ΔΙΑΧΕΊΡΙΣΗ ΑΣΘΕΝΟΎΣ ΜΕ ΠΡΏΙΜΗ ΕΠΑΝΑΠΌΛΩΣΗ · Brugada syndrome...
Transcript of ΔΙΑΧΕΊΡΙΣΗ ΑΣΘΕΝΟΎΣ ΜΕ ΠΡΏΙΜΗ ΕΠΑΝΑΠΌΛΩΣΗ · Brugada syndrome...
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
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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