Atrioventricular block in acute inferior wall myocardial infarction: harbinger of associated obstruction of the left anterior descending coronary artery.

In a prospective study 51 consecutive patients who survived the acute phase of inferior wall myocardial infarction underwent coronary arteriography. Eleven patients developed some degree of atrioventricular (AV) block in the acute phase of infarction that disappeared within a few days and was considered by electrocardiographic analysis to be located in the AV node. Patients with AV block during acute myocardial infarction had a significantly higher prevalence of left anterior descending coronary artery obstruction (91 versus 55%, p less than 0.05) than did patients without AV block and the obstruction preceded the exit of the first septal perforator branch in 73% of cases with heart block and in 30% of cases without block (p less than 0.01). The sensitivity, specificity and predictive values were 31, 95 and 91%, respectively, for the existence of left anterior descending coronary artery obstruction when AV block occurred during acute inferior myocardial infarction, and 40, 90 and 73%, respectively, for the occurrence of the coronary artery obstruction before the exit of the first septal perforator branch. Patients with inferior myocardial infarction and left anterior descending coronary artery obstruction have a sixfold greater chance of developing heart block in the acute phase of infarction than do patients with inferior infarction without such obstruction (p less than 0.05). These findings also support the observations that the proximal AV conduction system usually has a dual arterial blood supply from both the right and left anterior descending coronary arteries, and may explain the transient behavior of heart block and lack of necrosis of the AV node seen in these patients.

Electrical behavior of T-wave polarity alternans in patients with congenital long QT syndrome.

OBJECTIVES: This study was designed to evaluate the incidence and characteristics of onset of T-wave polarity alternans (TWPA) in patients with long QT syndrome. BACKGROUND: The T-wave alternans is a phenomenon that consists of beat-to-beat variability in the amplitude, morphology, and sometimes polarity of the T-wave, and it may trigger life-threatening arrhythmias. METHODS: The 24-h Holter recordings of 11 patients with congenital long QT syndrome were studied. Episodes of TWPA with 10 or more consecutive cycles were selected and analyzed as follows: 1) mean cycle length (MCL) and QTc interval duration (QTcI) of the episodes of TWPA and the 10 cycles preceding and succeeding the TWPA; 2) MCL and QTcI of the third, second, and first minute before onset (Mn_3, Mn_2, Mn_1); 3) MCL and QTcI from the tenth to the first cycle immediately preceding the onset of TWPA (R_10 to R_1); 4) MCL and QTcI from the first to the fourteenth cycle during alternans (R0 to R14); 5) MCL and QTcI from the first to the tenth cycle immediately succeeding TWPA (R+1 to R+10); 6) linear correlation (Lnc) between QT interval and cycle length (CL) (LncQT/CL) during alternans and for the 10 preceding cycles; 7) Lnc between the first three alternans cycles and episode duration (Lnc 3CL/EpD); and 8) difference between the longest and shortest QTc interval. We also selected episodes consisting of four or more consecutive cycles in order to analyze daily rhythms of the phenomenon. RESULTS: The TWPA was observed in 5 (45%) out of the 11 patients studied. The alternans process is initiated by a sudden shortening of the first alternans cycle without previous heart rate changes and ends at the moment when prolongation of the cycle tends to occur. LncQT/ CL-alternans: r = 0.38 +/- 0.2 (p = 0.20); without alternans: r = 0.81 +/- 0.06 (p = 0.01). Lnc 3CL/EpD: r = 0.002 (p = 0.992). The QTc difference during alternans: 312.0 +/- 52.1 ms; without alternans: 86.0 +/- 36.4 ms (p = 0.001). Daily rhythm: 71% of the episodes occurred between 8 AM and 8 PM, with higher incidence during the morning. CONCLUSIONS: The TWPA was dependent on the cardiac CL; there was loss of the LncQT/CL and an increase in the QT interval variability. Like other biological variables, T-wave polarity alternans has a higher density during the morning.

Signal-averaged P wave in patients with Wolff-Parkinson-White syndrome after successful radiofrequency catheter ablation.

OBJECTIVES: We attempted to establish a relation between the atrial conduction time assessed by the signal-averaged P wave electrocardiogram and episodes of paroxysmal atrial fibrillation in patients with the Wolff-Parkinson-White syndrome. BACKGROUND: The incidence of paroxysmal atrial fibrillation is higher in patients with the Wolff-Parkinson-White syndrome than in normal persons. However, the role of intraatrial conduction delay in precipitating the disorganization of atrial rhythm is not completely understood. METHODS: The total duration of the signal-averaged P wave and the P wave in standard lead II was evaluated after successful radiofrequency catheter ablation in 28 patients with the Wolff-Parkinson-White syndrome. The data obtained from 17 patients (61%) with a documented history of prior paroxysmal atrial fibrillation (group I) were compared with those obtained from 11 patients (39%) without a history of atrial fibrillation (group 2). Both groups were further compared with a normal control population. RESULTS: The mean +/- SD signal-averaged P wave duration in group 1 was 141.94 +/- 9.47 ms (range 130.0 to 171.0). Fourteen patients (82%) in this group showed a P wave duration > 135.0 ms. In group 2, the signal-averaged P wave duration was 126.64 +/- 8.72 ms (range 111.0 to 136.0). Only one patient in this group (9%) showed a P wave duration > 135.0 ms (p < 0.000, group 1 vs. group 2). The signal-averaged P wave duration in the control group was 124.46 +/- 4.49 ms (range 115.0 to 129.5; p < 0.000, group 1 vs. the control group; p < 0.454, group 2 vs. the control group). The P wave duration in lead II was 92.06 +/- 8.85 ms in group 1 and 92.27 +/- 7.86 ms in group 2 (p < 0.949). Using a cutoff value of < 135.0 ms for a normal signal-averaged P wave duration, the method had a sensitivity and specificity and positive and negative predictive values of 82%, 91%, 93% and 77%, respectively, for identifying patients with clinical paroxysmal atrial fibrillation. CONCLUSIONS: In the current study, the signal-averaged P wave showed a prolonged intraatrial conduction time in patients with the Wolff-Parkinson-White syndrome and paroxysmal atrial fibrillation. These patients can be differentiated from those with the pre-excitation syndrome without clinical atrial fibrillation as well as from normal subjects. The prolonged intraatrial conduction time may serve as an atrial substratum for development and maintenance of the fibrillatory state.

Low temperature and aging-promoted expression of PUMP in potato tuber mitochondria.

In this communication, we show that the plant uncoupling mitochondrial protein (PUMP) present in potato tuber mitochondria is induced by aging at 28 degrees C and that this induction is strongly stimulated when the potato tubers are stored at low temperature (4 degrees C). PUMP activity was detected by the degree of linoleic acid (LA)-induced ATP-sensitive mitochondrial uncoupling measured as a function of the decrease in membrane potential (delta psi). The PUMP content was evaluated by immunoblot analysis using polyclonal antibodies raised against potato PUMP that specifically detected a 32 kDa band. In agreement with the effect of LA on delta psi, the content of the 32 kDa band increased during storage and was stimulated by low temperature. These results support the proposed role of PUMP in plant thermogenesis and possibly in fruit ripening and senescence.

AtPUMP: an Arabidopsis gene encoding a plant uncoupling mitochondrial protein.

A cDNA clone (AtPUMP) encoding a plant uncoupling mitochondrial protein was isolated from Arabidopsis thaliana. The cDNA contains an open reading frame of 921 nucleotides encoding 306 amino acids (predicted molecular weight 32,708). The predicted polypeptide is 81% identical and 89% similar to the potato UCP-like protein, and includes an energy transfer protein motif common to mitochondrial transporters. The AtPUMP gene exists as a single copy in the Arabidopsis genome. The corresponding transcript was expressed in all tissues and was strongly induced by cold treatment. We suggest that the putative AtPUMP protein may play a role in heat-requiring physiological events in Arabidopsis.

Functional reconstitution of Arabidopsis thaliana plant uncoupling mitochondrial protein (AtPUMP1) expressed in Escherichia coli.

The Arabidopsis thaliana uncoupling protein (UCP) gene was expressed in Escherichia coli and isolated protein reconstituted into liposomes. Linoleic acid-induced H+ fluxes were sensitive to purine nucleotide inhibition with an apparent K(i) (in mM) of 0.8 (GDP), 0.85 (ATP), 0.98 (GTP), and 1.41 (ADP); the inhibition was pH-dependent. Kinetics of AtPUMP1-mediated H+ fluxes were determined for lauric, myristic, palmitic, oleic, linoleic, and linolenic acids. Properties of recombinant AtPUMP1 indicate that it represents a plant counterpart of animal UCP2 or UCP3. This work brings the functional and genetic approaches together for the first time, providing strong support that AtPUMP1 is truly an UCP.

Mitochondrial uncoupling proteins in mammals and plants.

Uncoupling proteins (UCPs) belong to a distinct cluster of the mitochondrial anion carrier family. Up to five different uncoupling protein types were found in mitochondria of mammals and plants, and recently in fishes, fungi and protozoa. They exhibit a significantly conserved structure with several motifs specific to either the whole cluster or protein type. Uncoupling proteins, as well as the whole mitochondrial anion carrier gene family, probably emerged in evolution before the separation of animal, fungi, and plant kingdoms and originate from an anion/nucleotide or anion/anion transporter ancestor. Mammalian UCP1, UCP2, UCP3, and plant uncoupling proteins pUCP1 and pUCP2 are similar and seem to form one subgroup, whereas UCP4 and BMCP1 belong to a different group. Molecular, biochemical, and phylogenic data suggest that UCP2 could be considered as an UCP-prototype. UCP1 plays its biological role mainly in the non-shivering thermogenesis while the role of the other types is unknown. However, hypotheses have suggested that they are involved in the general balance of basic energy expenditure, protection from reactive oxygen species, and, in plants, in fruit ripening and seed ontogeny.

Early events in virus-plant interactions.

1. Plant viruses can only enter their host through a wounded plant cell. Once in the cytoplasm, the virion must be disassembled, and for certain viruses with a "+" RNA genome, cotranslational disassembly of virus particles has been described. 2. Subsequent to viral protein synthesis which requires the host translational machinery, the "+" RNA genome is replicated in the cytoplasm. Viral genome amplification requires at least one viral-coded non-structural protein in conjunction with one or more host factors. 3. Early events in virus infection can be studied in systems that hinder these events. This is the case of natural hosts that are resistant to viruses: mutant viruses which overcome such resistance have been described. It is also the case of genetically engineered plants that are protected from virus infection. Both types of systems should help in determining the mode of interaction involved, and possibly also the host factor(s) involved in the various steps of virus infection.

[Torsades de pointes: analysis of 105 episodes]. / Torsades de pointes: análise de 105 episódios.

PURPOSE: To analyze episodes of Torsades de Pointes (TP), in search of its electrocardiographic characteristics. PATIENTS AND METHODS: We analyzed 105 episodes of TP, in 4 patients using quinidine and diuretics, recorded by 24-hour Holter monitoring. The following parameters were studied; ventricular repolarization out of TP, rhythm disturbances before TP; ECG characteristics of the onset, the bouts and the end of the TP. RESULTS: Ventricular repolarization, out of the TP, was abnormal, with the presence of U-waves at the end of the T-waves, resulting in prolongation of the QT (QU) interval. The U-wave voltage was noted to be cycle-length dependent. Ventricular bigeminy preceded TP in 100 episodes (95%) and the mean interval between both parameters was 18 +/- 16 min. The onset of the TP episodes showed the "short/long/short cycle rule", hereby called "pre-pause cycle", "preparing cycle" and "trigger cycle" respectively. The rotatory QRS-T morphology around the baseline, was seen in 75% of episodes, at the beginning or throughout the bout. Monomorphic ventricular tachycardia pattern was seen in the other 25% of episodes. Termination of bouts was sudden in all cases, and persistent ventricular bigeminy led to another bout in 90 episodes (85%). CONCLUSION: In TP patients, there is enlargement of QT intervals mostly due to U-waves appearance. The U-waves seen in these cases, probably have an important role in the genesis of TP and are probably related to ventricular after-potentials (triggered activity). Ventricular bigeminy is a premonitory sign of TP in patients using class 1A antiarrhythmic drugs. Persistent ventricular bigeminy post-TP episodes is a strong indicator of another bout of TP. The onset of TP is more important than its morphology for the correct diagnosis of this arrhythmia.

The Brugada syndrome. Outcome of one case.

The Brugada syndrome is a rare condition, and due to its mutating manner of presentation it may be difficult to diagnose. We report one case and discuss the diagnostic aspects and the clinical outcome of one patient with characteristic findings of this syndrome. These findings are especially defined by J-ST elevation in the right leads of serial electrocardiographic records, wide oscillations of J points and ST segments during 24-hour Holter monitoring, and nocturnal sudden death. We stress the importance of the Holter monitor findings for diagnostic complementation. Through this method it is possible to establish a correlation between vigil activities and sleep and the variability of the degree of impairment in ventricular repolarization.

[High-resolution P-wave electrocardiogram in patients with a history of paroxysmal atrial fibrillation]. / O eletrocardiograma de alta resolução da onda P em pacientes com história de fibrilação atrial paroxística.

PURPOSE: To study by using the signal-averaged P wave, the atrial activation of patients with documented episodes of paroxysmal atrial fibrillation (PAF). METHODS: This study enrolled a total of 20 patients with documented episodes of paroxysmal atrial fibrillation (males 14; mean age 58.4 +/- 10.6 years). The signal-averaged P wave was recorded with a Corazonix Predictor II system. The total P wave duration was determined from the combined filtered x,y,z vector-magnitude and used for analysis. The results were compared with a normal group of 10 patients, matched in age. RESULTS: In the control group, the total P wave duration ranged from 120.0 to 135.0 (mean = 128.3 +/- 5.8) ms. In the group of PAF, the total P wave duration ranged from 118.0 to 168.5 (mean = 151.5 +/- 13.7) ms (p < 0.000). Sixteen (80%) of this patients showed a P wave duration > 140.0 ms. With a cut < 140.0 ms for the normal atrial activation, the sensitivity was 76%, specificity was 100%, positive and negative predictive value were 100% and 60% respectively for the method detected patients with PAF. CONCLUSION: Patients with PAF showed a prolonged signal-averaged P wave duration and should be differentiated by this method from the normal population.

[R-R variability in acute anterior infarct after thrombolytic therapy]. / Variabilidade de R-R no infarto agudo anterior após a terapêutica trombolítica.

PURPOSE: To analyse the effects of thrombolysis on the integrity of the autonomic nervous system, in patient with acute myocardial infarction (AMI) of the anterior wall, using the determination of the heart rate variability. METHODS: We prospectively evaluated the R-R variability of the 31 consecutive patients with anterior AMI submitted to coronary thrombolysis (25 males; mean age 59 +/- 14 years) from Holter tapes. An algorithm in a 286 computer program was used for heart rate variability (HRV). With this system, R-R variations during sinus rhythm and for a five consecutive minutes periods was determined. The results were expressed as the mean of the total determined periods; the standard deviation of the mean of all determined periods and the mean of the standard deviation. The reperfusion criteria was the early enzymatic rise of the CKMB activity levels (< or = 12 h) combined with a 50% or more reduction in the ST segment elevation within the first hour after thrombolytic therapy and the presence of an accelerated idioventricular rhythm at the same time. The reperfused group (group 1 = 16 patients) and non-reperfused group (group 2 = 15 patients) were compared in terms of R-R variability. RESULTS: Mean R-R: group 1 = 716 +/- 84 ms (540-820 ms); group 2 = 595 +/- 115 ms (390-870 ms)-p < 0.02. ms (34-92 ms); group 2 = 50 +/- 14 ms (23-77 ms)-p < 0.01. HRV 50 ms: group 1 = 2 patients; group 2 = 5 patients. Means SD of the R-R: group 1 = 44 +/- 14 ms (26-65 ms); group 2 = 39 +/- 17 ms (19-69 ms)-p: ns. CONCLUSION: Patients with anterior AMI and thrombolytic therapy demonstrate greater HRV; this finding suggested better integrity of the autonomic nervous system, with possible effects on prognosis.

[Antiarrhythmic drug effectiveness. Proposal for a new approach based on pharmacological hourly effects]. / Efficácia das drogas antiarrítmicas. Proposta para uma nova forma de avaliação baseada nos efeitos farmacológicos horários.

PURPOSE: To use a new approach in order to assess the antiarrhythmic drugs, based in the hourly autonomic effects and antiarrhythmic efficacy of sotalol. METHODS: Sixteen patients were evaluated in a randomized double-blind placebo-controlled study. Patients were classified in group 1 (anti-arrhythmic efficacy) and group 2 (no antiarrhythmic efficacy). The following parameters were analyzed: 1) clinical variables as age, gender, cardiac disease and ventricular ectopies density; 2) drug effects on pNN50 in 24-hour and on mean hourly cardiac cycle length; 3) percentage of hourly ventricular ectopies distribution and its correlation with pNN50 and with mean hourly cardiac cycle length in all patients; 4) drug effects on mean hourly cardiac cycle length in groups 1 and 2; 5) correlation between hourly pNN50 and ventricular ectopies density after sotalol administration in groups 1 and 2; 6) hourly drug efficacy in groups 1 and 2 and correlation with pNN50. RESULTS: Efficacy of the drug was present in 8 (50%) patients. Sotalol significantly increased 24-hour pNN50 (placebo 5.01 +/- 2.02%; after drug, 11.70 +/- 5.59%-p < 0.001), also increasing mean hourly cardiac cycle length during the day and night, in all patients (placebo 758.25 +/- 75.68 ms; after drug 967.71 +/- 80.17 ms-p < 0.000). It was noted that patients under placebo had different autonomic tonus; group 1 showed higher sympathetic activity as compared to group 2. Hourly drug efficacy was seen in 23 of 24-hour recordings in group 1 while it was not seen at any time in group 2. CONCLUSION: Sotalol significantly increased parasympathetic cardiac activity. The anti-arrhythmic response was related to the autonomic tonus seen before and after drug administration.

[Contribution of dynamic electrocardiography by Holter monitoring in the evaluation of congenital long QT syndrome patients]. / Contribuição de eletrocardiografia dinâmica pelo sistema Holter na avaliação de pacientes com a síndrome congênita do QT longo.

PURPOSE: The purpose of this study was to evaluate the value of ambulatory electrocardiogram as a clinical tool to assess ventricular repolarization in patients with the congenital long QT syndrome. METHODS: The study population comprised six patients and their data were compared to a control group of six patients matched in age and gender. The QT interval (ms), corrected by the heart rate, was measured in the first minute of each hour using two monitoring leads, with the mean of six consecutive complexes. The data obtained include the morphologic pattern of T wave, the mean 24-h QTc interval, relation between QT and cardiac cycle, QTc variability (assessed calculating hourly standard deviation of the interval and then obtaining the global 24-h mean), QTc dispersion (difference between the longest and shortest QTc interval). RESULTS: In all patients abnormal patterns of T waves were detected with frequent episodes of T wave alternans. Mean 24-h QTc--patients: 598.2 +/- 73.8 ms; controls: 436.1 +/- 8.9 ms (p = 0.000). Linear correlation and regression between QT and heart rate-patients: r = 0.812; controls: r = 0.967 (p = 0.000). QTc variability-patients: 36.9 +/- 17.2 ms; controls: 14.7 +/- 2.1 ms (p = 0.01). QTc dispersion-patients: 168.3 +/- 70.2 ms; controls: 53.3 +/- 8.1 ms (p = 0.000). CONCLUSION: The data showed increased hourly QTc variability. QTc dispersion and worse correlation between QT and heart rate. This data may reflect an abnormally augmented ventricular vulnerability.

[Evaluation of the ventricular arrhythmogenic profile of patients with dilated cardiomyopathy and reduced ejection fraction]. / Avaliação do perfil arritmogênico ventricular de pacientes com miocradiopatia dilatada e fralcão de Ejeção diminuída.

PURPOSE: To evaluate the arrhythmogenic profile of patients with dilated cardiomyopathy of low ejection fraction and its prognostic significance. METHODS: Data from 40 patients (30 males; mean age: 52 +/- 13 years) were analysed including ventricular arrhythmias (24h - Holter monitoring), autonomic balance from heart rate variability in time domain (rMSSD and pNN50 indexes), ventricular late potentials (signal averaged electrocardiogram (ECG) and dispersion of ventricular repolarization measured from 12-lead ECG. RESULTS: There was a high prevalence of ventricular arrhythmias with at least one episode of nonsustained ventricular tachycardia (VT) in 60% of the patients. Depressed vagal activity was observed in more than half of the patients. In only 30% of the patients the signal-averaged ECG was positive. The dispersion of ventricular repolarization ranged from 20 to 100 ms. The presence of > 30 ventricular premature beats or nonsustained VT on Holter monitoring was the most significant predictor of cardiac death and sudden cardiac death with a relative risk of 1.9 and 3.2, respectively (p = 0.01 and 0.000). CONCLUSION: In this study population it was noted that patients with dilated cardiomyopathy and low ejection fraction had an abnormal electrical and autonomic cardiac behaviour. These findings could represent risk factors for the occurrence of life-threatening arrhythmias or fatal events.

[Sinus node modification by catheter using radiofrequency current in a patient with inappropriate sinus tachycardia. Evaluation of early and late results]. / Modificação do nódulo sinusal via cateter por energia de radiofreqüência em paciente com taquicardia sinusal inapropriada. Avaliação dos resultados imediatos e tardios.

This article reports the early and late results of a patient in whom radiofrequency current was used to ablate an incessant inappropriate sinus tachycardia. During successful radiofrequency application there was a sudden change of rate and subsequent emergence of a stable rhythm with the same sinus node P wave characteristics. During follow-up, normal cardiac cycles were still present after six months of the procedure, although the patient still complained of palpitations, suggesting no correlation with the heart rate.

[Cardiac memory in patients with permanent artificial pacemakers]. / Memória cardíaca em pacientes com marcapasso artificial definitivo.

PURPOSE: To correlate the direction of QRS complex of paced beats and postpacing T wave, in patients with artificial pacemaker. METHODS: Thirty five patients with spontaneous rhythm obtained by chest wall stimulation or by programmability of the automatic interval. It was correlated in all patients, the direction forces of QRS complexes of paced beats and postpacing T waves in all 12 ECG leads. It was considered as a cardiac memory phenomenon when QRS complexes of paced beats and postpacing T waves had the same polarity. The phenomenon was correlated with the 12 ECG leads and with specific variables like spontaneous rhythm, QRS complex duration, type and modality of artificial stimulation and chronicity of the implant. RESULTS: The artificial QRS complexes and spontaneous T waves had the same direction in 5 or more leads of the frontal plane in 77% of the patients and in 50% of the patients in the horizontal plane. In patients with supraventricular command, this correlation was found in 82% of the patients and in 50% of the patients with idioventricular rhythm. Regardless of the type of spontaneous command, the phenomenon was better observed with normal intraventricular conduction. It was not found correlation between type, modality of stimulation and chronicity of the implant and cardiac memory. It was better observed in aVF, D2, D3 and V3, V4. CONCLUSION: The phenomenon of cardiac memory in patients with artificial pacemaker is very frequent. The most important factor to develop the phenomenon seem to be a normal pattern of ventricular activation.

[Relationship between mitral valve prolapse and arrhythmogenic right ventricular disease]. / Associação entre prolapso valvar mitral e doença ventricular direita arritmogênica.

PURPOSE: To evaluate some features of ventricular arrhythmias in patients with mitral valve prolapse. METHODS: We studied 25 patients (female: 19; mean age: 37 +/- 13 years) with ventricular arrhythmias, mitral valve prolapse and normal ventricular function. All patients underwent a 24h Holter and high resolution ECG (HRECG). The Qtc intervals were measured in lead II (normal < 0.44 s). In order to define the possible origin of the ventricular focus, the morphology of the ectopic beats were analysed in leads I, II, aVF, V1 using the following criteria: 1) LBBB morphology with left axis deviation in the frontal plane (FP): origin at the inflow tract of the right ventricle (RV); 2) LBBB morphology with right axis deviation in the FP: origin at the outflow tract of the RV; 3) RBBB morphology with left axis deviation in the FP: origin at the posterior region of the left ventricle (LV). RBBB morphology with right axis deviation in the FP: origin at the anterior region of the LV. RESULTS: Twenty three (92%) patients showed > 720 isolated ventricular ectopic beats/24 h. Paired ventricular response was detected in 18 (72%) patients and non-sustained VT in 15 (60%). HRECG was positive in six (24%) patients and Qtc interval was prolonged in 13 (52%). RV was the site of origin of the ventricular ectopic beats in 85% of the patients (outflow: 85%; inflow: 15%). Only five (20%) patients had arrhythmias from the LV. CONCLUSION: There was a high incidence of ventricular arrhythmias with a low incidence of positive HRECG tests, suggesting that the mechanisms of the arrhythmias do not correlate with slow intramyocardial conduction. It was noted a strong association between mitral valve prolapse, arrhythmogenic right ventricular disease and Qtc prolongation. It is possible that in some of this patients the finding could represent a global myocardial disease.

Arrhythmogenic cardiomyopathy of the right ventricle. Predictive value of QT interval dispersion to assess arrhythmogenic risk and sudden death.

OBJECTIVE: To determine in arrhythmogenic right ventricular cardiomyopathy the value of QT interval dispersion for identifying the induction of sustained ventricular tachycardia in the electrophysiological study or the risk of sudden cardiac death. METHODS: We assessed QT interval dispersion in the 12-lead electrocardiogram of 26 patients with arrhythmogenic right ventricular cardiomyopathy. We analyzed its association with sustained ventricular tachycardia and sudden cardiac death, and in 16 controls similar in age and sex. RESULTS: (mean +/- SD). QT interval dispersion: patients = 53.8+/-14.1 ms; control group = 35.0+/-10.6 ms, p = 0.001. Patients with induction of ventricular tachycardia: 52.5+/-13.8 ms; without induction of ventricular tachycardia: 57.5+/-12.8 ms, p =0.420. In a mean follow-up period of 41+/-11 months, five sudden cardiac deaths occurred. QT interval dispersion in this group was 62.0+/-17.8, and in the others it was 51.9+/-12.8 ms, p = 0.852. Using a cutoff > or =60 ms to define an increase in the degree of the QT interval dispersion, we were able to identify patients at risk of sudden cardiac death with a sensitivity of 60%, a specificity of 57%, and positive and negative predictive values of 25% and 85%, respectively. CONCLUSION: Patients with arrhythmogenic right ventricular cardiomyopathy have a significant increase in the degree of QT interval dispersion when compared with the healthy population. However it, did not identify patients with induction of ventricular tachycardia in the electrophysiological study, showing a very low predictive value for defining the risk of sudden cardiac death in the population studied.

[The electrocardiogram of high resolution during ventricular tachycardia]. / O eletrocardiograma de alta resolução durante taquicardia ventricular.

PURPOSE: To evaluate by the signal averaged-ECG (SAECG) the initial portion of the activation of the sustained ventricular tachycardia (SVT) and monomorphic repetitive ventricular tachycardia (MRVT), correlating the findings with those obtained during sinus rhythm (SR). METHODS: Ten patients was studied; five with SVT and five with MRVT. Patients with SVT presented a positive SAECG while patients with MRVT the test was negative, during SR. The findings of this two populations were compared with those obtained in a group of ten patients with advanced bundle branch block (ABBB: five RBBB and five LBBB). We analyzed in the vector-magnitude obtained during VT and ABBB, the root mean square of the initial 40 ms portion of the activation (RMS40) and the duration of the low amplitude signals < 40 microV from the beginning of the filtered QRS (LAS). To define the positiveness of the test in SR, we analyzed the final RMS40 (normal > 20 microV), the duration of the LAS < 40 microV at the end of the activation (normal < 38 ms) and the total QRS duration (QRSD-normal < 114 ms). RESULTS: (mean)-SVT in SR: RMS40 = 11.2 +/- 6.2 microV; LAS = 47.4 +/- 5.8 ms; QRSD = 131.2 +/- 8.7 ms. SVT during VT: RMS40 = 6.9 +/- 4.5 microV; LAS = 54.5 +/- 9.1 ms. RMVT in SR: RMS40 = 59.7 +/- 49.0 microV; LAS = 28.3 +/- 8.5 ms; QRSD = 93.1 +/- 13.0 ms. MRVT during VT: RMS = 25.2 +/- 8.8 microV; LAS = 28.9 +/- 11.1 ms. RBBB: RMS = 53.3 +/- 34.2 microV; LAS = 22.6 +/- 9.8 ms. LBBB: RMS = 54.7 +/- 37.3 microV; LAS = 11.4 +/- 4.6 ms. The comparison between the data from SVT and MRVT/ABBB showed p < 0.01. CONCLUSION: In the studied population, the SAECG was able to identify abnormal LAS initiating SVT, that were not present in MRVT and ABBB. This signals probably represents intra-myocardial slow conduction, as a portion of a re-entry circuit. There was an excellent correlation between the findings during SVT and MRVT with those obtained in SR.