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

http://www.hrsonline.org/

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

ALTERNÂNCIA DE ONDA TALTERNÂNCIA DE ONDA T

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

http://circ.ahajournals.org/content/vol108/issue8/images/large/22FF3.jpeg

DISPLASIA ARRITMOGÊNICA DO VDDISPLASIA ARRITMOGÊNICA DO VD

NasirNasir, K. et al. Circulation 2004;110:1527, K. et al. Circulation 2004;110:1527--15341534

NasirNasir, K. et al. Circulation , K. et al. Circulation 2004;110:15272004;110:1527--15341534

1212--lead ECG of a 40lead ECG of a 40--yearyear--old resuscitated manold resuscitated man

SSÍÍNDROME DE BRUGADANDROME DE BRUGADA

Circulation. 2005;111:659-670

Circulation. 2005;111:659-670

WPWWPW

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

Circulation. 2005;111:659-670