0.101, h-index: 9)
Acta Geologica Sinica (English Edition)     Hybrid Journal   (Followers: 3, SJR: 0.552, h-index: 41)
Acta Neurologica Scandinavica     Hybrid Journal   (Followers: 5, SJR: 1.203, h-index: 74)
Acta Obstetricia et Gynecologica Scandinavica     Hybrid Journal   (Followers: 15, SJR: 1.197, h-index: 81)
Acta Ophthalmologica     Hybrid Journal   (Followers: 6, SJR: 0.112, h-index: 1)
Acta Paediatrica     Hybrid Journal   (Followers: 56, SJR: 0.794, h-index: 88)
Acta Physiologica     Hybrid Journal   (Followers: 6, SJR: 1.69, h-index: 88)
Acta Polymerica     Hybrid Journal   (Followers: 9)
Acta Psychiatrica Scandinavica     Hybrid Journal   (Followers: 35, SJR: 2.518, h-index: 113)
Acta Zoologica     Hybrid Journal   (Followers: 6, SJR: 0.459, h-index: 29)
Acute Medicine & Surgery     Hybrid Journal   (Followers: 4)
Addiction     Hybrid Journal   (Followers: 35, SJR: 2.086, h-index: 143)
Addiction Biology     Hybrid Journal   (Followers: 13, SJR: 2.091, h-index: 57)
Adultspan J.     Hybrid Journal   (SJR: 0.127, h-index: 4)
Advanced Energy Materials     Hybrid Journal   (Followers: 27, SJR: 6.411, h-index: 86)
Advanced Engineering Materials     Hybrid Journal   (Followers: 26, SJR: 0.81, h-index: 81)
Advanced Functional Materials     Hybrid Journal   (Followers: 51, SJR: 5.21, h-index: 203)
Advanced Healthcare Materials     Hybrid Journal   (Followers: 14, SJR: 0.232, h-index: 7)
Advanced Materials     Hybrid Journal   (Followers: 268, SJR: 9.021, h-index: 345)
Advanced Materials Interfaces     Hybrid Journal   (Followers: 6, SJR: 1.177, h-index: 10)
Advanced Optical Materials     Hybrid Journal   (Followers: 7, SJR: 2.488, h-index: 21)
Advanced Science     Open Access   (Followers: 5)
Advanced Synthesis & Catalysis     Hybrid Journal   (Followers: 17, SJR: 2.729, h-index: 121)
Advances in Polymer Technology     Hybrid Journal   (Followers: 13, SJR: 0.344, h-index: 31)
Africa Confidential     Hybrid Journal   (Followers: 21)
Africa Research Bulletin: Economic, Financial and Technical Series     Hybrid Journal   (Followers: 13)
Africa Research Bulletin: Political, Social and Cultural Series     Hybrid Journal   (Followers: 10)
African Development Review     Hybrid Journal   (Followers: 33, SJR: 0.275, h-index: 17)
African J. of Ecology     Hybrid Journal   (Followers: 15, SJR: 0.477, h-index: 39)
Aggressive Behavior     Hybrid Journal   (Followers: 15, SJR: 1.391, h-index: 66)
Aging Cell     Open Access   (Followers: 11, SJR: 4.374, h-index: 95)
Agribusiness : an Intl. J.     Hybrid Journal   (Followers: 6, SJR: 0.627, h-index: 14)
Agricultural and Forest Entomology     Hybrid Journal   (Followers: 16, SJR: 0.925, h-index: 43)
Agricultural Economics     Hybrid Journal   (Followers: 45, SJR: 1.099, h-index: 51)
AIChE J.     Hybrid Journal   (Followers: 31, SJR: 1.122, h-index: 120)
Alcoholism and Drug Abuse Weekly     Hybrid Journal   (Followers: 7)
Alcoholism Clinical and Experimental Research     Hybrid Journal   (Followers: 7, SJR: 1.416, h-index: 125)
Alimentary Pharmacology & Therapeutics     Hybrid Journal   (Followers: 33, SJR: 2.833, h-index: 138)
Alimentary Pharmacology & Therapeutics Symposium Series     Hybrid Journal   (Followers: 3)
Allergy     Hybrid Journal   (Followers: 51, SJR: 3.048, h-index: 129)
Alternatives to the High Cost of Litigation     Hybrid Journal   (Followers: 3)
American Anthropologist     Hybrid Journal   (Followers: 145, SJR: 0.951, h-index: 61)
American Business Law J.     Hybrid Journal   (Followers: 24, SJR: 0.205, h-index: 17)
American Ethnologist     Hybrid Journal   (Followers: 90, SJR: 2.325, h-index: 51)
American J. of Economics and Sociology     Hybrid Journal   (Followers: 28, SJR: 0.211, h-index: 26)
American J. of Hematology     Hybrid Journal   (Followers: 33, SJR: 1.761, h-index: 77)
American J. of Human Biology     Hybrid Journal   (Followers: 12, SJR: 1.018, h-index: 58)
American J. of Industrial Medicine     Hybrid Journal   (Followers: 16, SJR: 0.993, h-index: 85)
American J. of Medical Genetics Part A     Hybrid Journal   (Followers: 16, SJR: 1.115, h-index: 61)
American J. of Medical Genetics Part B: Neuropsychiatric Genetics     Hybrid Journal   (Followers: 4, SJR: 1.771, h-index: 107)
American J. of Medical Genetics Part C: Seminars in Medical Genetics     Partially Free   (Followers: 6, SJR: 2.315, h-index: 79)
American J. of Physical Anthropology     Hybrid Journal   (Followers: 37, SJR: 1.41, h-index: 88)
American J. of Political Science     Hybrid Journal   (Followers: 272, SJR: 5.101, h-index: 114)
American J. of Primatology     Hybrid Journal   (Followers: 15, SJR: 1.197, h-index: 63)
American J. of Reproductive Immunology     Hybrid Journal   (Followers: 3, SJR: 1.347, h-index: 75)
American J. of Transplantation     Hybrid Journal   (Followers: 17, SJR: 2.792, h-index: 140)
American J. on Addictions     Hybrid Journal   (Followers: 9, SJR: 0.843, h-index: 57)
Anaesthesia     Hybrid Journal   (Followers: 136, SJR: 1.404, h-index: 88)
Analyses of Social Issues and Public Policy     Hybrid Journal   (Followers: 10, SJR: 0.397, h-index: 18)
Analytic Philosophy     Hybrid Journal   (Followers: 18)
Anatomia, Histologia, Embryologia: J. of Veterinary Medicine Series C     Hybrid Journal   (Followers: 3, SJR: 0.295, h-index: 27)
Anatomical Sciences Education     Hybrid Journal   (Followers: 1, SJR: 0.633, h-index: 24)
Andrologia     Hybrid Journal   (Followers: 2, SJR: 0.528, h-index: 45)
Andrology     Hybrid Journal   (Followers: 2, SJR: 0.979, h-index: 14)
Angewandte Chemie     Hybrid Journal   (Followers: 196)
Angewandte Chemie Intl. Edition     Hybrid Journal   (Followers: 219, SJR: 6.229, h-index: 397)
Animal Conservation     Hybrid Journal   (Followers: 39, SJR: 1.576, h-index: 62)
Animal Genetics     Hybrid Journal   (Followers: 8, SJR: 0.957, h-index: 67)
Animal Science J.     Hybrid Journal   (Followers: 6, SJR: 0.569, h-index: 24)
Annalen der Physik     Hybrid Journal   (Followers: 5, SJR: 1.46, h-index: 40)
Annals of Anthropological Practice     Partially Free   (Followers: 2, SJR: 0.187, h-index: 5)
Annals of Applied Biology     Hybrid Journal   (Followers: 7, SJR: 0.816, h-index: 56)
Annals of Clinical and Translational Neurology     Open Access   (Followers: 1)
Annals of Human Genetics     Hybrid Journal   (Followers: 9, SJR: 1.191, h-index: 67)
Annals of Neurology     Hybrid Journal   (Followers: 47, SJR: 5.584, h-index: 241)
Annals of Noninvasive Electrocardiology     Hybrid Journal   (Followers: 2, SJR: 0.531, h-index: 38)
Annals of Public and Cooperative Economics     Hybrid Journal   (Followers: 9, SJR: 0.336, h-index: 23)
Annals of the New York Academy of Sciences     Hybrid Journal   (Followers: 5, SJR: 2.389, h-index: 189)
Annual Bulletin of Historical Literature     Hybrid Journal   (Followers: 13)
Annual Review of Information Science and Technology     Hybrid Journal   (Followers: 14)
Anthropology & Education Quarterly     Hybrid Journal   (Followers: 25, SJR: 0.72, h-index: 31)
Anthropology & Humanism     Hybrid Journal   (Followers: 17, SJR: 0.137, h-index: 3)
Anthropology News     Hybrid Journal   (Followers: 15)
Anthropology of Consciousness     Hybrid Journal   (Followers: 11, SJR: 0.172, h-index: 5)
Anthropology of Work Review     Hybrid Journal   (Followers: 11, SJR: 0.256, h-index: 5)
Anthropology Today     Hybrid Journal   (Followers: 90, SJR: 0.545, h-index: 15)
Antipode     Hybrid Journal   (Followers: 49, SJR: 2.212, h-index: 69)
Anz J. of Surgery     Hybrid Journal   (Followers: 7, SJR: 0.432, h-index: 59)
Anzeiger für Schädlingskunde     Hybrid Journal   (Followers: 1)
Apmis     Hybrid Journal   (Followers: 1, SJR: 0.855, h-index: 73)
Applied Cognitive Psychology     Hybrid Journal   (Followers: 70, SJR: 0.754, h-index: 69)
Applied Organometallic Chemistry     Hybrid Journal   (Followers: 7, SJR: 0.632, h-index: 58)
Applied Psychology     Hybrid Journal   (Followers: 206, SJR: 1.023, h-index: 64)
Applied Psychology: Health and Well-Being     Hybrid Journal   (Followers: 49, SJR: 0.868, h-index: 13)
Applied Stochastic Models in Business and Industry     Hybrid Journal   (Followers: 5, SJR: 0.613, h-index: 24)
Aquaculture Nutrition     Hybrid Journal   (Followers: 14, SJR: 1.025, h-index: 55)
Aquaculture Research     Hybrid Journal   (Followers: 31, SJR: 0.807, h-index: 60)
Aquatic Conservation Marine and Freshwater Ecosystems     Hybrid Journal   (Followers: 36, SJR: 1.047, h-index: 57)
Arabian Archaeology and Epigraphy     Hybrid Journal   (Followers: 11, SJR: 0.453, h-index: 11)
Archaeological Prospection     Hybrid Journal   (Followers: 12, SJR: 0.922, h-index: 21)
Archaeology in Oceania     Hybrid Journal   (Followers: 13, SJR: 0.745, h-index: 18)
Archaeometry     Hybrid Journal   (Followers: 27, SJR: 0.809, h-index: 48)
Archeological Papers of The American Anthropological Association     Hybrid Journal   (Followers: 15, SJR: 0.156, h-index: 2)
Architectural Design     Hybrid Journal   (Followers: 25, SJR: 0.261, h-index: 9)
Archiv der Pharmazie     Hybrid Journal   (Followers: 4, SJR: 0.628, h-index: 43)
Archives of Drug Information     Hybrid Journal   (Followers: 5)
Archives of Insect Biochemistry and Physiology     Hybrid Journal   (SJR: 0.768, h-index: 54)
Area     Hybrid Journal   (Followers: 12, SJR: 0.938, h-index: 57)
Art History     Hybrid Journal   (Followers: 246, SJR: 0.153, h-index: 13)
Arthritis & Rheumatology     Hybrid Journal   (Followers: 50, SJR: 1.984, h-index: 20)
Arthritis Care & Research     Hybrid Journal   (Followers: 26, SJR: 2.256, h-index: 114)
Artificial Organs     Hybrid Journal   (Followers: 1, SJR: 0.872, h-index: 60)
ASHE Higher Education Reports     Hybrid Journal   (Followers: 15)
Asia & the Pacific Policy Studies     Open Access   (Followers: 16)
Asia Pacific J. of Human Resources     Hybrid Journal   (Followers: 323, SJR: 0.494, h-index: 19)
Asia Pacific Viewpoint     Hybrid Journal   (Followers: 1, SJR: 0.616, h-index: 26)
Asia-Pacific J. of Chemical Engineering     Hybrid Journal   (Followers: 8, SJR: 0.345, h-index: 20)
Asia-pacific J. of Clinical Oncology     Hybrid Journal   (Followers: 6, SJR: 0.554, h-index: 14)
Asia-Pacific J. of Financial Studies     Hybrid Journal   (SJR: 0.241, h-index: 7)
Asia-Pacific Psychiatry     Hybrid Journal   (Followers: 4, SJR: 0.377, h-index: 7)
Asian Economic J.     Hybrid Journal   (Followers: 8, SJR: 0.234, h-index: 21)
Asian Economic Policy Review     Hybrid Journal   (Followers: 4, SJR: 0.196, h-index: 12)
Asian J. of Control     Hybrid Journal   (SJR: 0.862, h-index: 34)
Asian J. of Endoscopic Surgery     Hybrid Journal   (SJR: 0.394, h-index: 7)
Asian J. of Organic Chemistry     Hybrid Journal   (Followers: 6, SJR: 1.443, h-index: 19)
Asian J. of Social Psychology     Hybrid Journal   (Followers: 5, SJR: 0.665, h-index: 37)
Asian Politics and Policy     Hybrid Journal   (Followers: 12, SJR: 0.207, h-index: 7)
Asian Social Work and Policy Review     Hybrid Journal   (Followers: 5, SJR: 0.318, h-index: 5)
Asian-pacific Economic Literature     Hybrid Journal   (Followers: 5, SJR: 0.168, h-index: 15)
Assessment Update     Hybrid Journal   (Followers: 4)
Astronomische Nachrichten     Hybrid Journal   (Followers: 2, SJR: 0.701, h-index: 40)
Atmospheric Science Letters     Open Access   (Followers: 29, SJR: 1.332, h-index: 27)
Austral Ecology     Hybrid Journal   (Followers: 15, SJR: 1.095, h-index: 66)
Austral Entomology     Hybrid Journal   (Followers: 9, SJR: 0.524, h-index: 28)
Australasian J. of Dermatology     Hybrid Journal   (Followers: 8, SJR: 0.714, h-index: 40)
Australasian J. On Ageing     Hybrid Journal   (Followers: 6, SJR: 0.39, h-index: 22)
Australian & New Zealand J. of Statistics     Hybrid Journal   (Followers: 14, SJR: 0.275, h-index: 28)
Australian Accounting Review     Hybrid Journal   (Followers: 4, SJR: 0.709, h-index: 14)
Australian and New Zealand J. of Family Therapy (ANZJFT)     Hybrid Journal   (Followers: 3, SJR: 0.382, h-index: 12)
Australian and New Zealand J. of Obstetrics and Gynaecology     Hybrid Journal   (Followers: 47, SJR: 0.814, h-index: 49)
Australian and New Zealand J. of Public Health     Hybrid Journal   (Followers: 11, SJR: 0.82, h-index: 62)
Australian Dental J.     Hybrid Journal   (Followers: 7, SJR: 0.482, h-index: 46)
Australian Economic History Review     Hybrid Journal   (Followers: 4, SJR: 0.171, h-index: 12)
Australian Economic Papers     Hybrid Journal   (Followers: 29, SJR: 0.23, h-index: 9)
Australian Economic Review     Hybrid Journal   (Followers: 6, SJR: 0.357, h-index: 21)
Australian Endodontic J.     Hybrid Journal   (Followers: 3, SJR: 0.513, h-index: 24)
Australian J. of Agricultural and Resource Economics     Hybrid Journal   (Followers: 3, SJR: 0.765, h-index: 36)
Australian J. of Grape and Wine Research     Hybrid Journal   (Followers: 5, SJR: 0.879, h-index: 56)
Australian J. of Politics & History     Hybrid Journal   (Followers: 14, SJR: 0.203, h-index: 14)
Australian J. of Psychology     Hybrid Journal   (Followers: 18, SJR: 0.384, h-index: 30)
Australian J. of Public Administration     Hybrid Journal   (Followers: 408, SJR: 0.418, h-index: 29)
Australian J. of Rural Health     Hybrid Journal   (Followers: 5, SJR: 0.43, h-index: 34)
Australian Occupational Therapy J.     Hybrid Journal   (Followers: 72, SJR: 0.59, h-index: 29)
Australian Psychologist     Hybrid Journal   (Followers: 12, SJR: 0.331, h-index: 31)
Australian Veterinary J.     Hybrid Journal   (Followers: 20, SJR: 0.459, h-index: 45)
Autism Research     Hybrid Journal   (Followers: 36, SJR: 2.126, h-index: 39)
Autonomic & Autacoid Pharmacology     Hybrid Journal   (SJR: 0.371, h-index: 29)
Banks in Insurance Report     Hybrid Journal   (Followers: 1)
Basic & Clinical Pharmacology & Toxicology     Hybrid Journal   (Followers: 11, SJR: 0.539, h-index: 70)
Basic and Applied Pathology     Open Access   (Followers: 2, SJR: 0.113, h-index: 4)
Basin Research     Hybrid Journal   (Followers: 5, SJR: 1.54, h-index: 60)
Bauphysik     Hybrid Journal   (Followers: 2, SJR: 0.194, h-index: 5)
Bauregelliste A, Bauregelliste B Und Liste C     Hybrid Journal  
Bautechnik     Hybrid Journal   (Followers: 1, SJR: 0.321, h-index: 11)
Behavioral Interventions     Hybrid Journal   (Followers: 9, SJR: 0.297, h-index: 23)
Behavioral Sciences & the Law     Hybrid Journal   (Followers: 24, SJR: 0.736, h-index: 57)
Berichte Zur Wissenschaftsgeschichte     Hybrid Journal   (Followers: 9, SJR: 0.11, h-index: 5)
Beton- und Stahlbetonbau     Hybrid Journal   (Followers: 2, SJR: 0.493, h-index: 14)
Biochemistry and Molecular Biology Education     Hybrid Journal   (Followers: 6, SJR: 0.311, h-index: 26)
Bioelectromagnetics     Hybrid Journal   (Followers: 1, SJR: 0.568, h-index: 64)
Bioengineering & Translational Medicine     Open Access  
BioEssays     Hybrid Journal   (Followers: 10, SJR: 3.104, h-index: 155)
Bioethics     Hybrid Journal   (Followers: 14, SJR: 0.686, h-index: 39)
Biofuels, Bioproducts and Biorefining     Hybrid Journal   (Followers: 1, SJR: 1.725, h-index: 56)
Biological J. of the Linnean Society     Hybrid Journal   (Followers: 16, SJR: 1.172, h-index: 90)
Biological Reviews     Hybrid Journal   (Followers: 4, SJR: 6.469, h-index: 114)
Biologie in Unserer Zeit (Biuz)     Hybrid Journal   (Followers: 42, SJR: 0.12, h-index: 1)
Biology of the Cell     Full-text available via subscription   (Followers: 9, SJR: 1.812, h-index: 69)
Biomedical Chromatography     Hybrid Journal   (Followers: 6, SJR: 0.572, h-index: 49)
Biometrical J.     Hybrid Journal   (Followers: 5, SJR: 0.784, h-index: 44)
Biometrics     Hybrid Journal   (Followers: 36, SJR: 1.906, h-index: 96)
Biopharmaceutics and Drug Disposition     Hybrid Journal   (Followers: 10, SJR: 0.715, h-index: 44)
Biopolymers     Hybrid Journal   (Followers: 18, SJR: 1.199, h-index: 104)
Biotechnology and Applied Biochemistry     Hybrid Journal   (Followers: 45, SJR: 0.415, h-index: 55)
Biotechnology and Bioengineering     Hybrid Journal   (Followers: 160, SJR: 1.633, h-index: 146)
Biotechnology J.     Hybrid Journal   (Followers: 14, SJR: 1.185, h-index: 51)
Biotechnology Progress     Hybrid Journal   (Followers: 39, SJR: 0.736, h-index: 101)
Biotropica     Hybrid Journal   (Followers: 20, SJR: 1.374, h-index: 71)
Bipolar Disorders     Hybrid Journal   (Followers: 9, SJR: 2.592, h-index: 100)
Birth     Hybrid Journal   (Followers: 38, SJR: 0.763, h-index: 64)
Birth Defects Research Part A : Clinical and Molecular Teratology     Hybrid Journal   (Followers: 2, SJR: 0.727, h-index: 77)
Birth Defects Research Part B: Developmental and Reproductive Toxicology     Hybrid Journal   (Followers: 6, SJR: 0.468, h-index: 47)
Birth Defects Research Part C : Embryo Today : Reviews     Hybrid Journal   (SJR: 1.513, h-index: 55)
BJOG : An Intl. J. of Obstetrics and Gynaecology     Partially Free   (Followers: 243, SJR: 2.083, h-index: 125)

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Journal Cover Annals of Noninvasive Electrocardiology
  [SJR: 0.531]   [H-I: 38]   [2 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1082-720X - ISSN (Online) 1542-474X
   Published by John Wiley and Sons Homepage  [1580 journals]
  • Loperamide cardiotoxicity: “A Brief Review”
    • Authors: Tamer Akel; Soad Bekheit
      Abstract: Loperamide is a popular antidiarrheal medication that has been used for many years. It is currently gaining more attention among healthcare professionals due to its increasing potential for side effects. At present, it is considered safe enough to be sold over the counter. In contrast with other opioid agonists, loperamide is a peripherally acting μ-receptor agonist exerting its effects mainly on the myenteric plexus of the gastrointestinal longitudinal muscle layer. It decreases peristalsis and fluid secretion resulting in longer gastrointestinal transit time. The bioavailability of the drug is extremely low. Moreover, it is actively excluded from the central nervous system; hence, it lacks the central effects of euphoria and analgesia at the recommended dosages. Loperamide abuse has been steadily increasing in the United States. Abusers typically ingest high doses in desire to achieve a satisfactory central nervous system drug penetration. This has made it a potential over the counter substitute for self-treating opioid withdrawal symptoms and achieving euphoric effects.
      PubDate: 2017-11-10T06:15:22.127952-05:
      DOI: 10.1111/anec.12505
       
  • Issue Information
    • PubDate: 2017-11-04T03:22:03.255572-05:
      DOI: 10.1111/anec.12412
       
  • Response of Robyns to the Tse's letter to editor
    • Authors: Tomas Robyns; Hua Rong Lu, David J. Gallacher, Christophe Garweg, Joris Ector, Rik Willems, Stefan Janssens, Dieter Nuyens
      PubDate: 2017-11-04T03:22:02.29015-05:0
      DOI: 10.1111/anec.12515
       
  • Efficacy and safety of intravenous vernakalant for the rapid conversion of
           recent-onset atrial fibrillation: A meta-analysis
    • Authors: Tamer Akel; James Lafferty
      Abstract: BackgroundAtrial fibrillation is a common cardiac arrhythmia with increasing prevalence in the aging population. It is a major cause of emergency department visits worldwide. Vernakalant, a relatively new antiarrhythmic drug with selectively preferential effects on the atrial tissue is currently used in many European countries for the termination of recent-onset atrial fibrillation. Presently, the drug is still not approved by the United States Food and Drug Administration due to safety concerns. We evaluate the efficacy and safety of vernakalant for the conversion of recent-onset atrial fibrillation or atrial flutter into normal sinus rhythm (NSR).MethodsPubMed/MEDLINE (1993–2017), the Cochrane Central Register of Controlled Trials (2000–2017), and reference lists of relevant articles were searched for randomized controlled trials (RCTs) comparing vernakalant to a control drug and extracted subsequently.ResultsNine RCTs were identified and included in the meta-analysis. Pooled analysis of events extracted for a total of 1421 patients with recent-onset atrial fibrillation showed a statistically significant increase in cardioversion within 90 minutes from drug infusion (Relative Risk [RR], 6.61; 95% Confidence Interval [CI], 2.78 – 15.71; p 
      PubDate: 2017-11-04T03:00:34.176623-05:
      DOI: 10.1111/anec.12508
       
  • Clinical applications of QT/RR hysteresis assessment: A systematic
           review
    • Authors: Hugo Gravel; Vincent Jacquemet, Nagib Dahdah, Daniel Curnier
      Abstract: BackgroundQT/RR hysteresis (QT-hys) is an index of the time accommodation of ventricular repolarization to heart rate changes. This report comprehensively reviews studies addressing QT-hys as a biomarker of medical conditions.MethodsThis is a secondary analysis of data from a recent systematic review pertaining to methods of assessment of QT-hys. Articles included in the former review were filtered in order to select original articles investigating the association of QT-hys with medical conditions in humans.ResultsNineteen articles fulfilled our inclusion criteria. Given the heterogeneity of the methods and investigated conditions, no pooled analysis of data could be implemented. QT-hys was mostly studied as a risk marker of severe arrhythmias, as a predictor of the long QT syndrome (LQTS) phenotypes and genotypes and as a marker of exercise-induced ischemia. An increased QT-hys appears to be implicated in arrhythmogenesis, although the evidence in this regard relies on few human studies. An augmented QT-hys was reported in the LQTS, predominantly in the LQT2 genotype, but conflicting results were obtained between studies using different methods of assessment. In addition, QT-hys appears to be a useful marker of stress-induced myocardial ischemia in patients suspected of coronary artery disease.ConclusionsQT-hys evaluation has potential clinical utility in at least some clinical conditions. Further studies of the clinical validity of QT-hys assessment are warranted, particularly condition specific studies based on QT-hys evaluation methods that provide separate estimates of QT-hys and QT/RR dependency.
      PubDate: 2017-10-30T04:30:33.039657-05:
      DOI: 10.1111/anec.12514
       
  • Catecholaminergic polymorphic ventricular tachycardia, an update
    • Authors: Andrés R. Pérez-Riera; Raimundo Barbosa-Barros, Marianne P. C. de Rezende Barbosa, Rodrigo Daminello-Raimundo, Augusto A. de Lucca, Luiz C. de Abreu
      Abstract: Catecholaminergic polymorphic ventricular tachycardia is a rare devastating lethal inherited disorder or sporadic cardiac ion channelopathy characterized by unexplained syncopal episodes, and/or sudden cardiac death (SCD), aborted SCD (ASCD), or sudden cardiac arrest (SCA) observed in children, adolescents, and young adults without structural heart disease, consequence of adrenergically mediated arrhythmias: exercise-induced, by acute emotional stress, atrial pacing, or β-stimulant infusion, even when the electrocardiogram is normal. The entity is difficult to diagnose in the emergency department, given the range of presentations; thus, a familiarity with and high index of suspicion for this pathology are crucial. Furthermore, recognition of the characteristic findings and knowledge of the management of symptomatic patients are necessary, given the risk of arrhythmia recurrence and SCA. In this review, we will discuss the concept, epidemiology, genetic background, genetic subtypes, clinical presentation, electrocardiographic features, diagnosis criteria, differential diagnosis, and management.
      PubDate: 2017-10-19T07:30:14.764568-05:
      DOI: 10.1111/anec.12512
       
  • Brugada phenocopy caused by a compressive mediastinal tumor
    • Authors: Andrés R. Pérez-Riera; Raimundo Barbosa Barros, Rodrigo Daminello-Raimundo, Marianne P. C. Resende Barbosa, Luiz C. de Abreu
      Abstract: Recently, it has been shown that even experts in electrocardiography cannot differentiate the electrocardiographic pattern of genuine Brugada syndrome (BrS) from Brugada phenocopy (BrP). For this reason, this differentiation depends on the presence of established criteria both for BrS and BrP. In this manuscript, we present a patient with type 1 Brugada electrocardiographic pattern caused by expansive anterior mediastinal non-Hodgkin's lymphoma (NHL) with mechanical compression on the right ventricular outflow tract. The electrocardiographic pattern disappeared rapidly after antineoplastic measures.
      PubDate: 2017-10-15T23:51:17.838044-05:
      DOI: 10.1111/anec.12509
       
  • Recurrent extensive anterior myocardial infarction with left and right
           bundle branch block
    • Authors: Hexi Jiang; Qinghua Chang, Yingjie Zhang, Renguang Liu
      Abstract: The diagnosis of myocardial infarction with left bundle branch block is difficult. We report a case of 56-year-old man with old extensive anterior myocardial infarction and left bundle branch block (masked each other). The recurrent myocardial infarction indicated right bundle branch block and first-degree atrioventricular block, making a clear diagnosis of complicated and interesting ECG.
      PubDate: 2017-10-15T23:50:49.218208-05:
      DOI: 10.1111/anec.12506
       
  • The effect of head-up tilt upon markers of heart rate variability in
           patients with atrial fibrillation
    • Authors: Hitesh C. Patel; Carl Hayward, Andrew J. Wardle, Lee Middleton, Alexander R. Lyon, Carlo Di Mario, Tushar V. Salukhe, Richard Sutton, Stuart D. Rosen
      Abstract: BackgroundHeart rate variability (HRV) analysis is uncommonly undertaken in patients with atrial fibrillation (AF) due to an assumption that ventricular response is random. We sought to determine the effects of head-up tilt (HUT), a stimulus known to elicit an autonomic response, on HRV in patients with AF; we contrasted the findings with those of patients in sinus rhythm (SR).MethodsConsecutive, clinically indicated tilt tests were examined for 207 patients: 176 in SR, 31 in AF. Patients in AF were compared to an age-matched SR cohort (n = 69). Five minute windows immediately before and after tilting were analyzed using time-domain, frequency-domain and nonlinear HRV parameters. Continuous, noninvasive assessment of blood pressure, heart rate and stroke volume were available in the majority of patients.ResultsThere were significant differences at baseline in all HRV parameters between AF and age matched SR. HUT produced significant hemodynamic changes, regardless of cardiac rhythm. Coincident with these hemodynamic changes, patients in AF had a significant increase in median [quartile 1, 2] DFA-α2 (+0.14 [−0.03, 0.32], p 
      PubDate: 2017-10-15T23:50:20.14247-05:0
      DOI: 10.1111/anec.12511
       
  • Heart failure study of multipoint pacing effects on ventriculoarterial
           coupling: Rationale and design of the HUMVEE trial
    • Authors: Christina Chrysohoou; Polychronis Dilaveris, Christos-Konstantinos Antoniou, Ioannis Skiadas, Konstantinos Konstantinou, Konstantinos Gatzoulis, Ioannis Kallikazaros, Dimitrios Tousoulis
      Abstract: Cardiac resynchronization therapy (CRT) is an established therapy for symptomatic heart failure (HF). Unfortunately, many recipients remain nonresponders. Studies have revealed the potential role of multipoint pacing (MPP) in improving response and outcomes. The aim of this study is to compare the effects of MPP against those of standard biventricular pacing (BVP) on (i) ventriculoarterial coupling (VAC) and energy efficiency of the failing heart, (ii) diastolic function, (iii) quality of life, and (iv) NT-proBNP levels and glomerular filtration rate (GFR) during a follow-up of 13 months.HUMVEE is a single-center, prospective, observational, crossover cohort study. Seventy-six patients with BVP indication will be implanted with a system able to deliver both pacing modes. BVP will be activated at implantation and optimized 1 month after. At 6 months postoptimization MPP will be activated and optimized. Optimization will be performed based on stroke volume maximization, as assessed by ultrasound. Laboratory measurements (GFR and NT-proBNP) and echocardiographic studies (VAC calculation, strain rate, diastolic function) will be performed at implantation, 6 months post-BVP optimization and at the end of 13 months of follow-up (6 months post-MPP optimization). Potential reduction in arrhythmogenesis by MPP will also be assessed. MPP is a pacing modality with the potential to improve HF patients’ outcomes. The HUMVEE trial will attempt to associate any potential added beneficial effects of MPP over standard BVP with alterations in VAC and energy efficiency of the heart, thus uncovering a novel mechanistic link between MPP and improved outcomes in HF.
      PubDate: 2017-10-15T23:45:21.062033-05:
      DOI: 10.1111/anec.12510
       
  • Baseline fragmented QRS increases the risk of major arrhythmic events in
           Brugada syndrome: Systematic review and meta-analysis
    • Authors: Pattara Rattanawong; Tanawan Riangwiwat, Narut Prasitlumkum, Nath Limpruttidham, Napatt Kanjanahattakij, Pakawat Chongsathidkiet, Wasawat Vutthikraivit, Eugene H. Chung
      Abstract: BackgroundFragmented QRS reflects disturbances in the myocardium predisposing the heart to ventricular tachyarrhythmias. Recent studies suggest that fragmented QRS (fQRS) is associated with major arrhythmic events in Brugada syndrome. However, a systematic review and meta-analysis of the literature has not been done. We assessed the association between fQRS and major arrhythmic events in Brugada syndrome by a systematic review of the literature and a meta-analysis.MethodsWe comprehensively searched the databases of MEDLINE and EMBASE from inception to May 2017. Included studies were published prospective or retrospective cohort studies that compared major arrhythmic events (ventricular fibrillation, sustained ventricular tachycardia, sudden cardiac arrest, or sudden cardiac death) in Brugada syndrome with fQRS versus normal QRS. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals.ResultsNine studies from January 2012 to May 2017 were included in this meta-analysis involving 2,360 subjects with Brugada syndrome (550 fQRS and 1,810 non-fQRS). Fragmented QRS was associated with major arrhythmic events (pooled risk ratio =3.36, 95% confidence interval: 2.09-5.38, p 
      PubDate: 2017-10-14T02:35:46.453025-05:
      DOI: 10.1111/anec.12507
       
  • The prognostic significance of early and late right precordial lead (V4R)
           ST-segment elevation in patients with acute anterior myocardial infarction
           
    • Authors: Muhammed Keskin; Ahmet Okan Uzun, Edibe Betül Börklü, Mert İlker Hayıroğlu, Ceyhan Türkkan, Ahmet İlker Tekkeşin, Ömer Kozan
      Abstract: BackgroundThe predictive significance of ST-segment elevation (STE) in lead V4R in patients with anterior ST-segment elevation myocardial infarction (STEMI) has not been well-understood. In this study, we evaluated the prognostic value of early and late STE in lead V4R in patients with anterior STEMI.MethodsA total 451 patients with anterior STEMI who treated with primary percutaneous coronary intervention (PPCI) were prospectively enrolled in this study. All patients were classified according to presence of STE (>1 mm) in lead V4R at admission and/or 60 min after PPCI. Based on this classification, all patients were divided into three subgroups as no V4R STE (Group 1), early but not late V4R STE (Group 2) and late V4R STE (Group 3).ResultsIn-hospital mortality had higher rates at group 2 and 3 and that had 2.1 and 4.1-times higher mortality than group 1. Late V4R STE remained as an independent risk factor for cardiogenic shock (odds ratio [OR] 2.6; 95% confidence interval [CI] 1.9–4.3; p 
      PubDate: 2017-10-14T02:30:24.027085-05:
      DOI: 10.1111/anec.12513
       
  • Propensity score matching analysis of the impact of Syntax score and
           Syntax score II on new onset atrial fibrillation development in patients
           with ST segment elevation myocardial infarction
    • Authors: Ibrahim Rencuzogullari; Metin Çağdaş, Suleyman Karakoyun, Mahmut Yesin, Mustafa O. Gürsoy, İnanç Artaç, Doğan İliş, Suleyman C. Efe, Ibrahim H. Tanboga
      Abstract: BackgroundNew-onset atrial fibrillation (NOAF) is a common complication in the setting of ST segment elevation myocardial infarction (STEMI), and worsened short/long-term prognosis. Several clinical parameters have already been associated with NOAF development. However, relationship between NOAF and coronary artery disease (CAD) severity in STEMI patients is unclear. This study evaluates the relationship between NOAF and CAD severity using Syntax score (SS) and Syntax score II (SSII) in STEMI patients who were treated with primary percutaneous coronary intervention (pPCI).MethodWe enrolled 1,565 consecutive STEMI patients who were treated with pPCI. Patients with NOAF were compared to patients without NOAF in the entire study population and in a matched population defined by propensity score matching.ResultsPatients with NOAF had significantly higher SS and SSII than those without, both in the matched population (18.6 ± 4 vs 16.75 ± 3.6; p 
      PubDate: 2017-10-04T01:56:12.388505-05:
      DOI: 10.1111/anec.12504
       
  • Parathyroid hormone is related to QT interval independent of serum calcium
           in patients with coronary artery disease
    • Authors: Nicholas O. Palmeri; Karina W. Davidson, William Whang, Ian M. Kronish, Donald Edmondson, Marcella D. Walker
      Abstract: BackgroundElevated serum parathyroid hormone (PTH) is associated with increased risk of cardiovascular death, including sudden cardiac death, in patients with and without parathyroid disease. In small studies, PTH levels have been associated with changes in cardiac conduction and repolarization. Changes in the corrected QT interval (QTc) in particular are thought to be mediated by the effect of PTH on serum calcium. There is limited evidence to suggest PTH may affect cardiac physiology independent of its effects on serum calcium, but there is even less data linking PTH to changes in electrical conduction and repolarization independent of serum calcium.MethodsECG data were examined from the PULSE database—an observational cohort study designed to examine depression after acute coronary syndromes (ACS) at a single, urban American medical center. In all, 407 patients had PTH and ECG data for analysis.ResultsThe QTc was longer in patients with elevated PTH levels compared with those without elevated PTH levels (451 ± 38.6 ms vs. 435 ± 29.8 ms; p 
      PubDate: 2017-09-26T05:16:15.151188-05:
      DOI: 10.1111/anec.12496
       
  • Marked exercise-induced T-wave heterogeneity in symptomatic diabetic
           patients with nonflow-limiting coronary artery stenosis
    • Authors: Fernando G. Stocco; Ederson Evaristo, Nishant R. Shah, Michael K. Cheezum, Jon Hainer, Courtney Foster, Bruce D. Nearing, Ernest Gervino, Richard L. Verrier
      Abstract: BackgroundT-wave heterogeneity (TWH) independently predicted cardiovascular mortality in Health Survey 2000 based on 12-lead ECGs recorded at rest. We investigated whether TWH is elevated during exercise tolerance testing (ETT) in symptomatic diabetic patients with nonflow-limiting coronary artery stenosis compared to control subjects without diabetes.MethodsCases were all patients (n = 20) with analyzable ECG recordings during both rest and ETT who were enrolled in the Effects of Ranolazine on Coronary Flow Reserve (CFR) in Symptomatic Patients with Diabetes and Suspected or Known Coronary Artery Disease (RAND-CFR) study (NCT01754259); median CFR was 1.44; 80% of cases had CFR 0.8, a range not associated with inducible ischemia. TWH was analyzed from precordial leads V4, V5, and V6 by second central moment analysis, which assesses the interlead splay of T-waves about a mean waveform.ResultsDuring exercise to similar rate-pressure products (p = .31), RAND-CFR patients exhibited a 49% increase in TWH during exercise (rest: 49 ± 5 μV; exercise: 73 ± 8 μV, p = .003). By comparison, in control subjects, TWH was not significantly altered (rest: 52 ± 11 μV; ETT: 38 ± 5 μV, p = .19). ETT-induced ST-segment depression>1 mm (p = .11) and Tpeak-Tend (p = .18) and QTc intervals (p = .80) failed to differentiate cases from controls.ConclusionsTWH is capable of detecting latent repolarization abnormalities, which are present during ETT in diabetic patients with nonflow-limiting stenosis but not in control subjects. The technique developed in this study permits TWH analysis from archived ECGs and thereby enables mining of extensive databases for retrospective studies and hypothesis testing.
      PubDate: 2017-09-26T05:15:27.968577-05:
      DOI: 10.1111/anec.12503
       
  • Postimplantation ventricular ectopic burden and clinical outcomes in
           cardiac resynchronization therapy-defibrillator patients: a MADIT-CRT
           substudy
    • Authors: Anne-Christine Ruwald; Mehmet K. Aktas, Martin H. Ruwald, Valentina Kutyifa, Scott McNitt, Christian Jons, Suneet Mittal, Jonathan S. Steinberg, James P. Daubert, Arthur J. Moss, Wojciech Zareba
      Abstract: BackgroundFrequent ventricular ectopy on preimplantation Holter has been associated with attenuated benefit from cardiac resynchronization therapy (CRT). However, it is unclear whether ectopic burden measured post-CRT implantation can be utilized to evaluate long-term prognosis. We aimed to describe the association between post-CRT implantation ectopic burden and subsequent risk of clinical outcomes.MethodsAt the 12-month follow-up visit, 24-hour Holter recordings were performed in 698 CRT-D patients from the MADIT-CRT study. The mean number of ventricular premature complexes (VPCs/hour) was calculated. High ectopic burden was defined as>10 VPCs/hour and low burden as ≤10 VPCs/hour. Multivariate Cox proportional hazards models were utilized to assess the association between 12-month ectopic burden and the risk of the end points of heart failure (HF) or death and ventricular tachyarrhythmias (VT/VF).ResultsAt 12 months, 282 (40%) patients presented with low ectopic burden and 416 (60%) patients presented with high ectopic burden. The 3-year risk of HF/death and VT/VF was lower in patients with a low burden (7% and 8%) and significantly higher (25% and 24%) in patients with high burden. In multivariate analyses, patients with a high ectopic burden had approximately threefold increased risk of both HF/death (HR=2.76 [1.62–4.70], p 
      PubDate: 2017-09-20T06:21:24.511859-05:
      DOI: 10.1111/anec.12491
       
  • Main artifacts in electrocardiography
    • Authors: Andrés Ricardo Pérez-Riera; Raimundo Barbosa-Barros, Rodrigo Daminello-Raimundo, Luiz Carlos Abreu
      Abstract: Electrocardiographic artifacts are defined as electrocardiographic alterations, not related to cardiac electrical activity. As a result of artifacts, the components of the electrocardiogram (ECG) such as the baseline and waves can be distorted. Motion artifacts are due to shaking with rhythmic movement. Examples of motion artifacts include tremors with no evident cause, Parkinson’s disease, cerebellar or intention tremor, anxiety, hyperthyroidism, multiple sclerosis, and drugs such as amphetamines, xanthines, lithium, benzodiazepines, or shivering (due to hypothermia, fever (rigor due to shaking), cardiopulmonary resuscitation by chest compression (oscillations of great amplitude) and patients who move their limbs during the test, causing sudden irregularities in the ECG baseline that may resemble premature contractions or interfere with ECG wave shapes, or other supraventricular and ventricular arrhythmias. When the skeletal muscles experience shaking, the ECG is “bombarded” by apparently random electrical activity.
      PubDate: 2017-09-20T06:13:10.089784-05:
      DOI: 10.1111/anec.12494
       
  • Myocardial bridging is associated with exercise-induced ventricular
           arrhythmia and increases in QT dispersion
    • Authors: Makiko Nishikii-Tachibana; Vedant S. Pargaonkar, Ingela Schnittger, Francois Haddad, Ian S. Rogers, Jennifer A. Tremmel, Paul J. Wang
      Abstract: BackgroundA myocardial bridge (MB) has been associated with ventricular arrhythmia and sudden death during exercise. QT dispersion (QTd) is a measure of abnormal repolarization and may predict ventricular arrhythmia. We investigated the frequency of ventricular arrhythmias during exercise and the QTd at rest and after exercise, in patients with an MB compared to a normal cohort.MethodsWe studied the rest and stress ECG tracings of patients with an MB suspected by focal septal buckling on exercise echocardiography (EE) (Echo-MB group, N = 510), those with an MB confirmed by another examination (MB group, N = 110), and healthy controls (Control group, N = 198).ResultsThe frequency of exercise-induced premature ventricular contractions (PVCs) was significantly higher in the Echo-MB and MB groups compared with the Control group (both p 
      PubDate: 2017-09-18T03:45:26.047476-05:
      DOI: 10.1111/anec.12492
       
  • Sudden cardiac death in isolated right ventricular
           hypertrabeculation/noncompaction cardiomyopathy
    • Authors: Soad Bekheit; Boutros Karam, Farshid Daneshvar, Julie Zaidan, Rabih Tabet, Jonathan Spagnola, James Lafferty
      Abstract: Hypertrabeculation/noncompaction of the myocardium is a rare disorder that involves most commonly the left ventricle of the heart and it has been recognized as a distinct cardiomyopathy by the World Health Organization. However, it is extremely rare for this condition to involve exclusively the right ventricle. We report the cases of three patients who presented with ventricular tachyarrhythmia and sudden cardiac death. They were found to have isolated right ventricular hypertrabeculation/noncompaction on echocardiography. This supports the hypothesis that this condition is highly arrhythmogenic and is associated with high mortality similarly to the left ventricular hypertrabeculation/noncompaction cardiomyopathy.
      PubDate: 2017-09-12T23:22:39.439191-05:
      DOI: 10.1111/anec.12487
       
  • Total cosine R-to-T for predicting ventricular arrhythmic and mortality
           outcomes: A systematic review and meta-analysis
    • Authors: Gary Tse; Mengqi Gong, Cheuk Wai Wong, Cynthia Chan, Stamatis Georgopoulos, Yat Sun Chan, Bryan P. Yan, Guangping Li, Paula Whittaker, Ana Ciobanu, Sadeq Ali-Hasan-Al-Saegh, Sunny H. Wong, William K. K. Wu, George Bazoukis, Konstantinos Lampropoulos, Wing Tak Wong, Lap Ah Tse, Adrian M. Baranchuk, Konstantinos P. Letsas, Tong Liu,
      Abstract: BackgroundThe total cosine R-to-T (TCRT), a vectorcardiographic marker reflecting the spatial difference between the depolarization and repolarization wavefronts, has been used to predict ventricular tachycardia/fibrillation (VT/VF) and sudden cardiac death (SCD) in different clinical settings. However, its prognostic value has been controversial.ObjectiveThis systematic review and meta-analysis evaluated the significance of TRCT in predicting arrhythmic and/or mortality endpoints.MethodsPubMed and Embase databases were searched through December 31, 2016.ResultsOf the 890 studies identified initially, 13 observational studies were included in our meta-analysis. A total of 11,528 patients, mean age 47 years old, 72% male, were followed for 43 ± 6 months. Data from five studies demonstrated lower TCRT values in myocardial infarction patients with adverse events (syncope, ventricular arrhythmias, or sudden cardiac death) compared to those without these events (mean difference = −0.36 ± 0.05, p  .05; I2 = 80%).ConclusionTCRT is lower in MI patients at high risk of adverse events when compared to those free from such events. It can provide additional risk stratification beyond the use of clinical parameters and traditional electrocardiogram markers. Its value in other diseases such as heart failure requires further studies.
      PubDate: 2017-09-12T23:22:23.519607-05:
      DOI: 10.1111/anec.12495
       
  • Specificity of wide QRS complex tachycardia criteria and algorithms in
           patients with ventricular preexcitation
    • Authors: Marek Jastrzębski; Paweł Moskal, Piotr Kukla, Kamil Fijorek, Roksana Kisiel, Danuta Czarnecka
      Abstract: BackgroundDespite substantial progress in the field of differentiation between ventricular tachycardia (VT) and supraventricular tachycardia (SVT) with wide QRS complexes, differentiation between VT and preexcited SVT remains largely unresolved due to significant overlap in QRS morphology. Our aim was to assess the specificities of various single ECG criteria and sets of criteria (Brugada algorithm, aVR algorithm, Steurer algorithm, and the VT score) for diagnosis of VT in a sizable cohort of patients with preexcitation.MethodsWe performed a retrospective study of consecutive accessory pathway ablation procedures to identify preexcited tachycardias. Among 670 accessory pathway ablation procedures, 329 cases with good quality ECG with either bona fide preexcited SVT (n = 30) or a surrogate preexcited SVT (fast paced atrial rhythm with full preexcitation, n = 299) were identified. ECGs were analyzed with the use of wide QRS complex algorithms/criteria to determine specificities of these methods.ResultsThe Steurer algorithm and VT score (≥3 points), with specificities of 97.6% and 96.1%, respectively, were significantly (p 
      PubDate: 2017-09-12T23:22:09.015326-05:
      DOI: 10.1111/anec.12493
       
  • Differentiation of wide QRS tachycardia: Garbage in, garbage out
    • Authors: Marek Jastrzębski; Piotr Kukla
      PubDate: 2017-08-30T04:36:39.940915-05:
      DOI: 10.1111/anec.12486
       
  • Pregbalin induced recurrent syncopal attacks with prolong QT interval
    • Authors: Adem Adar; Fahri Cakan, Orhan Önalan
      Abstract: Long QT syndrome may lead to fatal dysrhythmia. Prolongation of QT interval due to pregabalin has been shown in rats and no data is available in humans. We report a 80-year-old female patient using pregabalin. She was presented to emergency room with syncope attacks. Her admission electrocardiography demonstrated prolonged QT interval. After excluding the possible causes of the long QT syndrome, we attributed prolonged QT interval to pregabalin therapy. After discontinuation of pregabalin QT interval returned to normal range and patient experienced no further syncope attacks. It is first time for documentation of prolonged QT due to pregabalin in humans.
      PubDate: 2017-08-30T04:36:27.461405-05:
      DOI: 10.1111/anec.12489
       
  • Premature ventricular contraction-induced concealed retrograde
           penetration: Electrocardiographic manifestations on anterograde
           ventricular preexcitation
    • Authors: Damián Longo; Adrian Baranchuk
      Abstract: In patients with manifest anterograde ventricular preexcitation, the electrocardiographic manifestation of the anomalous conduction through the simultaneous conduction over the atrioventricular (AV) node and the accessory pathway (“delta wave”); depends on several factors, the most representative being the conduction velocity over one or another connection. Occasionally, ventricular ectopic beats may present with retrograde penetration over one or both conduction pathways (AV node and/or accessory pathway), impacting on the morphology of the next immediate anterogradely conducted QRS. We present a case of a young patient with WPW syndrome and ectopic ventricular beats with different manifestations on the postectopic QRS due to concealed penetration of different conduction pathways.
      PubDate: 2017-08-24T00:21:30.291728-05:
      DOI: 10.1111/anec.12488
       
  • Supraventricular tachycardia, pregnancy, and water: A new insight in
           lifesaving treatment of rhythm disorders
    • Authors: Francesco Massari; Pietro Scicchitano, Angela Potenza, Marco Sassara, Mariella Sanasi, Mariarosa Liccese, Marco Matteo Ciccone, Pasquale Caldarola
      Abstract: Pregnancy may predispose to paroxysmal supraventricular tachycardia (SVT), in subjects with or without identifiable heart disease. Many physiological conditions such as autonomic nervous system changes, altered systemic hemodynamics, etc. can contribute to the onset of arrhythmias during pregnancy. Some cases reported the occurrence of arrhythmias in relation to systemic fluid variations. We report the case of a pregnant woman who experienced SVT due to fluid depletion, detected by bioimpedance vector analysis (BIVA), which was successfully treated by water repletion under tight BIVA monitoring. Emergency physicians can overcome dangerous drug administration by considering historical examination and using fast and reproducible techniques such as BIVA.
      PubDate: 2017-08-19T03:15:58.597648-05:
      DOI: 10.1111/anec.12490
       
  • Role of surface electrocardiogram precordial leads in localizing different
           anatomic sites of ectopic atrial tachycardia arising from lower right
           atrium in pediatric population
    • Authors: Lamyaa Elsayed Allam; Rania Samir Ahmed, Mazen Tawfik Ghanem
      Abstract: BackgroundThe study was designed to examine P wave morphology (PWM) in precordial leads (V1–V6) during ectopic atrial tachycardia (EAT) originating from low right atrium (RA) to identify the anatomic sites of these foci in children.MethodsTwenty-three consecutive pediatric patients (56% females, mean age 8.5 ± 2.5) with EAT originating from the low RA underwent detailed atrial endocardial activation mapping and radiofrequency ablation. PWM during EAT was analyzed using standard 12-lead ECG in relation to successful ablation sites in RA.ResultsEctopic atrial tachycardia originated from coronary sinus ostium (CSo) in 12 patients, nonseptal tricuspid annulus (TA) in five, lower crista terminalis (CT) in three and lower free wall in three. In lead V1, PWM showed a positive pattern during EAT originating from CSo (8/12) [91.7% sensitivity, 100% specificity, 100% positive predictive value (PPV), 100% negative predictive value (NPV)]. A negative pattern was observed in EAT originating from lower free wall (1/3) and nonseptal TA (5/5) [50% sensitivity, 100% specificity, 100% PPV, 75% NPV], while isoelectric pattern was in EAT originating from lower CT (3/3) [100% sensitivity, 100% specificity, 100% PPV, 100% NPV]. In leads V3–V6, PWM showed a negative pattern in at least two consecutive leads during EAT from CSo (12/12), nonseptal TA (5/5) and lower free wall (3/3) while it was positive in EAT originating from lower CT (3/3) [100% sensitivity, 95% specificity, 75% PPV and 100% NPV].ConclusionsP wave morphology in precordial leads can help differentiate the anatomic sites of EAT from lower RA with high PPVs and NPVs.
      PubDate: 2017-08-19T03:15:30.349023-05:
      DOI: 10.1111/anec.12485
       
  • Impact of functional training on geometric indices and fractal correlation
           property of heart rate variability in postmenopausal women
    • Authors: Marianne P. da C. Rezende Barbosa; Luiz C. M. Vanderlei, Lucas M. Neves, Carolina Takahashi, Paula R. dos S. Torquato, Ana Claúdia de S. Fortaleza, Ismael F. Freitas Júnior, Isabel C. E. Sorpreso, Luiz C. Abreu, Andrés R. Pérez Riera
      Abstract: BackgroundTo evaluate the influence of functional training on the geometric indices of heart rate variability (HRV) and fractal correlation properties of the dynamics of heart rate in menopausal women.MethodsOf 39 women who were in the period of menopause for more than a year and who did not practice any regular physical activity were divided into: Functional training group (FTG = 50 ± 4.5 years; 67.64 ± 11.64 kg; 1.5 ± 0.05 m) that executed the functional training (FT) and all proposals by reviews and the Control group (58.45 ± 4.8 years; 66.91 ± 13.24 kg; 1.55 ± 0.05 m) who performed all assessments but not FT. The training consisted of 18 weeks (three times a week) and the volunteers performed three sets of 11 functional exercises followed by a walk in each of the sessions. The autonomic nervous system modulation was evaluated by analysis of HRV and the indices obtained were: RR intervals, RRTRI, TINN, SD1, SD2, SD1/SD2, qualitative analysis of Poincaré plot and DFA (alfa-1, alfa-2 and alfa-1/alfa-2). The Student's t-test for unpaired samples (normal data) or Mann-Whitney test nonnormal data) were used to compare the differences obtained between the final moment and the initial moment of the studied groups (p 
      PubDate: 2017-07-25T05:05:24.9221-05:00
      DOI: 10.1111/anec.12469
       
  • Congenital Long QT syndrome and torsade de pointes
    • Authors: Nabil El-Sherif; Gioia Turitto, Mohamed Boutjdir
      Abstract: Since its initial description by Jervell and Lange-Nielsen in 1957, the congenital long QT syndrome (LQTS) has been the most investigated cardiac ion channelopathy. A prolonged QT interval in the surface electrocardiogram is the sine qua non of the LQTS and is a surrogate measure of the ventricular action potential duration (APD). Congenital as well as acquired alterations in certain cardiac ion channels can affect their currents in such a way as to increase the APD and hence the QT interval. The inhomogeneous lengthening of the APD across the ventricular wall results in dispersion of APD. This together with the tendency of prolonged APD to be associated with oscillations at the plateau level, termed early afterdepolarizations (EADs), provides the substrate of ventricular tachyarrhythmia associated with LQTS, usually referred to as torsade de pointes (TdP) VT. This review will discuss the genetic, molecular, and phenotype characteristics of congenital LQTS as well as current management strategies and future directions in the field.
      PubDate: 2017-07-02T23:15:41.442398-05:
      DOI: 10.1111/anec.12481
       
  • The sensitivity of 38 heart rate variability measures to the addition of
           artifact in human and artificial 24-hr cardiac recordings
    • Authors: Nicolas J. C. Stapelberg; David L. Neumann, David H. K. Shum, Harry McConnell, Ian Hamilton-Craig
      Abstract: BackgroundArtifact is common in cardiac RR interval data derived from 24-hr recordings and has a significant impact on heart rate variability (HRV) measures. However, the relative impact of progressively added artifact on a large group of commonly used HRV measures has not been assessed. This study compared the relative sensitivity of 38 commonly used HRV measures to artifact to determine which measures show the most change with increasing increments of artifact. A secondary aim was to ascertain whether short-term and long-term HRV measures, as groups, share similarities in their sensitivity to artifact.MethodsUp to 10% of artifact was added to 20 artificial RR (ARR) files and 20 human cardiac recordings, which had been assessed for artifact by a cardiac technician. The added artifact simulated deletion of RR intervals and insertion of individual short RR intervals. Thirty-eight HRV measures were calculated for each file. Regression analysis was used to rank the HRV measures according to their sensitivity to artifact as determined by the magnitude of slope.ResultsRMSSD, SDANN, SDNN, RR triangular index and TINN, normalized power and relative power linear measures, and most nonlinear methods examined are most robust to artifact.ConclusionShort-term time domain HRV measures are more sensitive to added artifact than long-term measures. Absolute power frequency domain measures across all frequency bands are more sensitive than normalized and relative frequency domain measures. Most nonlinear HRV measures assessed were relatively robust to added artifact, with Poincare plot SD1 being most sensitive.
      PubDate: 2017-07-02T23:15:34.316947-05:
      DOI: 10.1111/anec.12483
       
  • A rare form of extremely wide QRS complex due to reversed homologous
           electrical ventricular separation of acute heart failure
    • Authors: Sujuan Yan; Jianhua Yu, Zhen Xia, Bo Zhu, Jinzhu Hu, Juxiang Li
      Abstract: Electrical ventricular separation, as a special complete intraventricular block, denotes that ventricles be electrically separated into two or more parts caused by severe and wide damage of myocardium and conduction. Electrical ventricular separation can be divided into homologous and heterologous, homologous electrical ventricular separation is a rare phenomenon, literally the excitement of whole ventricle originate from supraventricle, on ECG, there are two different QRS waves which connect with an isoelectric line, one ST segment and T wave. We report a valve heart disease presented with complicated electrophysiological characteristics, which has reversed complex homologous electrical ventricular separation with second degree intraventricular block.
      PubDate: 2017-06-29T01:55:27.544786-05:
      DOI: 10.1111/anec.12482
       
  • The association of QT interval components with atrial fibrillation
    • Authors: Nikhil Patel; Wesley T. O'Neal, S. Patrick Whalen, Elsayed Z. Soliman
      Abstract: BackgroundAlthough abnormalities of the QT interval are associated with atrial fibrillation (AF), it is unclear whether ventricular depolarization (QRS duration) or repolarization (JT interval) is a more important marker of AF risk.MethodsThis analysis included 4,181 (95% white; 59% women) participants from the Cardiovascular Health Study (CHS) who were free of baseline AF and major intraventricular delay. A linear scale was used to compute heart rate adjusted QT (QTa), QRS (QRSa), and JT (JTa) intervals. Prolonged QTa, QRSa, and JTa were defined by values greater than the sex-specific 95th percentile for each measurement. AF events were ascertained during the annual study electrocardiograms and from hospitalization discharge data. Cox regression was used to compute hazard ratios (HR) and 95% confidence intervals (CI) for the associations of prolonged QTa, QRSa, and JTa with AF, separately.ResultsOver a mean follow-up of 12.1 years, a total of 1,236 (30%) AF events were detected. An increased risk of AF (HR = 1.50. 95% CI = 1.20, 1.88) was observed with prolonged QTa. When we examined the association between individual components of the QTa interval and AF, the risk of AF was limited to prolonged JTa (HR = 1.31, 95% CI = 1.04, 1.65) and not prolonged QRSa (HR = 1.00, 95% CI = 0.77, 1.30). Similar results were obtained per 1-SD increase in QTa (HR = 1.07, 95% CI = 1.01, 1.13), QRSa (HR = 0.99, 95% CI = 0.94, 1.06), and JTa (HR = 1.07, 95% CI = 1.01, 1.13).ConclusionsThe JT interval is a more important marker of AF risk in the QT interval among persons who do not have ventricular conduction delays.
      PubDate: 2017-06-29T01:50:23.369648-05:
      DOI: 10.1111/anec.12467
       
  • Ranolazine reduces repolarization heterogeneity in symptomatic patients
           with diabetes and non–flow-limiting coronary artery stenosis
    • Authors: Ederson Evaristo; Fernando G. Stocco, Nishant R. Shah, Michael K. Cheezum, Jon Hainer, Courtney Foster, Bruce D. Nearing, Marcelo Di Carli, Richard L. Verrier
      Abstract: BackgroundExperimental evidence suggests that ranolazine decreases susceptibility to ischemia-induced arrhythmias independent of effects on coronary artery blood flow.ObjectiveIn symptomatic diabetic patients with non–flow-limiting coronary artery stenosis with diffuse atherosclerosis and/or microvascular dysfunction, we explored whether ranolazine reduces T-wave heterogeneity (TWH), an electrocardiographic (ECG) marker of arrhythmogenic repolarization abnormalities shown to predict sudden cardiac death.MethodsWe studied all 16 patients with analyzable ECG recordings during rest and exercise tolerance testing before and after 4 weeks of ranolazine in the double-blind, crossover, placebo-controlled RAND-CFR trial (NCT01754259). TWH was quantified without knowledge of treatment assignment by second central moment analysis, which assesses the interlead splay of T waves in precordial leads about a mean waveform. Myocardial blood flow (MBF) was measured by positron emission tomography.ResultsAt baseline, prior to randomization, TWH during rest was 54 ± 7 μV and was not altered following placebo (47 ± 6 μV, p = .47) but was reduced by 28% (to 39 ± 5 μV, p = .002) after ranolazine. Ranolazine did not increase MBF at rest. Exercise increased TWH after placebo by 49% (to 70 ± 8 μV, p = .03). Ranolazine did not reduce TWH during exercise (to 75 ± 16 μV), and there were no differences among the groups (p = .95, ANOVA). TWH was not correlated with MBF at rest before (r2 = .07, p = .36) or after ranolazine (r2 = .23, p = .06).ConclusionsIn symptomatic diabetic patients with non-flow-limiting coronary artery stenosis with diffuse atherosclerosis and/or microvascular dysfunction, ranolazine reduced TWH at rest but not during exercise. Reduction in repolarization abnormalities appears to be independent of alterations in MBF.
      PubDate: 2017-06-27T02:17:53.073178-05:
      DOI: 10.1111/anec.12480
       
  • Asystole caused by Hydroxycut Hardcore: A case report and literature
           review
    • Authors: Julie Zaidan; Rabih Tabet, Boutros Karam, Farshid Daneshvar, Mohammed Raza, Soad Bekheit
      Abstract: Obesity is a rising epidemic worldwide driving people to search for remedy through nonconventional therapies. Hydroxycut products are popular supplements used as weight loss aids. Many reports revealed serious adverse effects related to their ingestion. We report the case of a 37-year-old healthy male patient who presented following an episode of syncope. On telemetry, he manifested recurrent sinus node arrests, including a symptomatic 24 s sinus pause. The patient admitted to taking Hydroxycut Hardcore for 10 days previously. After discontinuation of the drug, his symptoms completely resolved. This is the first case of Hydroxycut-associated syncope secondary to bradyarrhythmia.
      PubDate: 2017-06-27T01:32:34.696777-05:
      DOI: 10.1111/anec.12479
       
  • Bigeminal sandwiches galore
    • Authors: Thomas Lindow; Angelica Niklasson, Daniel Manna, Olle Pahlm
      Abstract: A long run of PVCs “sandwiched” in between the sinus beats resulting in an almost doubling of the heart rate—interpolated PVCs in bigeminy—is described. This case illustrates three interesting aspects of interpolated PVCs. Although they are not uncommon, long runs of interpolated PVCs in bigeminy are rare findings. In this case, the arrhythmia had a duration of 3 minutes. Second, it illustrates the “age-old wisdom” of partial retrograde conduction. Also, even though the arrhythmia resulted in an almost doubling of the heart rate, the patient remained asymptomatic.
      PubDate: 2017-06-27T01:28:07.545128-05:
      DOI: 10.1111/anec.12484
       
  • ECG-derived Cheyne-Stokes respiration and periodic breathing in healthy
           and hospitalized populations
    • Authors: Adelita Tinoco; Barbara J. Drew, Xiao Hu, David Mortara, Bruce A. Cooper, Michele M. Pelter
      Abstract: BackgroundCheyne-Stokes respiration (CSR) has been investigated primarily in outpatients with heart failure. In this study we compare CSR and periodic breathing (PB) between healthy and cardiac groups.MethodsWe compared CSR and PB, measured during 24 hr of continuous 12-lead electrocardiographic (ECG) Holter recording, in a group of 90 hospitalized patients presenting to the emergency department with symptoms suggestive of acute coronary syndrome (ACS) to a group of 100 healthy ambulatory participants. We also examined CSR and PB in the 90 patients presenting with ACS symptoms, divided into a group of 39 (43%) with confirmed ACS, and 51 (57%) with a cardiac diagnosis but non-ACS. SuperECG software was used to derive respiration and then calculate CSR and PB episodes from the ECG Holter data. Regression analyses were used to analyze the data. We hypothesized SuperECG software would differentiate between the groups by detecting less CSR and PB in the healthy group than the group of patients presenting to the emergency department with ACS symptoms.ResultsHospitalized patients with suspected ACS had 7.3 times more CSR episodes and 1.6 times more PB episodes than healthy ambulatory participants. Patients with confirmed ACS had 6.0 times more CSR episodes and 1.3 times more PB episodes than cardiac non-ACS patients.ConclusionContinuous 12-lead ECG derived CSR and PB appear to differentiate between healthy participants and hospitalized patients.
      PubDate: 2017-06-15T02:35:24.624942-05:
      DOI: 10.1111/anec.12462
       
  • Electrical storm in a patient with Duchenne muscular dystrophy
           cardiomyopathy triggered by abrupt β-blocker interruption
    • Authors: Nikolaos Fragakis; Melani Sotiriadou, Lydia Krexi, Vassilios Vassilikos
      Abstract: We present a case of a young man with Duchenne muscular dystrophy cardiomyopathy (DMDC) having an implantable cardioverter defibrillator for secondary prevention, who presented with electrical storm shortly after β-blocker interruption. The patient was stabilized and remained free of ventricular arrhythmias soon after reinitiating b-adrenoreceptor antagonists. The present case highlights the importance of sympathetic blockage in patients with DMDC due to existing pathophysiology of excess diastolic Ca2+ leak from sarcoplasmic reticulum as a result of ryanodine receptor dysfunction.
      PubDate: 2017-06-15T02:31:57.793847-05:
      DOI: 10.1111/anec.12477
       
  • Brugada syndrome, Brugada phenocopy or none'
    • Authors: Umut Kocabas; Can Hasdemir, Esra Kaya, Cuneyt Turkoglu, Adrian Baranchuk
      Abstract: Brugada syndrome is a form of inherited arrhythmia syndrome characterized by a distinct ST-segment elevation in the right precordial leads. Brugada phenocopies are clinical entities that present with an electrocardiographic pattern identical to Brugada syndrome and may obey to various clinical conditions. We present a case of a suicidal attempt using a high dose of propafenone causing a Brugada-type electrocardiographic pattern. Is this a Brugada syndrome case, a Brugada phenocopy or something else'
      PubDate: 2017-06-13T02:21:01.174389-05:
      DOI: 10.1111/anec.12470
       
  • New insights into the clinical signs of supraventricular tachycardia: The
           “sign of lace-tying”
    • Authors: Dominique Blommaert; Fabien Dormal, Olivier Deceuninck, Olivier Xhaet, Elisabeth Ballant, Luc De Roy
      Abstract: BackgroundSupraventricular tachycardias (SVT) are a common arrhythmia therefore an accurate diagnosis is of clinical importance. Although an ECG performed during tachycardia greatly aids diagnosis, patient history and predisposing factors also improve diagnostic accuracy.MethodsThis prospective study included 100 consecutive patients undergoing electrophysiological study for SVT with the aim to reassess their clinical characteristics and describe frequent predisposing factors, such as the “sign of lace-tying” that to our knowledge has not previously been reported. Each patient completed an extensive questionnaire (70 questions) during their hospital stay.ResultsOur series comprised: 67% of patients with atrioventricular nodal reentrant tachycardia (AVNRT); 24% with an accessory pathway; and 9% presented atrial tachycardia. Half of the population were male and 29% of the cohort presented hypertension. Syncope during tachycardia appeared in 15% of patients, dizziness in 52% and thoracic pain in 59%. We encountered a predisposing risk factor for SVT in 53% of cases; with 32% exhibiting an anteflexion of the trunk termed the “sign of lace-tying.” Data also showed that younger patients tended to present AVRT and regular pounding in the neck appeared only in patients with AVNRT.ConclusionsOverall, our study has highlighted the importance of considering clinical signs and patient characteristics both before and during SVT for the precise diagnosis of paroxysmal SVT. Furthermore, 32% of patients presented the “sign of lace-tying” or body position change before SVT, implying a diagnosis of SVT.
      PubDate: 2017-06-08T01:00:51.540362-05:
      DOI: 10.1111/anec.12471
       
  • Inhibition of left ventricular stimulation due to left ventricular lead
           failure and the left ventricular T-wave protection algorithm in patient
           with cardiac resynchronization therapy and pacemaker dependency
    • Authors: Andrzej Ząbek; Barbara Małecka, Maciej Dębski, Krzysztof Boczar, Jacek Lelakowski
      Abstract: The electrocardiogram (ECG) interpretation in patients with cardiac resynchronization therapy (CRT) is often a perplexing problem. The difficulty in the device evaluation increases in the presence of unfamiliar timing cycles and a lead dysfunction.
      Authors describe a special function of a Biotronik CRT devices called the left ventricle T-wave protection (LVTP), and demonstrate its behavior in a patient with left ventricular (LV) lead failure. This report shows that sometimes it might be difficult to understand the loss of resynchronization in 12-lead ECG when LVTP feature is on, and a malfunction of left ventricular lead sensing occurs.
      PubDate: 2017-06-08T00:35:47.01899-05:0
      DOI: 10.1111/anec.12473
       
  • Effects of intranasal kinetic oscillation stimulation on heart rate
           variability
    • Authors: Markus Jerling; Iwona Cygankiewicz, Nabil Al-Tawil, Borje Darpo, Anders Ljungström, Wojciech Zareba
      Abstract: BackgroundKinetic oscillation stimulation in the nasal cavity (KOS) has been shown to have positive symptomatic effects in subjects with non-allergic rhinitis and in patients with migraine.MethodsTo evaluate the effect of KOS on autonomic function, we assessed heart rate variability (HRV) in this small exploratory study in 12 healthy subjects. KOS treatment was performed using a minimally invasive system with a single-use catheter inserted into the nasal cavity. During treatment, the tip was inflated and oscillated with a mean pressure of 95 millibar and amplitude of the oscillations of 100 millibar at a frequency of 68 Hz. Treatment was given for 15 minutes sequentially on each side. Heart rate variability was assessed during five 30-minutes periods before, during and immediately after KOS treatment and 3.5 hours thereafter. KOS resulted in a substantial reduction of HRV.ResultsAs compared to baseline recorded during 30 minutes preceding treatment, VLF was reduced by 65%, LF by 55%, the ratio LF/HF by 44%, with somewhat smaller observed effects in the time domain; SDNN and RMSDD were reduced by of 36% and 18%, respectively. Heart rate remained stable during treatment with minimal mean changes from 68 ± 7 bpm before to 68 ± 9 and 69 ± 9 bpm during and after treatment. Reduction of HRV parameters was consistently seen in all subjects, with rapid onset and return towards baseline values during post-treatment observation periods.ConclusionsKOS has an effect on the autonomic balance with pronounced heart-rate independent reduction on HRV.
      PubDate: 2017-06-07T05:35:27.452062-05:
      DOI: 10.1111/anec.12474
       
  • Changes in arrhythmogenic properties and five-year prognosis after
           carbon-ion radiotherapy in patients with mediastinum cancer
    • Authors: Mari Amino; Koichiro Yoshioka, Makiyoshi Shima, Tohru Okada, Mio Nakajima, Yoshiya Furusawa, Shigetaka Kanda, Sadaki Inokuchi, Teruhisa Tanabe, Yuji Ikari, Tadashi Kamada
      Abstract: IntroductionCarbon-ion irradiation of rabbit hearts has improved left ventricular conduction abnormalities through upregulation of gap junctions. However, to date, there has been no investigation on the effect of carbon-ion irradiation on electrophysiological properties in human. We investigated this effect in patients with mediastinum extra-cardiac cancer treated with carbon-ion radiotherapy that included irradiating the heart.Methods and ResultsIn April–December 2009, eight patients were prospectively enrolled (including two male, aged 72.5 ± 13.0 years). They were treated with 44–72 Gray equivalent (GyE), with their hearts exposed to 1.3–19.1 GyE. High-resolution ambulatory electrocardiography was performed before and after radiotherapy to investigate arrhythmic events, late potentials (LPs), and heart rate variability. Five patients had pre-existing premature ventricular contraction (PVC)/atrial contraction (PAC) or paroxysmal atrial fibrillation (PAF)/AF; after irradiation, this improved in four patients with PVC/PAF/AF and did not deteriorate in one patient with PAC. Ventricular LP findings did not deteriorate and improved in one patient. In eight cases with available atrial LP findings, there was no deterioration, and two patients showed improvements. The low frequency/high frequency ratio of heart rate variability improved or did not deteriorate in the six patients who received radiation exposure to the bilateral stellate ganglions. During the five-year follow-up for the prognosis, six of the eight patients died because of cancer; there was no history of hospitalization for cardiac events.ConclusionAlthough this preliminary study has several limitations, carbon-ion beam irradiation to the heart is not immediately cardiotoxic and demonstrates consistent signals of arrhythmia reduction.
      PubDate: 2017-06-07T05:30:52.318607-05:
      DOI: 10.1111/anec.12468
       
  • Repetitive ventricular tachycardia in a syncopal child: Cause or
           incidental finding '
    • Authors: Martial Massin; Caroline Jacquemart, Karim Khaldi
      Abstract: A 15-year-old girl suffered recurrent syncopal episodes during 7 years. Events were precipitated by exercise or emotional stress, leading to the diagnosis of reflex syncope. Exercise testing induced recurrent salvos of nonsustained right ventricular outflow tract tachycardia. This arrhythmia is often asymptomatic, reflex syncope is very frequent and both causes are related to the same triggering situations. It was therefore essential to obtain recordings during syncopal events and to observe the clinical evolution under effective treatment in order to make the right diagnosis.
      PubDate: 2017-05-30T01:05:40.903912-05:
      DOI: 10.1111/anec.12472
       
  • Progression of early repolarization patterns at a four year follow-up in a
           female flight crew population: Implications for aviation medicine
    • Authors: Gwénolé Rohel; Eric Perrier, Aurélien Delluc, Jonathan Monin, Olivier Manen, Philippe Paule, Marie Piquemal, Jacques Mansourati, Ulric Vinsonneau
      Abstract: BackgroundTo assess the prevalence, the appearance, and the distribution, as well as the fluctuation over time of early repolarization patterns after four years in a female population derived from the French aviation sector.MethodsThis was a retrospective longitudinal study from 1998 to 2010 of a population of female employees who received a full clinical examination and an electrocardiogram (ECG) upon their recruitment and after a period of four years.ResultsA total of 306 women were included (average of 25.87 ± 3.3 years of age). The prevalence of early repolarization was 9.2%. The most common appearance was J-point slurring for 64.3% (i.e. 20/28 subjects) that occurred in the inferior leads for 28.6% (i.e. 8/28 subjects). After four years, the prevalence was 7.5%, with a regression of this aspect in five of the subjects. There were no changes in the ECG in terms of the distribution and the appearance among the 23 subjects for whom the aspect persisted. Over the course of this four year period all of the subjects remained asymptomatic.ConclusionsEarly repolarization in this largely physically inactive female population was common, and it fluctuated over time. At present, no particular restrictions can be placed on asymptomatic flight crew who exhibit this feature in the absence of a prior medical history for heart disease.
      PubDate: 2017-05-30T01:00:26.28217-05:0
      DOI: 10.1111/anec.12451
       
  • Coronary sinus lead delay index for optimization of coronary sinus lead
           placement
    • Authors: Mevlüt Koç; Onur Kaypakli, Gökhan Gözübüyük, Durmus Yıldıray Şahin
      Abstract: AimOptimization of coronary sinus (CS) lead position to the latest activated left ventricular (LV) area is important to increase cardiac resynchronization therapy (CRT) response. We aimed to detect the relationship between coronary sinus lead delay index (CSDI) and echocardiographic, electrocardiographic response to CRT treatment.MethodsWe prospectively included 137 consecutive patients with heart failure (HF) diagnosis, QRS ≥ 120 ms, left bundle branch block (LBBB), New York Heart Association score (NYHA) II–IV, LV ejection fraction (LVEF)
      PubDate: 2017-05-30T00:52:52.077553-05:
      DOI: 10.1111/anec.12454
       
  • Rationale and design of a randomized trial to assess the safety and
           efficacy of MultiPoint Pacing (MPP) in cardiac resynchronization therapy:
           The MPP Trial
    • Authors: Gery Tomassoni; James Baker, Raffaele Corbisiero, Charles Love, David Martin, Robert Sheppard, Seth J. Worley, Kwangdeok Lee, Imran Niazi,
      Abstract: BackgroundAlthough the majority of Class III congestive heart failure (HF) patients treated with cardiac resynchronization therapy (CRT) show a clinical benefit, up to 40% of patients do not respond to CRT. This paper reports the design of the MultiPoint Pacing (MPP) trial, a prospective, randomized, double-blind, controlled study to evaluate the safety and efficacy of CRT using MPP compared to standard biventricular (Bi-V) pacing.MethodsA maximum of 506 patients with a standard CRT-D indication will be enrolled at up to 50 US centers. All patients will be implanted with a CRT-D system (Quartet LV lead Model 1458Q with a Quadra CRT-D, Abbott) that can deliver both MPP and Bi-V pacing. Standard Bi-V pacing will be activated at implant. At 3 months postimplant, patients in whom the echocardiographic parameters during MPP are equal or better than during Bi-V pacing are randomized (1:1) to either an MPP or Bi-V arm.ResultsThe primary safety endpoint is freedom from system-related complications at 9 months. Each patient's response to CRT will be evaluated using a heart-failure clinical composite score, consisting of a change in NYHA functional class, patient global assessment score, HF events, and cardiovascular death. The primary efficacy endpoint is the proportion of responders in the MPP arm compared with the Bi-V arm between 3 and 9 months.ConclusionThis trial seeks to evaluate whether MPP via a single quadripolar LV lead improves hemodynamic and clinical responses to CRT, both in clinical responders and nonresponders.
      PubDate: 2017-05-18T05:51:26.981888-05:
      DOI: 10.1111/anec.12448
       
  • Conventional and right-sided screening for subcutaneous ICD in a
           population with congenital heart disease at high risk of sudden cardiac
           death
    • Authors: Pau Alonso; Joaquín Osca, Joaquín Rueda, Oscar Cano, Pedro Pimenta, Ana Andres, María José Sancho, Luis Martinez
      Abstract: BackgroundInformation regarding suitability for subcutaneous defibrillator (sICD) implantation in tetralogy of Fallot (ToF) and systemic right ventricle is scarce and needs to be further explored. The main objective of our study was to determine the proportion of patients with ToF and systemic right ventricle eligible for sICD with both, standard and right-sided screening methods. Secondary objectives were: (i) to study sICD eligibility specifically in patients at high risk of sudden cardiac death, (ii) to identify independent predictors for sICD eligibility, and (iii) to compare the proportion of eligible patients in a nonselected ICD population.MethodsWe recruited 102 patients with ToF, 33 with systemic right ventricle, and 40 consecutive nonselected patients. Conventional electrocardiographic screening was performed as usual. Right-sided alternative screening was studied by positioning the left-arm and right-arm electrodes 1 cm right lateral of the xiphoid midline. The Boston Scientific ECG screening tool was utilized.ResultsIn high-risk patients with ToF, eligibility was higher with right-sided screening in comparison with standard screening (61% vs. 44%; p = .018). Eligibility in high-risk right ventricle population was identical with both screening methods (77%, p = ns). The only independent predictor for sICD eligibility was QRS duration.ConclusionIn high-risk patients with ToF, right-sided implantation of the sICD could be an alternative to a conventional ICD. In patients with a systemic right ventricle, implantation of a sICD is an alternative to a conventional sICD.
      PubDate: 2017-05-15T23:45:33.288892-05:
      DOI: 10.1111/anec.12461
       
  • Predictors and implications of early left ventricular ejection fraction
           improvement in new-onset idiopathic nonischemic cardiomyopathy with narrow
           QRS complex: A NEOLITH substudy
    • Authors: Norman C. Wang; Evan C. Adelstein, Sandeep K. Jain, Stuart G. Mendenhall, Alaa A. Shalaby, Andrew H. Voigt, Samir Saba
      Abstract: BackgroundPredictors and implications of early left ventricular ejection fraction (LVEF) improvement with guideline-directed medical therapy (GDMT) in new-onset idiopathic nonischemic cardiomyopathy (NICM) with narrow QRS complex are not well described. The objectives were to describe predictors of LVEF improvement after 3 months on GDMT and adverse cardiac events based on post-GDMT LVEF status (≤35% vs.>35%).MethodsA retrospective cohort study was performed in subjects with new-onset NICM, LVEF ≤35%, and narrow QRS complex. Associations for baseline variables with post-GDMT LVEF improvement and absolute change in LVEF (∆LVEFGDMT) were assessed. Cox proportional hazards models assessed associations for post-GDMT LVEF status with adverse cardiac events.ResultsIn 70 subjects, 31 (44%) had post-GDMT LVEF ≤35% after a median follow-up time of 97.5 days (interquartile range, 84–121 days). In final multivariable models, severely dilated left ventricular end-diastolic diameter (LVEDD), compared with normal LVEDD, strongly predicted post-GDMT LVEF ≤35% (odds ratio, 7.77; 95% confidence interval [CI], 1.39–43.49; p = .02) and ∆LVEFGDMT (β = −15.709; standard error = 4.622; p = .001). Subjects with post-GDMT LVEF ≤35% were more likely to have adverse cardiac events over a median follow-up time of 970.5 days (unadjusted hazard ratio, 2.15; 95% CI, 0.93–4.96; p = .07). In the post-GDMT LVEF ≤35% group, 9 of 26 subjects (35%) had long-term LVEF > 35%.ConclusionIn new-onset NICM with narrow QRS complex, nondilated LVEDD predicted early LVEF improvement. Those with post-GDMT LVEF ≤35% had higher risk of adverse cardiac events, but a substantial proportion demonstrated continued long-term LVEF improvement.
      PubDate: 2017-05-12T06:06:26.868444-05:
      DOI: 10.1111/anec.12466
       
  • Intermittent preexcitation indicates “a low-risk” accessory pathway:
           Time for a paradigm shift'
    • Authors: Marek Jastrzębski; Piotr Kukla, Maciej Pitak, Andrzej Rudziński, Adrian Baranchuk, Danuta Czarnecka
      Abstract: We report three patients with intermittent loss of the preexcitation pattern in the ECG that had undergone an electrophysiological study. Despite apparently poorly conducting accessory pathway (AP), in each case a fast anterograde conduction, either during spontaneous atrial fibrillation or during incremental atrial pacing (on isoproterenol) was documented; shortest preexcited RR intervals of 200–240 ms were observed. We review the literature and conclude that intermittent preexcitation observed on resting 12-lead ECG lacks sufficient specificity for the diagnosis of an AP with long refractory period and cannot be considered a substitute for electrophysiological study in patients with this electrocardiographical phenomenon.
      PubDate: 2017-05-12T04:50:50.734775-05:
      DOI: 10.1111/anec.12464
       
  • Impact of T wave amplitude in lead aVR on predicting cardiac events in
           ischemic and nonischemic cardiomyopathy patients with an implantable
           cardioverter defibrillator
    • Authors: Yoshihiro Tanaka; Tetsuo Konno, Yudai Tamura, Toyonobu Tsuda, Hiroshi Furusho, Masayuki Takamura, Kenji Sakata, Masakazu Yamagishi, Kenshi Hayashi
      Abstract: BackgroundT wave amplitudes during ventricular repolarization in the lead aVR (TAaVR) are shown to be associated with adverse cardiac events in patients with several cardiovascular diseases, such as postmyocardial infarction. However, the utility of TAaVR has not been previously evaluated in patients with cardiomyopathy who have received implantable cardioverter defibrillators (ICD). Patients with ischemic or nonischemic cardiomyopathy (ICM or NICM, respectively) and who received an ICD may experience worsening of their condition due to the introduction of electric shock during treatment. This study aimed to investigate the utility of TAaVR in the prediction of cardiac events in ICM or NICM patients with ICD.MethodsNinety-three consecutive ICM or NICM patients with ICD were retrospectively analyzed (median age: 64 years; male: 77.4%; ICD for secondary prevention: 76.3%; NICM: 64.5%). The median follow-up period was 31 months. The primary endpoint was defined as composite cardiac events, including cardiac death, major ventricular arrhythmic events (MVAE), or hospitalization due to heart failure (HHF).ResultsMultivariate Cox regression analysis demonstrated that less negative TAaVR (−0.1 mV ≤ TAaVR
      PubDate: 2017-04-25T06:10:42.104885-05:
      DOI: 10.1111/anec.12452
       
  • Impact of atrial fibrillation detected by extended monitoring—A
           population-based cohort study
    • Authors: Mathias C. Busch; Stefan Gross, Dietrich Alte, Jan A. Kors, Henry Völzke, Till Ittermann, André Werner, Anne Krüger, Raila Busch, Marcus Dörr, Stephan B. Felix
      Abstract: BackgroundThe clinical relevance of extended monitoring of AF in the general population is unclear. The study evaluated the detection of AF using transtelephonic electrocardiography and the clinical relevance of additional AF findings, especially with regard to stroke risk and mortality.MethodsThe data of 1678 volunteers participating in the tele-ECG-subproject of the Study of Health in Pomerania was evaluated. Occurrence of AF as revealed by tele-ECG and conventional ECG was evaluated. Associations with mortality, history of stroke, and other clinical parameters were analyzed.ResultsAF was detected in 21 subjects (1.3%) by conventional ECG (ECG-AF) and in 43 (2.6%) by tele-ECG. All individuals with AF revealed by conventional ECG were also diagnosed to have AF by tele-ECG; 22 were diagnosed by tele-ECG only (Tele-AF).During follow-up (median: 6.3 years) 42/1635, 1/22, and 5/21 participants died in the no-AF-, tele-AF-, and ECG-AF groups (p 
      PubDate: 2017-04-25T06:00:54.260803-05:
      DOI: 10.1111/anec.12453
       
  • A new modality for the estimation of corrected flow time via
           electrocardiography as an alternative to Doppler ultrasonography
    • Authors: Hooman Hossein-Nejad; Payam Mohammadinejad, Atefeh Zeinoddini, Seyedhossein Seyedhosseini Davarani, Mohsen Banaie
      Abstract: BackgroundEvaluation of corrected flow time (FTc) via ultrasonography is one of the suggested modalities for the assessment of intravascular volume status. This study aimed to compare the results of FTc of carotid artery measured via ultrasonography, as a measure of mechanical outcome of the cardiac cycle, with the results of FTc estimation from a new modified formula via electrocardiography (ECG), as a measure of electrical function of the cardiac cycle.MethodsHealthy volunteers were evaluated before and after a passive leg raising (PLR) maneuver. FTc was measured concurrently before and after PLR via a modified method from ECG and via ultrasonography of the carotid artery.ResultsA total number of 98 healthy volunteers (51 women and 47 men) with a mean age of 30.69 ± 6.28 years were included. There was a significant correlation between FTc measured by ultrasonography and estimated by ECG both before PLR and after PLR (r = .878, p 
      PubDate: 2017-04-22T02:25:33.269517-05:
      DOI: 10.1111/anec.12456
       
  • Automated T-wave analysis can differentiate acquired QT prolongation from
           congenital long QT syndrome
    • Authors: Alan Sugrue; Peter A. Noseworthy, Vaclav Kremen, J. Martijn Bos, Bo Qiang, Ram K. Rohatgi, Yehu Sapir, Zachi I. Attia, Peter Brady, Pedro J. Caraballo, Samuel J. Asirvatham, Paul A. Friedman, Michael J. Ackerman
      Abstract: BackgroundProlongation of the QT on the surface electrocardiogram can be due to either genetic or acquired causes. Distinguishing congenital long QT syndrome (LQTS) from acquired QT prolongation has important prognostic and management implications. We aimed to investigate if quantitative T-wave analysis could provide a tool for the physician to differentiate between congenital and acquired QT prolongation.MethodsPatients were identified through an institution-wide computer-based QT screening system which alerts the physician if the QTc ≥ 500 ms. ECGs were retrospectively analyzed with an automated T-wave analysis program. Congenital LQTS was compared in a 1:3 ratio to those with an identified acquired etiology for QT prolongation (electrolyte abnormality and/or prescription of known QT prolongation medications). Linear discriminant analysis was performed using 10-fold cross-validation to statistically test the selected features.ResultsThe 12-lead ECG of 38 patients with congenital LQTS and 114 patients with drug-induced and/or electrolyte-mediated QT prolongation were analyzed. In lead V5, patients with acquired QT prolongation had a shallower T wave right slope (−2,322 vs. −3,593 mV/s), greater T-peak-Tend interval (109 vs. 92 ms), and smaller T wave center of gravity on the x axis (290 ms vs. 310 ms; p 
      PubDate: 2017-04-21T00:16:10.852738-05:
      DOI: 10.1111/anec.12455
       
  • Positive T wave in lead aVR as an independent predictor for 1-year major
           adverse cardiac events in patients with first anterior wall ST-segment
           elevation myocardial infarction
    • Authors: Akihiro Kobayashi; Naoki Misumida, Shunsuke Aoi, Yumiko Kanei
      Abstract: BackgroundPositive T wave in lead aVR has been shown to predict an adverse in-hospital outcome in patients with anterior wall ST-segment elevation myocardial infarction (STEMI). However, the prognostic value of positive T wave in lead aVR on a long-term outcome has not been fully explored.MethodsWe performed a retrospective analysis of 190 consecutive patients with first anterior wall STEMI who underwent an emergent coronary angiogram. Patients were divided into those with positive T wave > 0 mV and those with negative T wave ≦ 0 mV in lead aVR. Baseline and angiographic characteristics, and in-hospital revascularization procedures were recorded. In addition, in-hospital and 1-year major adverse cardiac events (MACE) including death, recurrent myocardial infarction, and target vessel revascularization were recorded.ResultsAmong 190 patients, 37 patients (19%) had positive T wave and 153 patients (81%) had negative T wave in lead aVR. Patients with positive T wave had higher rate of left main disease defined as stenosis ≥50% (11% vs. 2%, p = .028) than those with negative T wave. Patients with positive T wave had higher rate of 1-year MACE (38% vs. 13%, p 
      PubDate: 2017-02-16T01:15:28.652031-05:
      DOI: 10.1111/anec.12442
       
  • ECG in athlete: “Normal or pathologic variant'”
    • Authors: Helder Dores; António Freitas
      PubDate: 2017-02-13T03:35:24.509025-05:
      DOI: 10.1111/anec.12438
       
 
 
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