ECG Handbook of Contemporary Challenges

246 Pages·2015·41.72 MB·English

by  Mohammad Shenasa

EDITED BY:
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FOREWORD BY:
Hein J.J. Wellens, MD

THE ECG HA N D BO O K
O F CO N TEM P O RA RY
CHA LLEN G ES

THE ECG HA N D BO O K
O F CO N TEM P O RA RY
CHA LLEN G ES
EDITORS
Mohammad Shenasa, MD
Mark E. Josephson, MD
N.A. Mark Estes III, MD
© 2015 Mohammad Shenasa, Mark E. Josephson, N.A. Mark Estes III
Cardiotext Publishing, LLC
3405 W. 44th Street
Minneapolis, Minnesota 55410
USA
www.cardiotextpublishing.com
Any updates to this book may be found at: www.cardiotextpublishing.com/
ecg-handbook-of-contemporary-challenges
Comments, inquiries, and requests for bulk sales can be directed to the publisher at: [email protected].
All rights reserved. No part of this book may be reproduced in any form or by any means without the prior
permission of the publisher.
All trademarks, service marks, and trade names used herein are the property of their respective owners and are
used only to identify the products or services of those owners.
This book is intended for educational purposes and to further general scientific and medical knowledge,
research, and understanding of the conditions and associated treatments discussed herein. This book is not
intended to serve as and should not be relied upon as recommending or promoting any specific diagnosis or
method of treatment for a particular condition or a particular patient. It is the reader’s responsibility to
determine the proper steps for diagnosis and the proper course of treatment for any condition or patient,
including suitable and appropriate tests, medications or medical devices to be used for or in conjunction with
any diagnosis or treatment.
Due to ongoing research, discoveries, modifications to medicines, equipment and devices, and changes in
government regulations, the information contained in this book may not reflect the latest standards,
developments, guidelines, regulations, products or devices in the field. Readers are responsible for keeping up to
date with the latest developments and are urged to review the latest instructions and warnings for any medicine,
equipment or medical device. Readers should consult with a specialist or contact the vendor of any medicine or
medical device where appropriate.
Except for the publisher’s website associated with this work, the publisher is not affiliated with and does not
sponsor or endorse any websites, organizations or other sources of information referred to herein.
The publisher and the authors specifically disclaim any damage, liability, or loss incurred, directly or indirectly,
from the use or application of any of the contents of this book.
Unless otherwise stated, all figures and tables in this book are used courtesy of the authors.
Library of Congress Control Number: 2015931353
ISBN: 978-1-935395-88-1
Printed in The United States of America
CO NTENTS
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
Chapter 1: Normal Electrocardiograms Today . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Galen Wagner
Chapter 2: ECG Manifestations of Concealed Conduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Mohammad-Reza Jazayeri
Chapter 3: P-Wave Indices and the PR Interval—Relation to Atrial Fibrillation and Mortality. . . . . . . . . . . . . . 27
Konstantinos N. Aronis and Jared W. Magnani
Chapter 4: The Athlete’s Electrocardiogram. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Yousef Bader, Mark S. Link, and N.A. Mark Estes III
Chapter 5: E lectrocardiographic Markers of Arrhythmic Risk and Sudden Cardiac Death in
Pediatric and Adolescent Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Edward P. Walsh and Dominic J. Abrams
Chapter 6: Electrocardiographic Markers of Sudden Cardiac Death in Different Substrates . . . . . . . . . . . . . . . 83
Mohammad Shenasa and Hossein Shenasa
Chapter 7: E lectrocardiographic Markers of Arrhythmic Events and Sudden
Death in Channelopathies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Sergio Richter, Josep Brugada, Ramon Brugada, and Pedro Brugada
Chapter 8: Early Repolarization Syndrome: Its Relationship to ECG Findings and Risk Stratification. . . . . . . 125
Arnon Adler, Ofer Havakuk, Raphael Rosso, and Sami Viskin
Chapter 9: D iagnostic Electrocardiographic Criteria of Early Repolarization and Idiopathic
Ventricular Fibrillation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Mélèze Hocini, Ashok J. Shah, Pierre Jaïs, and Michel Haïssaguerre
Chapter 10: P revalence and Significance of Early Repolarization (a.k.a. Haïssaguerre or
J-Wave Pattern/ Syndrome) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Victor Froelicher
Chapter 11: T-Wave Alternans: Electrocardiographic Characteristics and Clinical Value . . . . . . . . . . . . . . . . . . 155
Stefan H. Hohnloser
Chapter 12: E lectrocardiographic Markers of Phase 3 and Phase 4 Atrioventricular Block and
Progression to Complete Heart Block. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
John M. Miller, Rahul Jain, and Eric L. Krivitsky
Chapter 13: M yocardial Infarction in the Presence of Left Bundle Branch Block or
Right Ventricular Pacing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Cory M. Tschabrunn and Mark E. Josephson
v
vi CONTENTS
Chapter 14: T-Wave Memory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Henry D. Huang, Mark E. Josephson, and Alexei Shvilkin
Chapter 15: Electrocardiographic Markers of Progressive Cardiac Conduction Disease . . . . . . . . . . . . . . . . . . . 191
Vincent Probst and Hervé Le Marec
Chapter 16: Sex- and Ethnicity-Related Differences in Electrocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Anne B. Curtis and Hiroko Beck
Chapter 17: Electrocardiograms in Biventricular Pacing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
John Rickard, Victor Nauffal, and Alan Cheng
Chapter 18: E ffect of Cardiac and Noncardiac Drugs on Electrocardiograms:
Electrocardiographic Markers of Drug-Induced Proarrhythmias
(QT Prolongation, TdP, and Ventricular Arrhythmias) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Chinmay Patel, Eyad Kanawati, and Peter Kowey
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
CO NTRIBUTO RS
Ed it o rs
Mohammad Shenasa, MD, FACC, FHRS, FAHA, FESC N.A. Mark Estes III, MD, FACC, FHRS, FAHA, FESC
Attending Physician, Department of Cardiovascular Professor of Medicine,
Services, O’Conner Hospital; Heart & Rhythm Tufts University School of Medicine;
Medical Group, San Jose, California Director, New England Cardiac Arrhythmia Center,
Tufts Medical Center, Boston, Massachusetts
Mark E. Josephson, MD, FACC, FHRS, FAHA
Chief, Cardiovascular Medicine Division; Director,
Harvard-Thorndike Electrophysiology Institute and
Arrhythmia Service, Beth Israel Deaconess Medical
Center; Herman C. Dana Professor of Medicine,
Harvard Medical School, Boston, Massachusetts
Co n t rib u t o rs
Dominic J. Abrams, MD, MRCP Josep Brugada, MD, PhD
Assistant Professor of Pediatrics, Harvard Medical Chairman, Cardiovascular Center; Professor,
School; Director, Inherited Cardiac Arrhythmia Fundacio Clinic; Medical Director, Hospital Clinic,
Program, Boston Children’s Hospital, Boston, Barcelona, Spain
Massachusetts
Pedro Brugada, MD, PhD
Arnon Adler, MD Heart Rhythm Management Center,
Tel Aviv Medical Center, Tel Aviv University, Cardiovascular Center, Free University of Brussels,
Tel Aviv, Israel Brussels, Belgium
Konstantinos N. Aronis, MD Ramon Brugada, MD, PhD
Senior Resident, Department of Medicine, Dean of Faculty of Medicine, Reial Academia de
Boston University Medical Center, Medicinia de Catalunya, Barcelona, Spain
Boston, Massachusetts
Alan Cheng, MD
Yousef Bader, MD Associate Professor of Medicine;
Senior Fellow in Clinical Cardiac Electrophysiology, Director, Arrhythmia Device Service,
Tufts Medical Center, Division of Cardiac John Hopkins Hospital,
Electrophysiology; Instructor in Medicine, Baltimore, Maryland
Tufts University School of Medicine,
Boston, Massachusetts Anne B. Curtis, MD, FACC, FHRS, FACP, FAHA
Charles and Mary Bauer Professor and Chair,
Hiroko Beck, MD UB Distinguished Professor,
Assistant Professor, Clinical Cardiac Department of Medicine,
Electrophysiology, University of Buffalo, School of Medicine and Biomedical Sciences,
Buffalo, New York University of Buffalo, Buffalo, New York
vii
viii CONTRIBUTORS
Victor Froelicher, MD, FACC, FAHA, FACSM Peter Kowey, MD, FACC, FAHA, FHRS
Professor of Medicine, Professor of Medicine and Clinical Pharmacology,
Department of Cardiovascular Medicine, Jefferson Medical College; William Wikoff
Stanford University, Stanford, California Smith Chair in Cardiovascular Research, Lankenau
Institute for Medical Research,
Michel Haïssaguerre, MD Wynnewood, Pennsylvania
Hôpital Cardiologique du Haut-Lévêque and
the Université Victor Segalen Bordeaux II,
Eric L. Krivitsky, MD
Bordeaux, France
Electrophysiologist, Chattanooga Heart Institute,
Chattanooga, Tennessee
Ofer Havakuk, MD
Tel Aviv Medical Center, Cardiology Department,
Hervé Le Marec, MD, PhD
Tel Aviv, Israel
Professor of Cardiology, Director of L’institut du
thorax, Nantes University Hospital, Nantes, France
Mélèze Hocini, MD
Hôpital Cardiologique du Haut-Lévêque and
the Université Victor Segalen Bordeaux II, Mark S. Link, MD
Bordeaux, France Professor of Medicine, Tufts University School of
Medicine; Co-Director, Cardiac Electrophysiology
Stefan H. Hohnloser, MD and Pacemaker Laboratory; Director, Center for the
Professor of Medicine and Cardiology, Evaluation of Heart Disease in Athletes,
J.W. Goethe University, Boston, Massachusetts
Department of Cardiology,
Division of Clinical Electrophysiology,
Jared W. Magnani, MD, MS
Frankfurt, Germany
Assistant Professor, Department of Medicine,
Boston University School of Medicine,
Henry D. Huang, MD
Boston, Massachusetts
Clinical Electrophysiology Fellow,
Harvard-Thorndike Arrhythmia Institute,
John M. Miller, MD
Harvard Medical School; Beth Israel Deaconess
Professor of Medicine, Indiana University School of
Medical Center, Boston, Massachusetts
Medicine; Director, Clinical Cardiac
Electrophysiology, Indianapolis, Indiana
Rahul Jain, MD, MPH
Assistant Professor, Indiana University School of
Medicine; Cardiac Electrophysiology Service, VA Victor Nauffal, MD
Hospital, Indianapolis, Indiana Postdoctoral Fellow, Division of Cardiology,
Department of Medicine, Johns Hopkins Hospital,
Pierre Jaïs, MD Baltimore, Maryland
Department of Rhythmologie,
Hôpital Cardiologique du Haut-Lévêque
Chinmay Patel, MD, FACC
and the Université Bordeaux II,
Clinical Cardiac Electrophysiologist,
Bordeaux, France
Pinnacle Health Cardiovascular Institute,
Harrisburg, Pennsylvania
Mohammad-Reza Jazayeri, MD, FACC, FAHA
Director of Electrophysiology,
Vincent Probst, MD, PhD
Laboratory and Arrhythmia Service,
Professor of Cardiology, Director of the Cardiologic
Heart and Vascular Center,
Department, L’institut du thorax
Bellin Health Systems, Inc.,
Nantes University Hospital, Nantes, France
Green Bay, Wisconsin
Eyad Kanawati, MD Sergio Richter, MD
Cardiovascular Disease Fellow, Associate Professor of Medicine and Cardiology,
Department of Cardiology, Department of Electrophysiology,
Lankenau Medical Center, Heart Center – University of Leipzig,
Wynnewood, Pennsylvania Leipzig, Germany