Post on 10-Dec-2018
ELETROCARDIOGRAMA ELETROCARDIOGRAMA ––IMPLICAIMPLICAÇÇÕES DE ALTERAÕES DE ALTERAÇÇÕES ÕES ENCONTRADAS EM INDIVENCONTRADAS EM INDIVÍÍDUOS DUOS
ASSINTOMASSINTOMÁÁTICOSTICOSCurso de Reciclagem em Cardiologia daCurso de Reciclagem em Cardiologia da
Região SulRegião Sul
SSéérgio Luiz Zimmermannrgio Luiz Zimmermann
DECLARADECLARAÇÇÃO DO POTENCIAL ÃO DO POTENCIAL CONFLITO DE INTERESSECONFLITO DE INTERESSE
PalestrantePalestrante: :
SSÉÉRGIO LUIZ ZIMMERMANNRGIO LUIZ ZIMMERMANN
ApresentaApresentaçção:ão:
ELETROCARDIOGRAMA ELETROCARDIOGRAMA –– IMPLICAIMPLICAÇÇÕES DE ÕES DE ALTERAALTERAÇÇÕES ENCONTRADAS EM INDIVÕES ENCONTRADAS EM INDIVÍÍDUOS DUOS ASSINTOMASSINTOMÁÁTICOSTICOS
NENHUM CONFLITO DE INTERESSENENHUM CONFLITO DE INTERESSE
Einthoven W. Einthoven W. GalvanometrischeGalvanometrische registratieregistratie van van hethetmenselijkmenselijk electrocardiogram. In: electrocardiogram. In: HerinneringsbundelHerinneringsbundel Prof. Prof. S.S. S.S. RosensternRosenstern [Galvanometric registration of the human [Galvanometric registration of the human electrogramelectrogram]. ]. LeidenLeiden, the Netherlands: , the Netherlands: EduardEduard IjdoIjdo; 1902; ; 1902; 101101––106.106.
(Circulation. 2004;109:562(Circulation. 2004;109:562--564.)564.)
The Electrocardiogram 102 Years After The Electrocardiogram 102 Years After Einthoven Einthoven Hein J.J. Hein J.J. WellensWellens, MD; Anton P. , MD; Anton P. GorgelsGorgels, MD, MD
INTERVALO QT CORRIGIDOINTERVALO QT CORRIGIDO
Formula de BazettFormula de Bazett
QTc=QT/QTc=QT/√√ RR--RR
N N EnglEngl J Med 2000; 342:514J Med 2000; 342:514--515, Feb 17, 2000515, Feb 17, 2000
HimalaianHimalaian T T waveswaves in the in the congenitalcongenitalLQTS. LQTS. DawoodDawood DarbarDarbar et al. Circulation, et al. Circulation, 2005;vol.111,no.112005;vol.111,no.11
A : QT= 280A : QT= 280
B : QT= 220B : QT= 220
C : QT= 260C : QT= 260
GaitaGaita, F. et al. Circulation 2003;108:965, F. et al. Circulation 2003;108:965--970970
QT CURTOQT CURTO
1212--lead ECG of a 40lead ECG of a 40--yearyear--old resuscitated manold resuscitated man
SSÍÍNDROME DE BRUGADANDROME DE BRUGADA
From the University of Leipzig, Heart From the University of Leipzig, Heart CenterCenter, Cardiology, Cardiology--Department of Electrophysiology, Leipzig, GermanyDepartment of Electrophysiology, Leipzig, Germany.
Circulation.Circulation. 2004;110:7662004;110:766--769769
ElectrocardiographicElectrocardiographic Predictors of Arrhythmic Death and Total Mortality Predictors of Arrhythmic Death and Total Mortality in the in the MulticenterMulticenter UnsustainedUnsustained Tachycardia TrialTachycardia TrialPeter J. Zimetbaum, MDPeter J. Zimetbaum, MD; Alfred E. Buxton, MD; William ; Alfred E. Buxton, MD; William BatsfordBatsford, MD; John D. , MD; John D. Fisher, MD; Gail E. Fisher, MD; Gail E. HafleyHafley, MS; Kerry L. Lee, PhD; Michael F. , MS; Kerry L. Lee, PhD; Michael F. OO’’Toole, MD; Richard L. Page, MD; Matthew Reynolds, MD; Mark E. Toole, MD; Richard L. Page, MD; Matthew Reynolds, MD; Mark E. JosephsonJosephson, MD, MD
1.638 p1.638 p322 randomizados322 randomizados1.316 registrados1.316 registrados
CoronariopatiaCoronariopatia
FE<40%FE<40%
TV não sustentadaTV não sustentada
Adjusted for Baseline Factors*
Wald2
P HR 95% CI
Arrhythmic death or cardiac arrestIVCD 7.29 0.0069 1.44 (1.11, 1.88)LBBB 4.22 0.0400 1.49 (1.02, 2.17)LAH 0.10 0.7492 0.95 (0.68, 1.32)LVH 7.00 0.0082 1.35 (1.08, 1.69)RBBB 0.04 0.8383 1.05 (0.65, 1.71)
Total mortalityIVCD 15.65 <0.0001 1.47 (1.22, 1.78)LBBB 13.94 0.0002 1.61 (1.26, 2.08)LAH 3.93 0.0474 1.25 (1.00, 1.55)LVH 2.49 0.1146 1.14 (0.97, 1.33)RBBB 0.15 0.6953 1.07 (0.77, 1.48)
Familial Sudden Death Is an Important Risk Factor
for Primary Ventricular Fibrillation
Circulation. 2006;114:1140-1145
University of Groningen, Groningen, the Netherlands
Contrast UnivariateMultivariate OR 95% CI POR 95% CI Family history of sudden death*
<0.0001
Male gender* 0.16Smoking, at time of infarct*
0.16
Hypertension* 0.96Diabetes* 0.24Hypercholesterolemia*
0.027
BMI* 0.066Medication* 0.88Cardiac history (last 12 mo)*
0.068
Anterior location infarct
0.23
ST deviation 0.001
Noninvasively
Block in the AP during exercise
Finding of intermittent pre-excitation
Block in the AP after drug administration
Invasively An anterograde RP of the AP >270 ms during intracardiac or esophageal stimulation
Findings Identifying the Low-Risk Patient
Findings Identifying the Low-Risk Patient
When to Perform Catheter Ablation in Asymptomatic PatientsWith a Wolff-Parkinson-White Electrocardiogram
Circulation. 2005;112:2201-2216 Hein J. Wellens, MD
Brugada, P. et al. Circulation 2005;112:279-292
Risk stratification scheme in patients with Brugadasyndrome according to clinical presentation
Circulation. 2005;111:659-670