ΔΙΑΧΕΊΡΙΣΗ ΑΣΘΕΝΟΎΣ ΜΕ ΠΡΏΙΜΗ ΕΠΑΝΑΠΌΛΩΣΗ

Δηµήτριος Λυσίτσας, MD, PhD, MRCP Επεµβατικός Ηλεκτροφυσιολόγος

Κλινική Άγιος Λουκάς

EARLY REPOLARISATION PATTERN• 2-5% of population • Predominance in young people, especially ones predisposed to vagotonia • Afrocaribeans • Males (77%) • Athletes, cocaine users, HCM • Normalizing with ageing

ECG CHARACTERISTICS• J deflection

•QRS notching or slurring descending limb of QRS, the S wave is  prematurely interrupted as it travels downhill before reaching the baseline •ST segment elevation

Concave or dome-like

• positive T wave

• V2-V5 leads •fluctuation of STE due to heart rate, vagal tone, cardiac drugs

Gussak et al IPEJ 2008

56 BPM

76 BPM

Importance of ECG leads positioning

DIFFERENTIAL DIAGNOSISCONDITIONS FEATURES

Reversible causes of early repolarization pattern on ECG must be excluded, namely acute schemia, Vasospastic angina Mostly normal CAG

Brugada syndrome limited to V1-V3 leads,

Early repolarization pattern INF/Lateral leads and Ajmaline injection attenuates ERP.

P=0.008

Haissaguerre et al NEJM 2008;358:2016-23

Rosso et al. JACC 2008;52:1231-38

NEJM 2009

RESULTS

SPECTRUM OF EARLY REPOLARISATION SYNDROME

GENETIC BASIS

HRS 2013

CIRC EP 2012

ICD AND COMPLICATIONS

....δεν είχαµε ιδέα, φοβόµασταν οτι το κοριτσάκι µας θα πεθάνει!

....εχω 2 παιδιά, δεν µπορώ να το ρισκάρω, πρέπει να βάλω το µηχάνηµα....

...µου είπε οτι όλα θα είναι οκ και ο απινιδωτής µε χτύπησε 12 φορές µπροστά στα παιδιά µου (απρόσφορες όλες οι θεραπείες)...

CONCLUSIONS• ER increases the RR of arrhythmic events, the AR remains very low.

• Special attention should be devoted to the family history of primary EVR abnormalities and/or SCD

• Incidental identification of ER should not be interpreted as a high risk marker.

• Additional diagnostic work-up, such as tilt-test, signal-averaging ECG, and electrophysiological studies with or without drug testing, should be considered on the case-by-case basis upon physician's discretion

• All patients with ER should continue to have modifiable cardiac risk factors addressed