Core Cardiology 12 lead ECG

12-Lead ECG Recordings

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Quantitative Assessment Our cardiologists - specifically trained in ECG manual reading - perform reliable measurements of ECG intervals using validated methods and algorithms. Qualitative Assessment The qualitative analysis consists in establishing a diagnosis, by describing the abnormalities observed on the electrocardiographic waveform: Rhythm qualification Morphology and conduction qualification T wave and U wave qualification. Continuous QC Policy All data generated by the cardiologists are subject to an extensive and complete quality control guaranteeing an optimal quality at every step of your ECG project.

In a Japanese study assessed the dynamicity of J-wave associated with idiopathic VF by analyzing its pause-dependent increase. The J-wave amplitude was measured in the beat immediately after a pause and compared with the mean J-wave measured in almost three beats before the pause. The pause was considered as an abnormal sudden prolongation of the interval R-R, induced by arrhythmias such us sinus arrest, sinoatrial block, atrioventricular block, or atrial and ventricular premature beats.

It is interesting to note that the pause-dependent increase of J-wave was observed only in patients with idiopathic VF and in none of the control patients and this augmentation was associated with depression of the ST-segment or inversion of the T-waves.

INTRODUCTION

This dynamicity could be well explained by the pause-dependent augmentation in transient outward current Ito of the AP. The same authors have further analyzed the J-wave dynamicity in the general patient population, with no symptoms and no history of IVF. They have observed an increase in amplitude of J-wave at high frequency but not at low frequencies and this may be due to a delay conduction[ 46 ].

So the analysis of the J-wave variations according to RR interval can be used to characterize the J-wave and use it for the arrhythmic risk stratification. Given the conflicting results between the different studies analyzed, possibly due to the non-uniformity of the case histories of patients treated, it is reasonable to think that, in addition to the seat and extent of the J-point changes, a key role is played by the characteristics of the segment elevation ST, as Tikkanen first demonstrated in his study, where the presence of a rapidly ascending ST was not associated with an increased risk of death from arrhythmia causes, unlike the detection of a horizontal or descending ST.

The maximum risk was achieved by the combination of an ER pattern in the inferior leads with an ST-segment elevation at J-point greater than 2 mm and a horizontal-descending ST[ 35 , 36 ]. It is also interesting to note that patients with rapidly ascending ST were mostly young, had low blood pressure, and signs of left ventricular hypertrophy. The literature shows that subjects with a good prognosis, who are young and athletic, with no evidence of structural heart disease have a high prevalence of an ER pattern with rapidly ascending ST elevation.

Conversely, individuals with a poor prognosis, due to advanced age, and who have had a myocardial infarction with or without arrhythmic complications, have a high prevalence of an ER pattern with a horizontally-downward ST[ 47 ]. It is also important to evaluate the J-wave dynamicity in order to recognize ECG features predictive of arrhythmic risk, which are the pause dependent augmentation, the large amplitude and the concomitant horizontal-descending ST-segment[ 45 ]. In conclusion, there is a correlation between lead ECG VR patterns and cardiac death due to arrhythmias, especially in inferior or inferolateral localized forms, associated with a J-point elevation of at least 2 mm and a horizontal ST pattern.

This pattern is more common in a poor prognosis population, i. There have been no risk stratifies for asymptomatic ER subjects and, to date, no primary prevention strategy has been established. It is currently impossible to make recommendations based on this incidental ECG finding in an asymptomatic individual.

In fact, if it is simple and almost automatic to propose defibrillator implantation for a patient with a personal history of cardiac arrest and an ECG showing a typical framework, it is much less easy to take a decision if the same ECG is recorded by chance in an asymptomatic subject.

The research carried out to date has highlighted some aspects of the problem but does not offer a one-size fits all approach. Moreover, it is not recommended that athletes should stop exercising or adopt specific preventive measures[ 48 ]. In symptomatic subjects the etiology of symptoms should be evaluated.

In cases of unexplained syncope with ER, an ECG may arouse suspicion if there is also a family history of sudden death or the occurrence of palpitations before syncope. Ventricular arrhythmias, if confirmed, clearly require the delivery of a defibrillation system in primary prevention[ 50 ]. It is still unclear if there is a different prognosis for patients presenting with notching or slurring patterns.

A greater characterization of the prognostic value of the ECG pattern of ER is necessary, but there is no doubt regarding the correlation between lead ECG VR patterns and cardiac death due to arrhythmias and that the higher risk was achieved by the combination of an ER pattern in the inferior leads with an ST-segment elevation at J-point greater than 2 mm and a horizontal-descending ST.

This pattern is also more common in a poor prognosis population, i.

Conversely, subjects with a good prognosis, who are young and athletic, with no evidence of structural heart disease show a high prevalence of an ER pattern with rapidly ascending ST elevation. Moreover, the evidence of pause-dependent increase in J-wave amplitude, highlighted in patients with idiopathic VF, has proved to be highly specific and high predictive of arrhythmic events. This simple phenomenon may be used for the stratification of arrhythmic risk in patients with J-wave.

Early repolarization in clinical practice. The authors declare no conflicts of interest for this article. This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers.

ECG Acquisition

Cardiac and cardiovascular systems. Grade B Very good: Ji FF L- Editor: National Center for Biotechnology Information , U. Journal List World J Cardiol v. Published online Aug All authors contributed to this manuscript. Published by Baishideng Publishing Group Inc.

Automated Noninvasive Blood Pressure – Human

Abstract The lead electrocardiogram ECG is still the most used tool in cardiology clinical practice. Ventricular repolarization, Cardiovascular diseases, Arrhythmic risk, Early repolarization, Arrhythmia. Open in a separate window. Old and new definition of early repolarization. Table 1 The main studies evaluating the relationship between early repolarization pattern and death due to arrhythmia. The frequency of J-point elevation among young athletes is intermediate Rosso et al[ 29 ], patients with IVF and 8.

Focus on ECG features Given the conflicting results between the different studies analyzed, possibly due to the non-uniformity of the case histories of patients treated, it is reasonable to think that, in addition to the seat and extent of the J-point changes, a key role is played by the characteristics of the segment elevation ST, as Tikkanen first demonstrated in his study, where the presence of a rapidly ascending ST was not associated with an increased risk of death from arrhythmia causes, unlike the detection of a horizontal or descending ST.

Invited manuscript Specialty type: Cardiac and cardiovascular systems Country of origin: Italy Peer-review report classification Grade A Excellent: A Grade B Very good: B, B Grade C Good: C Grade D Fair: D Grade E Poor: April 30, First decision: May 17, Article in press: July 13, P- Reviewer: Ventricular repolarization components on the electrocardiogram: J Am Coll Cardiol.

Ventricular repolarization measures for arrhythmic risk stratification. Dispersion of ventricular repolarization and arrhythmic cardiac death in coronary artery disease. Combined assessment of T-wave alternans and late potentials used to predict arrhythmic events after myocardial infarction. Ventricular repolarization dynamicity provides independent prognostic information toward major arrhythmic events in patients with idiopathic dilated cardiomyopathy.

Beat-to-beat QT interval variability: Dispersion of ventricular depolarization-repolarization: Napolitano C, Priori SG. Sudden cardiac arrest associated with early repolarization.

N Engl J Med. Lepeschkin E, Surawicz B. The measurement of the duration of the QRS interval. Experimental hypothermia; respiratory and blood pH changes in relation to cardiac function.

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