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      Differences of ventricular late potential between acute STEMI and NSTEMI patients Translated title: Diferencias del potencial tardío ventricular entre pacientes con infartos agudos STEMI y NSTEMI

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          Abstract

          OBJECTIVE: To discuss the positive rate of ventricular late potential (VLP) between patients with acute ST-segment elevation myocardial infarction (STEMI) and patients with acute non NSTEMI. METHODS: One hundred and sixty-three cases of acute myocardial infarction (90 patients with STEMI and 73 with NSTEMI), admitted to the first hospital of China Medical University between June 2011 and August 2011, underwent VLP examination. RESULTS: The VLP positive rate of the STEMI group was 54.4%, while that of the NSTEMI group was 38.4%, and the differences have statistical meaning (χ2 = 4.186, p < 0.05). The occurrence rate of ventricular arrhythmia in VLP positive patients was 11.7%, while in VLP negative patients it was 3.5% (χ2 = 4.005, p < 0.05). CONCLUSION: The VLP positive rate of the STEMI group is higher than that of the NSTEMI group.

          Translated abstract

          OBJETIVO: Analizar la tasa positiva del potencial tardío ventricular (PTV) entre pacientes con infarto agudo del miocardio sin elevación del segmento ST (NSTEMI por sus siglas en inglés) y el infarto agudo del miocardio con elevación del segmento ST (STEMI por sus siglas en inglés). MÉTODOS: Ciento sesenta y tres casos de infarto agudo de miocardio (90pacientes con STEMI) y 73 con NSTEMI, ingresados en la Universidad primer hospital de Medicina China entre junio y agosto de 2011, fueron sometidos a examen de PTV. RESULTADOS: La tasa positiva PVT del grupo STEMI fue 54.4%, mientras que la del grupo NSTEMI fue 38.4%, y las diferencias tienen significado estadístico (χ² = 4.186, p < 0.05). La tasa de ocurrencia de arritmia ventricular en pacientes PVTpositivos fue 11.7%, mientras que en los pacientes PVT negativos fue 3.5% (χ² = 4.005, p < 0.05). CONCLUSIÓN: La tasa PTV positiva del grupo STEMI es mayor que la del grupo NSTEMI.

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          Relationship of late potentials to the ventricular tachycardia circuit defined by entrainment.

          Catheter ablation of ventricular tachycardia (VT) depends on the localization of VT circuit. Late potential (LP) recordings in sinus rhythm suggest slow conduction and may help to identify the reentry circuit. Detailed entrainment mapping was performed to identify VT circuits in 15 patients with structural heart disease. LPs were identified during baseline non-VT rhythm and were defined as electrogram signals occurring beyond the end of surface QRS. The QRS-LP interval was measured from onset of QRS to the latest LP component. Entrainment was performed in 21 VTs, of which three entrance, 13 isthmus, 17 exit, and one outer loop sites were identified (n = 34). Bipolar electrograms (n = 133 sites) at and in proximity (<1.5 cm distance) to the VT circuit were analyzed. A higher incidence of LP was recorded near isthmus (89%) compared to entrance (57%) or exit (20%), p < 0.05. The QRS-LP intervals were markedly longer at entrance (218 +/- 27 ms) and isthmus (194 +/- 40 ms) compared to those recorded at exit (131 +/- 29 ms), p < 0.05. Electrograms near the VT circuit isthmus have a higher incidence of LP compared to that of entrance and exit; and the QRS-LP interval is significantly longer near entrance and isthmus compared to exit sites. These findings have important implications in substrate-based ablation strategies targeting LPs.
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            Prediction of long-term outcomes by signal-averaged electrocardiography in patients with unsustained ventricular tachycardia, coronary artery disease, and left ventricular dysfunction.

            An abnormal signal-averaged ECG (SAECG) is a noninvasive marker of the substrate of sustained ventricular tachycardia after myocardial infarction. We assessed its prognostic ability in patients with asymptomatic unsustained ventricular tachycardia, coronary artery disease, and left ventricular dysfunction. A blinded core laboratory analyzed SAECG tracings from 1925 patients in a multicenter trial. Cox proportional hazards modeling was used to examine individual and joint relations between SAECG variables and arrhythmic death or cardiac arrest (primary end point), cardiac death, and total mortality. We also assessed the prognostic utility of SAECG at different levels of ejection fraction (EF). A filtered QRS duration >114 ms (abnormal SAECG) independently predicted the primary end point and cardiac death, independent of clinical variables, cardioverter-defibrillator implantation, and antiarrhythmic drug therapy. With an abnormal SAECG, the 5-year rates of the primary end point (28% versus 17%, P=0.0001), cardiac death (37% versus 25%, P=0.0001), and total mortality (43% versus 35%, P=0.0001) were significantly higher. The combination of EF <30% and abnormal SAECG identified a particularly high-risk subset that constituted 21% of the total population. Thirty-six percent and 44% of patients with this combination succumbed to arrhythmic and cardiac death, respectively. SAECG is a powerful predictor of poor outcomes in this population. The noninvasive combination of an abnormal SAECG and reduced EF may have utility in selecting high-risk patients for intervention.
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              Distribution of late potentials within infarct scars assessed by ultra high-density mapping.

              Late potential (LP) electrograms represent areas of slow conduction and are often sites critical to reentrant tachycardia circuits. The distribution of LPs within infarct scar is not known.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                wimj
                West Indian Medical Journal
                West Indian med. j.
                The University of the West Indies (Mona, , Jamaica )
                0043-3144
                2309-5830
                November 2013
                : 62
                : 8
                : 721-723
                Affiliations
                [01] Shenyang orgnameThe First Hospital of China Medical University orgdiv1Department of Cardiology China
                Article
                S0043-31442013000800009
                7c97670b-2811-4fbf-b710-83e128739313

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 9, Pages: 3
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                SciELO West Indians

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                Original Articles

                ventricular arrhythmia,ventricular late potential,Infarto agudo del miocardio sin elevación del segmento ST,infarto agudo del miocardio con elevación del segmento ST,arritmia ventricular,potencial tardío ventricular,Acute non ST-segment elevation myocardial infarction,acute ST-segment elevation myocardial infarction

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