Characterization of early repolarization during ajmaline provocation and exercise tolerance testing
Background Early repolarization (ER) in the inferior electrocardiogram leads is associated with idiopathic ventricular fibrillation, but the majority of subjects with ER have a benign prognosis. At present, there are no risk stratifiers for asymptomatic ER. Objective To examine the response to ajmal...
Gespeichert in:
| Veröffentlicht in: | Heart rhythm 2013-02, Vol.10 (2), p.247-254 |
|---|---|
| Hauptverfasser: | , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 254 |
|---|---|
| container_issue | 2 |
| container_start_page | 247 |
| container_title | Heart rhythm |
| container_volume | 10 |
| creator | Bastiaenen, Rachel, MRCP Raju, Hariharan, MRCP Sharma, Sanjay, MD, FRCP Papadakis, Michael, MRCP Chandra, Navin, MRCP Muggenthaler, Martina, MRCP Govindan, Malini, BMed, FRACP Batchvarov, Velislav N., MD Behr, Elijah R., MD, MRCP |
| description | Background Early repolarization (ER) in the inferior electrocardiogram leads is associated with idiopathic ventricular fibrillation, but the majority of subjects with ER have a benign prognosis. At present, there are no risk stratifiers for asymptomatic ER. Objective To examine the response to ajmaline provocation and exercise in potentially high-risk subjects with ER and without a definitive cardiac diagnosis. Methods Electrocardiographic data were reviewed for ER at baseline and during ajmaline and exercise testing in 229 potentially high-risk patients (mean age 37.7±14.9 years; 55.9% men). ER was defined as J-point elevation in≥2 consecutive leads and stratified by type, territory, J-point height, and ST-segment morphology. Results Baseline ER was present in 26 (11.4%; 19 men) patients. During ajmaline provocation and exercise, there were no new ER changes. ER with rapidly ascending ST-segment and lateral ER consistently diminished. There were 7 patients with persistent ER during ajmaline and/or exercise. They were all men with inferior or inferolateral ER and horizontal/descending ST segment. Those with persistent ER during exercise were more likely to have a history of unexplained syncope than those in whom ER changes diminished ( P |
| doi_str_mv | 10.1016/j.hrthm.2012.10.032 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1287381235</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1547527112012453</els_id><sourcerecordid>1287381235</sourcerecordid><originalsourceid>FETCH-LOGICAL-c414t-94c2b33233069680a5fae81d9c0fbf069ed146531c8c5914b1bc6d9e04621d923</originalsourceid><addsrcrecordid>eNqFkTtP7DAQhS0E4v0LrnSVkiaLx06ySQESWvGSkCiA2nImE9a5SbzYCWL59Tgsl4IGubB1fM6M_Q1jf4DPgEN22syWblh2M8FBBGXGpdhi-5CmWSzzOWxP52Qep2IOe-zA-4ZzUWRc7rI9IXlehLXPcLHUTuNAzrzrwdg-snVE2rXryNHKtvpbr0Zn-udIN51uTU_RytlXi5s73VcRvZFD4ykabEtO9xhO5IeQOWI7tW49HX_th-zp6vJxcRPf3V_fLi7uYkwgGeIiQVFKKaTkWZHlXKe1phyqAnld1kGjCpIslYA5pgUkJZSYVQXxJBPBJeQhO9nUDU97GUNv1RmP1La6Jzt6BSKfyxyETINVbqzorPeOarVyptNurYCria5q1CddNdGdxEA3pP5-NRjLjqrvzH-cwXC2MVD45qshpzwaCigq4wgHVVnzS4PzH3kMrA3q9h-tyTd2dH0gqEB5obh6mAY8zRemIkkq5QfQlKK8</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1287381235</pqid></control><display><type>article</type><title>Characterization of early repolarization during ajmaline provocation and exercise tolerance testing</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Bastiaenen, Rachel, MRCP ; Raju, Hariharan, MRCP ; Sharma, Sanjay, MD, FRCP ; Papadakis, Michael, MRCP ; Chandra, Navin, MRCP ; Muggenthaler, Martina, MRCP ; Govindan, Malini, BMed, FRACP ; Batchvarov, Velislav N., MD ; Behr, Elijah R., MD, MRCP</creator><creatorcontrib>Bastiaenen, Rachel, MRCP ; Raju, Hariharan, MRCP ; Sharma, Sanjay, MD, FRCP ; Papadakis, Michael, MRCP ; Chandra, Navin, MRCP ; Muggenthaler, Martina, MRCP ; Govindan, Malini, BMed, FRACP ; Batchvarov, Velislav N., MD ; Behr, Elijah R., MD, MRCP</creatorcontrib><description>Background Early repolarization (ER) in the inferior electrocardiogram leads is associated with idiopathic ventricular fibrillation, but the majority of subjects with ER have a benign prognosis. At present, there are no risk stratifiers for asymptomatic ER. Objective To examine the response to ajmaline provocation and exercise in potentially high-risk subjects with ER and without a definitive cardiac diagnosis. Methods Electrocardiographic data were reviewed for ER at baseline and during ajmaline and exercise testing in 229 potentially high-risk patients (mean age 37.7±14.9 years; 55.9% men). ER was defined as J-point elevation in≥2 consecutive leads and stratified by type, territory, J-point height, and ST-segment morphology. Results Baseline ER was present in 26 (11.4%; 19 men) patients. During ajmaline provocation and exercise, there were no new ER changes. ER with rapidly ascending ST-segment and lateral ER consistently diminished. There were 7 patients with persistent ER during ajmaline and/or exercise. They were all men with inferior or inferolateral ER and horizontal/descending ST segment. Those with persistent ER during exercise were more likely to have a history of unexplained syncope than those in whom ER changes diminished ( P <.01). Subtle nondiagnostic structural abnormalities were demonstrated in 3 of these patients. Conclusions ER with horizontal/descending ST-segment morphology in the inferior or inferolateral leads that persists during exercise is more common in patients with prior unexplained syncope and may identify patients at higher risk of arrhythmic events. ER that persists during ajmaline provocation and/or exercise may reflect underlying subtle structural abnormalities and should prompt further investigation.</description><identifier>ISSN: 1547-5271</identifier><identifier>EISSN: 1556-3871</identifier><identifier>DOI: 10.1016/j.hrthm.2012.10.032</identifier><identifier>PMID: 23089898</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Ajmaline ; Ajmaline provocation ; Cardiovascular ; Cohort Studies ; Early repolarization ; Electrocardiogram ; Electrocardiography - methods ; Exercise Test - methods ; Exercise Tolerance - physiology ; Exercise tolerance testing ; Female ; Heart Conduction System - physiopathology ; Humans ; Idiopathic ventricular fibrillation ; Male ; Middle Aged ; Prognosis ; Prospective Studies ; Sensitivity and Specificity ; Ventricular Fibrillation - diagnosis ; Young Adult</subject><ispartof>Heart rhythm, 2013-02, Vol.10 (2), p.247-254</ispartof><rights>Heart Rhythm Society</rights><rights>2013 Heart Rhythm Society</rights><rights>Copyright © 2013 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c414t-94c2b33233069680a5fae81d9c0fbf069ed146531c8c5914b1bc6d9e04621d923</citedby><cites>FETCH-LOGICAL-c414t-94c2b33233069680a5fae81d9c0fbf069ed146531c8c5914b1bc6d9e04621d923</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1547527112012453$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23089898$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bastiaenen, Rachel, MRCP</creatorcontrib><creatorcontrib>Raju, Hariharan, MRCP</creatorcontrib><creatorcontrib>Sharma, Sanjay, MD, FRCP</creatorcontrib><creatorcontrib>Papadakis, Michael, MRCP</creatorcontrib><creatorcontrib>Chandra, Navin, MRCP</creatorcontrib><creatorcontrib>Muggenthaler, Martina, MRCP</creatorcontrib><creatorcontrib>Govindan, Malini, BMed, FRACP</creatorcontrib><creatorcontrib>Batchvarov, Velislav N., MD</creatorcontrib><creatorcontrib>Behr, Elijah R., MD, MRCP</creatorcontrib><title>Characterization of early repolarization during ajmaline provocation and exercise tolerance testing</title><title>Heart rhythm</title><addtitle>Heart Rhythm</addtitle><description>Background Early repolarization (ER) in the inferior electrocardiogram leads is associated with idiopathic ventricular fibrillation, but the majority of subjects with ER have a benign prognosis. At present, there are no risk stratifiers for asymptomatic ER. Objective To examine the response to ajmaline provocation and exercise in potentially high-risk subjects with ER and without a definitive cardiac diagnosis. Methods Electrocardiographic data were reviewed for ER at baseline and during ajmaline and exercise testing in 229 potentially high-risk patients (mean age 37.7±14.9 years; 55.9% men). ER was defined as J-point elevation in≥2 consecutive leads and stratified by type, territory, J-point height, and ST-segment morphology. Results Baseline ER was present in 26 (11.4%; 19 men) patients. During ajmaline provocation and exercise, there were no new ER changes. ER with rapidly ascending ST-segment and lateral ER consistently diminished. There were 7 patients with persistent ER during ajmaline and/or exercise. They were all men with inferior or inferolateral ER and horizontal/descending ST segment. Those with persistent ER during exercise were more likely to have a history of unexplained syncope than those in whom ER changes diminished ( P <.01). Subtle nondiagnostic structural abnormalities were demonstrated in 3 of these patients. Conclusions ER with horizontal/descending ST-segment morphology in the inferior or inferolateral leads that persists during exercise is more common in patients with prior unexplained syncope and may identify patients at higher risk of arrhythmic events. ER that persists during ajmaline provocation and/or exercise may reflect underlying subtle structural abnormalities and should prompt further investigation.</description><subject>Adult</subject><subject>Ajmaline</subject><subject>Ajmaline provocation</subject><subject>Cardiovascular</subject><subject>Cohort Studies</subject><subject>Early repolarization</subject><subject>Electrocardiogram</subject><subject>Electrocardiography - methods</subject><subject>Exercise Test - methods</subject><subject>Exercise Tolerance - physiology</subject><subject>Exercise tolerance testing</subject><subject>Female</subject><subject>Heart Conduction System - physiopathology</subject><subject>Humans</subject><subject>Idiopathic ventricular fibrillation</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Sensitivity and Specificity</subject><subject>Ventricular Fibrillation - diagnosis</subject><subject>Young Adult</subject><issn>1547-5271</issn><issn>1556-3871</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkTtP7DAQhS0E4v0LrnSVkiaLx06ySQESWvGSkCiA2nImE9a5SbzYCWL59Tgsl4IGubB1fM6M_Q1jf4DPgEN22syWblh2M8FBBGXGpdhi-5CmWSzzOWxP52Qep2IOe-zA-4ZzUWRc7rI9IXlehLXPcLHUTuNAzrzrwdg-snVE2rXryNHKtvpbr0Zn-udIN51uTU_RytlXi5s73VcRvZFD4ykabEtO9xhO5IeQOWI7tW49HX_th-zp6vJxcRPf3V_fLi7uYkwgGeIiQVFKKaTkWZHlXKe1phyqAnld1kGjCpIslYA5pgUkJZSYVQXxJBPBJeQhO9nUDU97GUNv1RmP1La6Jzt6BSKfyxyETINVbqzorPeOarVyptNurYCria5q1CddNdGdxEA3pP5-NRjLjqrvzH-cwXC2MVD45qshpzwaCigq4wgHVVnzS4PzH3kMrA3q9h-tyTd2dH0gqEB5obh6mAY8zRemIkkq5QfQlKK8</recordid><startdate>20130201</startdate><enddate>20130201</enddate><creator>Bastiaenen, Rachel, MRCP</creator><creator>Raju, Hariharan, MRCP</creator><creator>Sharma, Sanjay, MD, FRCP</creator><creator>Papadakis, Michael, MRCP</creator><creator>Chandra, Navin, MRCP</creator><creator>Muggenthaler, Martina, MRCP</creator><creator>Govindan, Malini, BMed, FRACP</creator><creator>Batchvarov, Velislav N., MD</creator><creator>Behr, Elijah R., MD, MRCP</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130201</creationdate><title>Characterization of early repolarization during ajmaline provocation and exercise tolerance testing</title><author>Bastiaenen, Rachel, MRCP ; Raju, Hariharan, MRCP ; Sharma, Sanjay, MD, FRCP ; Papadakis, Michael, MRCP ; Chandra, Navin, MRCP ; Muggenthaler, Martina, MRCP ; Govindan, Malini, BMed, FRACP ; Batchvarov, Velislav N., MD ; Behr, Elijah R., MD, MRCP</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c414t-94c2b33233069680a5fae81d9c0fbf069ed146531c8c5914b1bc6d9e04621d923</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Ajmaline</topic><topic>Ajmaline provocation</topic><topic>Cardiovascular</topic><topic>Cohort Studies</topic><topic>Early repolarization</topic><topic>Electrocardiogram</topic><topic>Electrocardiography - methods</topic><topic>Exercise Test - methods</topic><topic>Exercise Tolerance - physiology</topic><topic>Exercise tolerance testing</topic><topic>Female</topic><topic>Heart Conduction System - physiopathology</topic><topic>Humans</topic><topic>Idiopathic ventricular fibrillation</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Sensitivity and Specificity</topic><topic>Ventricular Fibrillation - diagnosis</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bastiaenen, Rachel, MRCP</creatorcontrib><creatorcontrib>Raju, Hariharan, MRCP</creatorcontrib><creatorcontrib>Sharma, Sanjay, MD, FRCP</creatorcontrib><creatorcontrib>Papadakis, Michael, MRCP</creatorcontrib><creatorcontrib>Chandra, Navin, MRCP</creatorcontrib><creatorcontrib>Muggenthaler, Martina, MRCP</creatorcontrib><creatorcontrib>Govindan, Malini, BMed, FRACP</creatorcontrib><creatorcontrib>Batchvarov, Velislav N., MD</creatorcontrib><creatorcontrib>Behr, Elijah R., MD, MRCP</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Heart rhythm</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bastiaenen, Rachel, MRCP</au><au>Raju, Hariharan, MRCP</au><au>Sharma, Sanjay, MD, FRCP</au><au>Papadakis, Michael, MRCP</au><au>Chandra, Navin, MRCP</au><au>Muggenthaler, Martina, MRCP</au><au>Govindan, Malini, BMed, FRACP</au><au>Batchvarov, Velislav N., MD</au><au>Behr, Elijah R., MD, MRCP</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Characterization of early repolarization during ajmaline provocation and exercise tolerance testing</atitle><jtitle>Heart rhythm</jtitle><addtitle>Heart Rhythm</addtitle><date>2013-02-01</date><risdate>2013</risdate><volume>10</volume><issue>2</issue><spage>247</spage><epage>254</epage><pages>247-254</pages><issn>1547-5271</issn><eissn>1556-3871</eissn><abstract>Background Early repolarization (ER) in the inferior electrocardiogram leads is associated with idiopathic ventricular fibrillation, but the majority of subjects with ER have a benign prognosis. At present, there are no risk stratifiers for asymptomatic ER. Objective To examine the response to ajmaline provocation and exercise in potentially high-risk subjects with ER and without a definitive cardiac diagnosis. Methods Electrocardiographic data were reviewed for ER at baseline and during ajmaline and exercise testing in 229 potentially high-risk patients (mean age 37.7±14.9 years; 55.9% men). ER was defined as J-point elevation in≥2 consecutive leads and stratified by type, territory, J-point height, and ST-segment morphology. Results Baseline ER was present in 26 (11.4%; 19 men) patients. During ajmaline provocation and exercise, there were no new ER changes. ER with rapidly ascending ST-segment and lateral ER consistently diminished. There were 7 patients with persistent ER during ajmaline and/or exercise. They were all men with inferior or inferolateral ER and horizontal/descending ST segment. Those with persistent ER during exercise were more likely to have a history of unexplained syncope than those in whom ER changes diminished ( P <.01). Subtle nondiagnostic structural abnormalities were demonstrated in 3 of these patients. Conclusions ER with horizontal/descending ST-segment morphology in the inferior or inferolateral leads that persists during exercise is more common in patients with prior unexplained syncope and may identify patients at higher risk of arrhythmic events. ER that persists during ajmaline provocation and/or exercise may reflect underlying subtle structural abnormalities and should prompt further investigation.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>23089898</pmid><doi>10.1016/j.hrthm.2012.10.032</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1547-5271 |
| ispartof | Heart rhythm, 2013-02, Vol.10 (2), p.247-254 |
| issn | 1547-5271 1556-3871 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1287381235 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adult Ajmaline Ajmaline provocation Cardiovascular Cohort Studies Early repolarization Electrocardiogram Electrocardiography - methods Exercise Test - methods Exercise Tolerance - physiology Exercise tolerance testing Female Heart Conduction System - physiopathology Humans Idiopathic ventricular fibrillation Male Middle Aged Prognosis Prospective Studies Sensitivity and Specificity Ventricular Fibrillation - diagnosis Young Adult |
| title | Characterization of early repolarization during ajmaline provocation and exercise tolerance testing |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-08T14%3A20%3A07IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Characterization%20of%20early%20repolarization%20during%20ajmaline%20provocation%20and%20exercise%20tolerance%20testing&rft.jtitle=Heart%20rhythm&rft.au=Bastiaenen,%20Rachel,%20MRCP&rft.date=2013-02-01&rft.volume=10&rft.issue=2&rft.spage=247&rft.epage=254&rft.pages=247-254&rft.issn=1547-5271&rft.eissn=1556-3871&rft_id=info:doi/10.1016/j.hrthm.2012.10.032&rft_dat=%3Cproquest_cross%3E1287381235%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1287381235&rft_id=info:pmid/23089898&rft_els_id=S1547527112012453&rfr_iscdi=true |