AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram

Rautaharju, Pentti M.; Surawicz, Borys; Gettes, Leonard S.

doi:10.1016/j.jacc.2008.12.014

Cited by 746 publications

(292 citation statements)

References 58 publications

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“…For instance, recommendations for proper lead monitoring in QT studies 74,75 are to choose the lead from a 12-lead ECG with the longest QTc interval that has a T wave with at least 2 mm of amplitude and a well-defined end. In addition, an important aspect of measuring QT intervals is using the same lead for repeat measurements to ensure consistency.…”

Section: Study Limitationsmentioning

confidence: 99%

Acquired Long QT Syndrome: Frequency, Onset, and Risk Factors in Intensive Care Patients

Kozik

Wung

2012

Critical Care Nurse

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Background Acquired long QT syndrome is a reversible condition that can lead to torsades de pointes and sudden cardiac death. Objective To determine the frequency, onset, frequency of medications, and risk factors for the syndrome in intensive care patients. Methods In a retrospective chart review of 88 subjects, hourly corrected QT intervals calculated by using the Bazett formula were collected. Acquired long QT syndrome was defined as a corrected QT of 500 milliseconds or longer or an increase in corrected QT of 60 milliseconds or greater from baseline level. Risk factors and medications administered were collected from patients’ medical records. Results The syndrome occurred in 46 patients (52%); mean time of onset was 7.4 hours (SD, 9.4) from time of admission. Among the 88 patients, 52 (59%) received a known QTc-prolonging medication. Among the 46 with the syndrome, 23 (50%) received a known QT-prolonging medication. No other risk factor studied was significantly predictive of the syndrome. Conclusions Acquired long QT syndrome occurs in patients not treated with a known QT-prolonging medication, indicating the importance of frequent QT monitoring of all intensive care patients.

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Section: Study Limitationsmentioning

confidence: 99%

Acquired Long QT Syndrome: Frequency, Onset, and Risk Factors in Intensive Care Patients

Kozik

Wung

2012

Critical Care Nurse

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“…Definitions for T‐wave abnormality and ST depression were in accordance with “Recommendations for the Standardization and Interpretation of the Electrocardiogram” by the American Heart Association, American College of Cardiology, and Heart Rhythm Association consensus statement 14. Isolated T‐wave abnormality was considered present if the T wave was inverted (at least 0.1 mV), isoelectric, or biphasic in leads V3 to V6, aVL, I, and II.…”

Section: Methodsmentioning

confidence: 99%

“…Isolated T‐wave abnormality was considered present if the T wave was inverted (at least 0.1 mV), isoelectric, or biphasic in leads V3 to V6, aVL, I, and II. In leads V1, aVR and III, T‐wave abnormalities were not evaluated, as those can be found as normal variants 14. Isolated ST‐depression was defined as the presence of at least 0.1 mV depression from the J point in at least 2 contiguous leads 14.…”

Section: Methodsmentioning

confidence: 99%

“…In leads V1, aVR and III, T‐wave abnormalities were not evaluated, as those can be found as normal variants 14. Isolated ST‐depression was defined as the presence of at least 0.1 mV depression from the J point in at least 2 contiguous leads 14. ST depression and T‐wave abnormality were considered to be simultaneously present when the T wave extended from the J point+60 ms until complete ventricular repolarization.…”

Section: Methodsmentioning

confidence: 99%

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T‐Wave Abnormality as Electrocardiographic Signature of Myocardial Edema in Non‐ST‐Elevation Acute Coronary Syndromes

Cardona

Zaręba

Nagaraja

et al. 2018

JAHA

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BackgroundT‐wave abnormalities are common during the acute phase of non‐ST‐segment elevation acute coronary syndromes, but mechanisms underlying their occurrence are unclear. We hypothesized that T‐wave abnormalities in the presentation of non‐ST‐segment elevation acute coronary syndromes correspond to the presence of myocardial edema.Methods and ResultsSecondary analysis of a previously enrolled prospective cohort of patients presenting with non‐ST‐segment elevation acute coronary syndromes was conducted. Twelve‐lead electrocardiography (ECG) and cardiac magnetic resonance with T2‐weighted imaging were acquired before invasive coronary angiography. ECGs were classified dichotomously (ie, ischemic versus normal/nonischemic) and nominally according to patterns of presentation: no ST‐ or T‐wave abnormalities, isolated T‐wave abnormality, isolated ST depression, ST depression+T‐wave abnormality. Myocardial edema was determined by expert review of T2‐weighted images. Of 86 subjects (65% male, 59.4 years), 36 showed normal/nonischemic ECG, 25 isolated T‐wave abnormalities, 11 isolated ST depression, and 14 ST depression+T‐wave abnormality. Of 30 edema‐negative subjects, 24 (80%) had normal/nonischemic ECGs. Isolated T‐wave abnormality was significantly more prevalent in edema‐positive versus edema‐negative subjects (41.1% versus 6.7%, P=0.001). By multivariate analysis, an ischemic ECG showed a strong association with myocardial edema (odds ratio 12.23, 95% confidence interval 3.65‐40.94, P<0.0001). Among individual ECG profiles, isolated T‐wave abnormality was the single strongest predictor of myocardial edema (odds ratio 23.84, 95% confidence interval 4.30‐132, P<0.0001). Isolated T‐wave abnormality was highly specific (93%) but insensitive (43%) for detecting myocardial edema.ConclusionsT‐wave abnormalities in the setting of non‐ST‐segment elevation acute coronary syndromes are related to the presence of myocardial edema. High specificity of this ECG alteration identifies a change in ischemic myocardium associated with worse outcomes that is potentially reversible.

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“…Furthermore, LQT3 patients have lower incidence of any type of cardiac event, but followed with much higher lethality (3). Baseline QTc ≥ 500ms is an independent risk factor (19). The history of syncope and their frequency is one of the most powerful predictors of subsequent serious cardiac events in adolescents (30).…”

Section: Risk Stratificationmentioning

confidence: 99%

Congenital long QT syndrome in children

Cerović¹,

Košutić²

2016

Medicinski podmladak

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ApstraktSindrom produženog QT intervala (engl. long QT syndrome, LQTS) je poremećaj repolarizacije komora miokarda koji se odlikuje produženjem QT intervala na elektrokardiogramu (EKG) i povećanim rizikom za nastanak ventrikularnih tahiaritmija i kardiogenih manifestacija. Može da bude stečeni ili kongenitalni, koji predstavlja skup kanalopatija usled mutacija u nekom od 15 do sada identifikovanih gena. Najčešći oblici kongenitalnog sindroma su LQT1, LQT2 i LQT3. Zbog produženja repolarizacije i, posledično, celog akcionog potencijala, stvaraju se uslovi za nastanak rane naknadne depolarizacije i izraženije transmuralne disperzije repolarizacije koje su, pojedinačno ili udruženo, osnova za nastanak Torsades de pointes ventrikularne tahikardije. Sindrom produženog QT intervala se klinički manifestuje palpitacijama, sinkopom, srčanim zastojem ili naprasnom srčanom smrću, a može da bude i asimptomatski. Provocirajući faktori za nastanak tegoba su specifični za određeni genotip. Ispitivanje LQTS obuhvata ličnu i porodičnu anamnezu sa naglaskom na karakteristične podatke (česte sinkope, iznenadna srčana smrt u porodici, nasledne aritmije), EKG u miru, test opterećenja i genetske analize, kao i druge dodatne metode (serijski EKG zapisi, 24h EKG holter, epinefrinski test). Za klinič-ko postavljanje dijagnoze koristi se Švarcov (Schwartz) skor, a kriterijumi za definitivno postavljanje dijagnoze zavise od Švar-covog skora, dužine QT intervala, postojanja mutacije i kliničke slike. Lečenje se zasniva na promeni životnih navika i terapiji β-blokatorima, a druge mogućnosti su ugradnja implantabilnog kardioverter-defibrilatora, permanentnog pejsmejkera ili hirurška simpatektomija. Sindrom produženog QT intervala je jedan od potencijalnih uzroka iznenadne srčane smrti koja čini 90% iznenadnih smrti mladih sportista. Kod dece sa LQTS preporuke za bavljenje sportom proizilaze iz preporuka za odrasle i podrazumevaju vrlo stroga ograničenja. Dalja istraživanja biće usmerena na bolje razumevanje genotip-fenotip korelacije kongenitalnih LQTS i očekuje se da će pružiti nove personalizovane terapijske mogućnosti i saznanja o ređim tipovima ovog sindroma, kao i jasnije preporuke za bavljenje fizičkom aktivnošću kod dece sa LQTS.Ključne reči: sindrom produženog QT intervala, deca, genetika, fizička aktivnost AbstractLong QT syndrome (LQTS) is a cardiac repolarization disorder characterized by prolonged QT interval on the electrocardiogram (ECG) and increased propensity to ventricular tachyarrhythmias and cardiac events. LQTS might be acquired or congenital, which presents a group of channelopathies that occur due to mutation in one of 15 so far identified genes. The most frequent types of congenital LTQS are LQT1, LQT2 and LQT3. Prolonged or delayed repolarization leads to the increase of action potential duration which predisposes early afterdepolarization, as well as the amplification of transmural dispersion of repolarization, both contributing to the development of Torsades de Pointes ventricular tachycardia. Clinical manifestatio...

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AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram

Cited by 746 publications

References 58 publications

Acquired Long QT Syndrome: Frequency, Onset, and Risk Factors in Intensive Care Patients

Acquired Long QT Syndrome: Frequency, Onset, and Risk Factors in Intensive Care Patients

T‐Wave Abnormality as Electrocardiographic Signature of Myocardial Edema in Non‐ST‐Elevation Acute Coronary Syndromes

Congenital long QT syndrome in children

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