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1.
Proc Natl Acad Sci U S A ; 112(32): E4495-504, 2015 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-26204914

RESUMO

Extrasystoles lead to several consequences, ranging from uneventful palpitations to lethal ventricular arrhythmias, in the presence of pathologies, such as myocardial ischemia. The role of working versus conducting cardiomyocytes, as well as the tissue requirements (minimal cell number) for the generation of extrasystoles, and the properties leading ectopies to become arrhythmia triggers (topology), in the normal and diseased heart, have not been determined directly in vivo. Here, we used optogenetics in transgenic mice expressing ChannelRhodopsin-2 selectively in either cardiomyocytes or the conduction system to achieve cell type-specific, noninvasive control of heart activity with high spatial and temporal resolution. By combining measurement of optogenetic tissue activation in vivo and epicardial voltage mapping in Langendorff-perfused hearts, we demonstrated that focal ectopies require, in the normal mouse heart, the simultaneous depolarization of at least 1,300-1,800 working cardiomyocytes or 90-160 Purkinje fibers. The optogenetic assay identified specific areas in the heart that were highly susceptible to forming extrasystolic foci, and such properties were correlated to the local organization of the Purkinje fiber network, which was imaged in three dimensions using optical projection tomography. Interestingly, during the acute phase of myocardial ischemia, focal ectopies arising from this location, and including both Purkinje fibers and the surrounding working cardiomyocytes, have the highest propensity to trigger sustained arrhythmias. In conclusion, we used cell-specific optogenetics to determine with high spatial resolution and cell type specificity the requirements for the generation of extrasystoles and the factors causing ectopies to be arrhythmia triggers during myocardial ischemia.


Assuntos
Complexos Cardíacos Prematuros/patologia , Miocárdio/patologia , Optogenética/métodos , Especificidade de Órgãos , Animais , Arritmias Cardíacas/complicações , Arritmias Cardíacas/patologia , Arritmias Cardíacas/fisiopatologia , Complexos Cardíacos Prematuros/complicações , Complexos Cardíacos Prematuros/fisiopatologia , Channelrhodopsins , Conexinas/metabolismo , Vasos Coronários/patologia , Vasos Coronários/fisiopatologia , Fenômenos Eletrofisiológicos , Humanos , Integrases/metabolismo , Ligadura , Masculino , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Isquemia Miocárdica/complicações , Isquemia Miocárdica/patologia , Isquemia Miocárdica/fisiopatologia , Miocárdio/metabolismo , Miócitos Cardíacos/metabolismo , Miócitos Cardíacos/patologia , Ramos Subendocárdicos/metabolismo , Ramos Subendocárdicos/patologia , Ramos Subendocárdicos/fisiopatologia , Proteína alfa-5 de Junções Comunicantes
2.
Tunis Med ; 95(2): 145-148, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29424877

RESUMO

Hisian extrasystoles originate from the His bundle. They are rare and usually misdiagnosed. In fact, they manifest on the EKG, with a p' wave located before, in or after the QRS complex. More rarely, the extrasystole blocks the propagation of the influx to the ventricles simulating a Mobitz II atrioventricular (AV) block. We report the case of a 36-Year-old woman with no medical History, suffering from presyncope and palpitations at rest. Her physical examination and EKG were normal. The 24-hour Holter monitoring showed some long periods with unexpected blocked p waves but with no significant pause. Considering her young age and the absence of causes of AV block, we performed an intracardiac electrophysiological study which showed hisian extrasystoles with normal conduction tissue properties at baseline and under flecainide. The diagnosis of hisian extrasystoles simulating Mobitz II AV block was made. A simple monitoring with beta-blockers therapy was recommended. Hisian extrasystoles may simulate first or second degree AV block with different therapeutic and prognostic implications. Nevertheless, these hisian extrasystoles may be the marker of a vulnerable AV conduction, long-term follow up should be considered.


Assuntos
Bloqueio Atrioventricular/diagnóstico , Fascículo Atrioventricular/anormalidades , Complexos Cardíacos Prematuros/diagnóstico , Adulto , Fascículo Atrioventricular/diagnóstico por imagem , Fascículo Atrioventricular/patologia , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/etiologia , Complexos Cardíacos Prematuros/etiologia , Complexos Cardíacos Prematuros/patologia , Complexos Cardíacos Prematuros/fisiopatologia , Diagnóstico Diferencial , Eletrocardiografia , Feminino , Humanos
3.
Med Sci Monit ; 17(7): CR369-75, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21709630

RESUMO

BACKGROUND: The aim of this study was to investigate the incidence and type of ECG changes in patients with leptospirosis regardless of clinical evidence of cardiac involvement. MATERIAL/METHODS: A total of 97 patients with serologically confirmed leptospirosis treated at the University Hospital for Infectious Diseases "Dr. Fran Mihaljevic" in Zagreb, Croatia, were included in this retrospective study. A 12-lead resting ECG was routinely performed in the first 2 days after hospital admission. Thorough past and current medical history was obtained, and careful physical examination and laboratory tests were performed. RESULTS: Abnormal ECG findings were found in 56 of 97 (58%) patients. Patients with abnormal ECG had significantly elevated values of bilirubin and alanine aminotransferase, lower values of potassium and lower number of platelets, as well as more frequently recorded abnormal chest x-ray. Non-specific ventricular repolarization disturbances were the most common abnormal ECG finding. Other recorded ECG abnormalities were sinus tachycardia, right branch conduction disturbances, low voltage of the QRS complex in standard limb leads, supraventricular and ventricular extrasystoles, intraventricular conduction disturbances, atrioventricular block first-degree and atrial fibrillation. Myopericarditis was identified in 4 patients. Regardless of ECG changes, the most commonly detected infection was with Leptospira interrogans serovar Australis, Leptospira interrogans serovar Saxkoebing and Leptospira kirschneri serovar Grippotyphosa. CONCLUSIONS: The ECG abnormalities are common at the beginning of disease and are possibly caused by the direct effect of leptospires or are the non-specific result of a febrile infection and metabolic and electrolyte abnormalities. New studies are required for better understanding of the mechanism of ECG alterations in leptospirosis.


Assuntos
Fibrilação Atrial/patologia , Bloqueio Atrioventricular/patologia , Complexos Cardíacos Prematuros/patologia , Eletrocardiografia , Leptospirose/fisiopatologia , Taquicardia Sinusal/patologia , Adulto , Alanina Transaminase/sangue , Fibrilação Atrial/etiologia , Bloqueio Atrioventricular/etiologia , Bilirrubina/sangue , Complexos Cardíacos Prematuros/etiologia , Croácia , Feminino , Humanos , Leptospirose/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taquicardia Sinusal/etiologia
4.
Phys Rev E Stat Nonlin Soft Matter Phys ; 79(3 Pt 1): 031921, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19391985

RESUMO

Cardiac mechanoelectric feedback can play an important role in different heart pathologies. In this paper, we show that mechanoelectric models which describe both the electric propagation and the mechanic contraction of cardiac tissue naturally lead to close systems of equations with global coupling among the variables. This point is exemplified using the Nash-Panfilov model, which reduces to a FitzHugh-Nagumo-type equation with global coupling in the linear elastic regime. We explain the appearance of self-oscillatory regimes in terms of the system nullclines and describe the different dynamical attractors. Finally, we study their basin of attraction in terms of the system size and the strength of the stretch-induced currents.


Assuntos
Condutividade Elétrica , Retroalimentação Fisiológica , Coração/fisiologia , Modelos Biológicos , Miocárdio/citologia , Fenômenos Biomecânicos , Complexos Cardíacos Prematuros/patologia , Complexos Cardíacos Prematuros/fisiopatologia , Elasticidade , Coração/fisiopatologia
5.
Physiol Res ; 66(4): 581-589, 2017 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-28406705

RESUMO

Hypertrophied hearts are known for increased risk of arrhythmias and are linked with reduced ischemic tolerance. However, still little is known about state characterized only by increased left ventricle (LV) mass fraction. Seventeen isolated rabbit hearts with various LV mass were divided into two groups according to LV weight/heart weight ratio (LVW/HW ratio), namely group H and L (with higher and lower LVW/HW ratio, respectively) and underwent three short cycles of global ischemia and reperfusion. The differences in electrogram (heart rate, QRS(max), mean number, onset and dominant form of ventricular premature beats) and in biochemical markers of myocardial injury (creatine kinase, lactate dehydrogenase - LDH) and lipid peroxidation (4-hydroxy-2-nonenal - 4-HNE) were studied. As compared to group L, hearts in group H exhibited lower tolerance to ischemia expressed as higher incidence and severity of arrhythmias in the first ischemic period as well as increase of LDH and 4-HNE after the first reperfusion. In the third cycle of ischemia-reperfusion, the preconditioning effect was observed in both electrophysiological parameters and LDH release in group H. Our results showed consistent trends when comparing changes in electrograms and biochemical markers. Moreover, 4-HNE seems to be good potential parameter of moderate membrane alteration following ischemia-reperfusion injury.


Assuntos
Complexos Cardíacos Prematuros/fisiopatologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Isquemia Miocárdica/fisiopatologia , Traumatismo por Reperfusão Miocárdica/fisiopatologia , Animais , Complexos Cardíacos Prematuros/patologia , Feminino , Coração , Hipertrofia Ventricular Esquerda/patologia , Preparação de Coração Isolado/métodos , Masculino , Isquemia Miocárdica/patologia , Traumatismo por Reperfusão Miocárdica/patologia , Coelhos
6.
J Am Coll Cardiol ; 20(2): 359-62, 1992 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-1378859

RESUMO

OBJECTIVE: The objective of this study was to evaluate the histologic features of the myocardium in children with abnormal ventricular ectopic rhythm but a structurally normal heart. BACKGROUND: Abnormal ventricular ectopic rhythm in children with a structurally normal heart is an uncommon but serious condition. Previous studies in adults with these findings have shown that approximately 10% have "primary electrical disease" and that 40% to 100% of these have abnormal histologic findings. METHODS: Endomyocardial biopsy samples were obtained prospectively in 33 subjects presenting with ventricular ectopic rhythm but a structurally normal heart by physical examination and noninvasive studies. Biopsy specimens were evaluated for histologic changes consistent with dilated cardiomyopathy or myocarditis and these results were compared with noninvasive and invasive clinical findings. RESULTS: Of the 33 subjects, 16 (48%) had normal myocardial histologic features (Group A), 14 (42%) had changes similar to the histologic features seen with idiopathic dilated cardiomyopathy (Group B) and 3 (9%) had lymphocytic myocarditis (Group C). Presenting clinical symptoms, surface electrocardiograms (ECGs), exercise stress testing and electrophysiologic stimulation tests failed to predict the biopsy results. Twenty-four-hour ambulatory ECGs showed a statistical difference between sustained and nonsustained ventricular tachycardia in Group A versus Group B (p less than 0.007), with Group A having more sustained ventricular tachycardia. Left ventricular function measured by fractional shortening on echocardiography did not differ between groups, but left ventricular end-diastolic dimension was greater in the subjects with abnormal histologic findings (Group B) (p less than 0.03). CONCLUSIONS: These results provide evidence that approximately 50% of children with abnormal ventricular ectopic rhythm but a structurally normal heart may have subclinical cardiomyopathy or unsuspected myocarditis.


Assuntos
Complexos Cardíacos Prematuros/patologia , Cardiomiopatia Dilatada/patologia , Miocardite/patologia , Miocárdio/patologia , Taquicardia/patologia , Biópsia , Complexos Cardíacos Prematuros/diagnóstico , Complexos Cardíacos Prematuros/etiologia , Cardiomiopatia Dilatada/complicações , Criança , Feminino , Humanos , Masculino , Miocardite/complicações , Taquicardia/diagnóstico , Taquicardia/etiologia
7.
Cardiovasc Res ; 21(4): 286-92, 1987 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-2443245

RESUMO

Tachycardia is known to increase the size of an evolving myocardial infarction, but the effect of frequent ventricular extrasystoles on infarct size is unknown. To determine the effect dogs were allocated to a control group (n = 15) or to groups of dogs with electrically induced ventricular bigeminy. Ventricular extrasystoles with short coupling intervals (mean 251 ms) were used to simulate interpolated premature complexes in 10 dogs, and extrasystoles with long coupling intervals (mean 606 ms) resulting in compensatory pauses were applied in 10 additional dogs. All dogs underwent single stage left anterior descending coronary artery ligation followed by a 6 h monitoring period. Premature stimulation was begun at the time of coronary artery occlusion and continued throughout the observation period. The ratio of myocardial infarct size to the region at risk of infarction was substantially larger in dogs with electrically induced, closely coupled extrasystoles (0.58(0.07); p less than 0.01) than in control dogs (0.24(0.06)) or dogs with widely coupled induced extrasystoles (0.32(0.07)). It is concluded that frequent closely coupled ventricular extrasystoles can increase the size of an evolving acute myocardial infarction.


Assuntos
Complexos Cardíacos Prematuros/complicações , Infarto do Miocárdio/patologia , Animais , Pressão Sanguínea , Complexos Cardíacos Prematuros/patologia , Cães , Estimulação Elétrica , Eletrocardiografia , Feminino , Frequência Cardíaca , Ventrículos do Coração/patologia , Masculino , Infarto do Miocárdio/etiologia , Tamanho do Órgão
8.
Int J Cardiol ; 10(3): 263-75, 1986 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-2420728

RESUMO

The contractile pattern of the regional left ventricular wall during premature ventricular contraction was analyzed in conscious dogs instrumented with an ultrasonic dimension gauge across the anterior and posterior left ventricular walls. Aortic flow was measured with an electromagnetic flow probe. A single premature ventricular contraction was induced by stimulating either the anterior or posterior wall with varied coupling intervals from 380 to 650 msec. Stroke volume of premature ventricular contraction was significantly smaller than that of premature atrial contraction with identical coupling intervals. In premature contractions, stroke volume was linearly related to coupling intervals. Though there was no isovolumic wall thickening in premature atrial contraction, the wall started to thicken during isovolumic ventricular systole in premature ventricular contraction. There was a clear inverse correlation between the ratio of the isovolumic wall thickening to the total wall thickening and coupling intervals. In premature ventricular contractions with identical coupling intervals, the deformation of thickening characteristics was more pronounced in regions with closer proximity to the ectopic focus. Thus it is concluded that the pump function is depressed in premature ventricular contraction, in part due to the increased ratio of wall thickening during isovolumic systole before the opening of the aortic valve. Isovolumic wall thickening increases along with the shorter coupling intervals and closer proximity to the ectopic focus. These alterations in left ventricular mechanical function due to ectopic contraction might induce serious sequelae, depending upon the ectopic focus in the presence of already depressed regional function.


Assuntos
Complexos Cardíacos Prematuros/patologia , Volume Cardíaco , Ventrículos do Coração/patologia , Animais , Estimulação Cardíaca Artificial , Cães , Eletrocardiografia , Hemodinâmica , Contração Miocárdica , Miocárdio/patologia , Volume Sistólico
9.
J Am Vet Med Assoc ; 184(5): 541-5, 1984 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-6200467

RESUMO

Premature ventricular contractions and ventricular tachycardia were detected in 10 dogs 1 to 48 hours after trauma. All dogs were treated aggressively if the arrhythmias became severe. One dog died, 8 were discharged with stable cardiac rhythm, and 1 was euthanatized. Necropsy revealed gross and microscopic lesions of acute myocardial necrosis, probably of ischemic origin. Cardiac arrhythmias were associated with thoracic trauma, neurologic injury, severe shock, and/or extensive tissue trauma.


Assuntos
Complexos Cardíacos Prematuros/veterinária , Doenças do Cão/etiologia , Taquicardia/veterinária , Ferimentos e Lesões/veterinária , Animais , Complexos Cardíacos Prematuros/etiologia , Complexos Cardíacos Prematuros/patologia , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/veterinária , Doenças do Cão/patologia , Cães , Eletrocardiografia , Feminino , Masculino , Miocárdio/patologia , Necrose , Choque/complicações , Choque/veterinária , Taquicardia/etiologia , Taquicardia/patologia , Traumatismos Torácicos/complicações , Traumatismos Torácicos/veterinária , Ferimentos e Lesões/complicações
10.
Klin Med (Mosk) ; 74(5): 17-20, 1996.
Artigo em Russo | MEDLINE | ID: mdl-8999174

RESUMO

7-day monitoring of cardiac rhythm has been conducted in 42 patients with myocardial infarction (MI) and 15 patients with chronic ischemic heart disease. Hour-by-hour analysis of extrasystole demonstrates that probability of ventricular arrhythmia is maximal in transmural MI, the first 3 days of acute MI are most arrhythmogenic. Follow-up of ventricular ectopic activity (VEA) showed the latter to significantly enhance early in the morning, afternoon and on the first 5 days after midnight. In unpenetrating MI, VEA intensifies in the morning, afternoon and postmidnight hoars. Atrial ectopic activity (AEA) in transmural MI enhances early in the morning, afternoon and at night (on the first 3 days). AEA in unpenetrating MI is more intensive late in the morning and afternoon.


Assuntos
Complexos Cardíacos Prematuros/patologia , Ritmo Circadiano , Infarto do Miocárdio/patologia , Doença Aguda , Idoso , Complexos Atriais Prematuros/patologia , Complexos Cardíacos Prematuros/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Fatores de Tempo , Complexos Ventriculares Prematuros/patologia
11.
PLoS One ; 7(6): e38430, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22701639

RESUMO

BACKGROUND: To study the applicability of prospective ECG-gated 320-detector CT coronary angiography (CTCA) in patients with ventricular premature beats (VPB), and determine the scanning mode that best maximizes image quality and reduces radiation dose. METHODS: 110 patients were divided into a VPB group (60 cases) and a control group (50 cases) using CTCA. All the patients then underwent coronary angiography (CAG) within one month. CAG served as a reference standard through which the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CTCA in diagnosing significant coronary artery stenosis (luminal stenosis ≥50%) could be analyzed. The two radiologists with more than 3 years' experience in cardiac CT each finished the image analysis after consultation. A personalized scanning mode was adopted to compare image quality and radiation dose between the two groups. METHODOLOGY/PRINCIPAL FINDINGS: At the coronary artery segment level, sensitivity, specificity, PPV, and NPV in the premature beat group were 92.55%, 98.21%, 88.51%, and 98.72% respectively. In the control group these values were found to be 95.79%, 98.42%, 90.11%, and 99.28% respectively. Between the two groups, specificity, sensitivity PPV, NPV was no significant difference. The two groups had no significant difference in image quality score (P>0.05). Heart rate (77.20±12.07 bpm) and radiation dose (14.62±1.37 mSv) in the premature beat group were higher than heart rate (58.72±4.73 bpm) and radiation dose (3.08±2.35 mSv) in the control group. In theVPB group, the radiation dose (34.55±7.12 mSv) for S-field scanning was significantly higher than the radiation dose (15.10±1.12 mSv) for M-field scanning. CONCLUSIONS/SIGNIFICANCE: With prospective ECG-gated scanning for VPB, the diagnostic accuracy of coronary artery stenosis is very high. Scanning field adjustment can reduce radiation dose while maintaining good image quality. For patients with slow heart rates and good rhythm, there was no statistically significant difference in image quality.


Assuntos
Complexos Cardíacos Prematuros/etiologia , Angiografia Coronária/métodos , Estenose Coronária/complicações , Estenose Coronária/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Complexos Cardíacos Prematuros/patologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e Especificidade
18.
Circulation ; 70(5): 793-8, 1984 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-6207954

RESUMO

The incidence of the coexistence of left ventricular false tendons and premature ventricular contractions (PVCs) was evaluated prospectively. Over 14 months, left ventricular false tendons were found in 71 (6.4%) of 1117 consecutive patients examined echocardiographically. Two types of false tendons were observed: longitudinal, from the ventricular septum to the posteroapical wall (n = 62), and transverse, between the septum and the lateral wall (n = 9). Among 62 patients with PVCs and no underlying heart disease, false tendons were detected in 35 (56%); 28 had unifocal and seven had bifocal PVCs. Episodes of ventricular tachycardia were documented in one of the 28 patients with unifocal PVCs and in one of the seven patients with bifocal PVCs. These PVCs were poorly controlled by antiarrhythmic drugs but easily suppressed by exercise. Left ventricular false tendons were detected in 36 patients on routine echocardiographic examinations performed in the other 1055 subjects, and 10 of these patients were judged to have no underlying heart disease. PVCs were detected in two (20%) of these 10 patients. Although a definite conclusion that left ventricular false tendons are arrhythmogenic cannot be derived from these results, the unexpectedly high incidence of the coexistence suggests that left ventricular false tendons may be an etiologic factor in the development of PVCs, especially the rate-dependent and medically uncontrollable PVCs seen in apparently healthy individuals.


Assuntos
Complexos Cardíacos Prematuros/patologia , Ventrículos do Coração/patologia , Adolescente , Adulto , Idoso , Criança , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Estudos Prospectivos , Ramos Subendocárdicos/patologia
19.
Eur Heart J ; 13(6): 732-7, 1992 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-1378010

RESUMO

This report describes the results of right ventricle endomyocardial biopsies from 26 subjects (mean age 27 +/- 10 years) with premature ventricular beats and normal cardiac anatomy and mechanical function. Light microscopy examination revealed normal myocardium in 10 subjects (38%), acute myocarditis in two (7%), borderline myocarditis in one (3.5%), non-specific histological abnormalities including cellular hypertrophy, fibrosis and degenerative changes in 11 (42%), vasculitis in one (3.5%) and findings compatible with right ventricular dysplasia in the final subject (3.5%). The frequency of ventricular premature beats, as assessed by Holter monitoring, and the results of electrophysiological testing did not correlate with histopathological findings and their severity. These data indicate that some young subjects with premature ventricular beats of unknown origin have abnormal right ventricular biopsy findings. Adequate follow-up will probably demonstrate the clinical utility of these observations.


Assuntos
Complexos Cardíacos Prematuros/patologia , Doença Aguda , Adulto , Biópsia por Agulha , Complexos Cardíacos Prematuros/complicações , Complexos Cardíacos Prematuros/fisiopatologia , Eletrocardiografia Ambulatorial , Feminino , Ventrículos do Coração/patologia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Miocardite/complicações , Miocardite/patologia , Função Ventricular Direita/fisiologia
20.
Z Rechtsmed ; 100(2-3): 176-89, 1988.
Artigo em Alemão | MEDLINE | ID: mdl-2459862

RESUMO

Partial absence and fatty replacement of the myocardial compacta of the right ventricular wall was observed in five young male adults, four of whom died suddenly and unexpectedly and one in a car accident. In one of these cases there was only one coronary orifice. Four cases of the so-called Uhl anomaly had histological findings indicating dysmorphic myocardial cells associated with minimal lymphohistiocytic infiltrates within the fatty tissue. In one case, chronic destructive inflammation was a prominent feature. Marked dysmorphic alterations in the myocardial fibers suggested the occurrence of arrhythmic episodes as the main cause of sudden heart failure and death.


Assuntos
Cardiomiopatias/congênito , Morte Súbita/patologia , Ventrículos do Coração/anormalidades , Tecido Adiposo/patologia , Adolescente , Adulto , Complexos Cardíacos Prematuros/patologia , Cardiomiopatias/patologia , Causas de Morte , Diagnóstico Diferencial , Insuficiência Cardíaca/patologia , Ventrículos do Coração/patologia , Humanos , Masculino
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