Early repolarization syndrome (ERS), demonstrated as J-point elevation on an electrocardiograph, was formerly thought to be a benign entity, but the recent studies have demonstrated that it can be linked to a considerable risk of life - threatening arrhythmias and sudden cardiac death (SCD). Early repolarization characteristics associated with SCD include high - amplitude J-point elevation, horizontal and/or downslopping ST segments, and inferior and/or lateral leads location. The prevalence of ERS varies between 3% and 24%, depending on age, sex and J-point elevation (0.05 mV vs 0.1 mV) being the main determinants. ERS patients are sporadic and they are at a higher risk of having recurrent cardiac events. Implantable cardioverter-defibrillator implantation and isoproterenol are the suggested therapies in this set of patients. On the other hand, asymptomatic patients with ERS are common and have a better prognosis. The risk stratification in asymptomatic patients with ERS still remains a grey area. This review provides an outline of the up-to-date evidence associated with ERS and the risk of life - threatening arrhythmias. Further prospective studies are required to elucidate the mechanisms of ventricular arrhythmogenesis in patients with ERS.
<p><strong>AIM OF THE STUDY</strong><strong>:</strong> Coronary artery bypass graft surgery is the gold standard for the treatment of multi-vessel and left main coronary artery disease. However, there is considerable debate that whether left internal mammary artery (IMA) should be taken as pedicled or skeletonized. This study was conducted to assess the difference in blood flow after application of topical vasodilator in skeletonized and pedicled IMA.</p><p><strong>METHODS</strong><strong>: </strong>In this study, each patient underwent either skeletonized (n=25) or pedicled IMA harvesting (n=25). The type of graft on each individual patient was decided randomly. Intra-operative variables such as conduit length and blood flow were measured by the surgeon himself. The length of the grafted IMA was carefully determined in-vivo, with the proximal and distal ends attached, from the first rib to IMA divergence. The IMA flow was measured on two separate occasions; before and after application of topical vasodilator. Known cases of subclavian artery stenosis and previous sternal radiation were excluded from the study.</p><p><strong>RESULTS</strong><strong>:</strong> The blood flow before application of topical vasodilator was similar in both the groups (<em>P</em>=0.227). However, the flow was significantly less in pedicled than skeletonized IMA after application of vasodilator (<em>P</em> < 0.0001). Similarly, the length of skeletonized graft was significantly higher than the length of pedicled graft (<em>P</em> < 0.0001).</p><p><strong>CONCLUSION</strong><strong>:</strong> Our study signifies that skeletonization of IMA results in increased graft length and blood flow especially after the application of topical vasodilator. However, we recommend that long term clinical trials should be conducted to fully determine long term patency rates of skeletonized IMA.</p>
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