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Characterization of early repolarization during ajmaline provocation and exercise tolerance testing.
MedLine Citation:
PMID:  23089898     Owner:  NLM     Status:  Publisher    
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 AND RESULTS: Electrocardiographic data were reviewed for ER at baseline and during ajmaline and exercise testing in 229 potentially high-risk patients (37.7±14.9 years; 55.9% male). ER was defined as J-point elevation in ≥2 consecutive leads and stratified by type, territory, J-point height and ST-segment morphology. Baseline ER was present in 26 (11.4%; 19 male). 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. These were all male 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<0.01). Subtle non-diagnostic structural abnormalities were demonstrated in three of these patients. CONCLUSION: 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 which persists during ajmaline provocation and/or exercise may reflect underlying subtle structural abnormalities and should prompt further investigation.
Rachel Bastiaenen; Hariharan Raju; Sanjay Sharma; Michael Papadakis; Navin Chandra; Martina Muggenthaler; Malini Govindan; Velislav N Batchvarov; Elijah R Behr
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-19
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012. Published by Elsevier Inc.
St George's University of London, Cardiovascular Research Centre, London, UK.
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