Legge di petrolio mongolia (catalog) 1 (2)
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Electrophysiological Basis of ECG Characteristics of Torsades de Pointes in Long QT Syndrome Nabil El-Sherif, MD a,b, *, Gioia Turitto, MD c , Mohamed Boutjdir, PhD a , Sajin Pilai, MD d , Bryan Otte, MA e , Roland Pedalino, MD f INTRODUCTION Both congenital and acquired long QT syndromes (LQTS) are caused by abnormalities (intrinsic and/ or acquired) of the ionic currents underlying repolar- ization. Prolongation of the repolarization phase acts as a primary step for the generation of early afterdepolarizations (EADs). EAD-induced triggered beats arise predominantly from the Purkinje network. 1 In LQTS, prolonged repolarization is associated with increased spatial dispersion of repolarization. 2,3 The focal EAD-induced triggered beats can infringe on the underlying substrate of inhomogeneous repolarization to initiate polymor- phic reentrant ventricular tachycardia (VT). 3 Tor- sades de pointes (TdP) is an ear-pleasing term that describes an eye-catching form of polymorphic VT. The term was first coined by Dessertenne 4 who described its electrocardiographic (ECG) pattern of continuously changing morphology of the QRS complexes that seem to twist around an imaginary baseline. The quasi-musical term and the intriguing ECG pattern have caught the attention of electro- physiologists for years and have been, to some extent, a driving force behind the focused interest into the role of genetics and cardiac ion channel pathophysiology in cardiac arrhythmias in general. 5 More importantly, it is useful to focus attention on the role of dispersion of ventricular repolarization in the genesis of malignant VTs. There is more than one electrophysiologic mechanism for polymorphic VT, and an under- standing of these mechanisms can be of valuable help in the proper management of individual Supported in part by Veterans Administration and the Narrows Institute for Biomedical Research. a State University of New York, Downstate Medical Center, Brooklyn, New York; b Cardiology Division, New York Harbor VA Healthcare System, Brooklyn, New York; c Electrophysiology Service, New York Methodist Hospital, Brooklyn, New York; d Cardiac Telemetry Service, New York Harbor VA Healthcare System, Brooklyn, New York; e Cardiology Research Program, New York Harbor VA Healthcare System, Brooklyn, New York; f Cardiology Section, Kings County Hospital, Brooklyn, New York * Corresponding author. E-mail address: [email protected] KEYWORDS Long QT syndrome Torsades de pointes Dispersion of repolarization Bigeminal rhythm T-wave alternans Mapping KEY POINTS In the long QT syndrome, prolonged repolarization is associated with increased spatial dispersion of repolarization. Prolongation of repolarization also acts as a primary step for the generation of early afterdepolari- zations (EADs). The focal EAD-induced triggered beats can infringe on the underlying substrate of inhomogeneous repolarization to initiate polymorphic reentrant ventricular tachycardia. Card Electrophysiol Clin 6 (2014) 433–444 http://dx.doi.org/10.1016/j.ccep.2014.05.011 1877-9182/14/$ – see front matter Published by Elsevier Inc. cardiacEP.theclinics.com
Transcript of Legge di petrolio mongolia (catalog) 1 (2)
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