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P7-03 Reverse remodelling after cardiac resynchronization therapy: early and long-term echocardiographic findings
Abstracts/International Journal of Cardiology 97 SuppL 2 (2004) S1~75 the combination of ETA receptor antagonists plus antioxidants may be beneficial in preventing the formation of excessive cardiac fibrosis.
POSTER SESSION P7
Electrophysiology and Pacing P7-01 ACCURATELY DIFFERENTIATING TREMOR-INDUCED PSEUDO-VENTRICULAR TACHYCARDIA BY A NEW STEPWISE ELECTROCARDIOGRAPHIC ALGORITHM Chun Yao Huan~ 1, Din E. Shan2, Chao Hung Lal 1, Man Cal Fong 1, Po Shun Huang 1, Hsien Hao Huang 3, C h e m ~ n Chiang 1,4, Shing Jong Lin 1'4. Division of CardiologN Department of MedicineZ;
Division of General Neurology, The Neurological Institute2, Department of Emergency Medicine3; Taipei Veterans General Hospital and National Yang-Ming University4, Taipei, Taiwcgt I n t r o d u c t i o n : Tremor4nduced electrocardiographic artifacts are prone to be misinterpreted as ventricular tachycardia (VT). We would like to find out the electrocardiographic criteria and to assemble an electrocardiographic algoritlnn showing diagnostic efficacies toidentify tremor4nduced pseudo VT. M e t h o d s : 118 patients presented with muscle tremor were e~rolled. 36 electrocardiograms showing tremor induced pseudo VT as well as 60 electrocardiograms documented as VTs were eraoiled. The reviewers were asked to apply the commonly used criteria for wide QRS complex tachy cardia differentiation, including Brugada criteria, to tell true VT from pseudo VT. Likewise, the possible clues for pseudo VT differentiation mentioned in previous case reports: Regular notches superimposed on the wide QRS like complex; and the new criteria developed by omselves: Small tiny regular or irregular spikes within the wide QRS like complex; and one of the frontal leads may present nomlal P and QRS wave, will also be examined. Finally, the diagnostic efficacy of a new stepwise elec trocardiog~-am algoritlnn including: 1) One of the frontal lead may show normal R QRS waves; 2) Small tiny irregular or regular spikes superim posed on the wide QRSqike complex; 3) Regular notches superimposed on the wide QRS like complex; and 4) Brugada criteria, would also be tested. Results: All the criteria, including Brugada criteria, originally designed to different VT within wide QRS tachycardia, couldn't provide satisfied differentiation power for us to recogilize the existence of pseudo VT. However, our new stepwise algorithm may effectively facilitate their differentiation. C o n c l u s i o n s : By keeping Ngh level of suspicion, meticulous clinical observation, as well as utilizing out new stepwise electrocardiographic algoritlml, pseudo VTs could be accurately and instantly recogitized within electrocardiograms D~sented with wide QRS tachyarrhytlmdas.
P7-02 T H E T I M E - D O M A I N SIGNAL.AVERAGE E C G A N D H E A R T RATE V A R I A B I L I T Y IN M I T R A L VALVE P R O L A P S E S Y N D R O M E A N D NORMAL TAIWANESE Kuan~ Min~ Yan~ 1, Gen Wang Yang 1, Chun Cheng Lin 1, Chih Ming Chen 2, I n g ~ a n g Yang3, Ten Fang Yang 1,4. 1Graduate
Institute of Medical Informatics, Taipei Medical University, Taiwan. 2Department of Electrical Engineering, National Taiwcgt University of Science and Technolog3; Taiwan. 3Department of Internal Medicine, Jen-Chi General Hospital, Taiwan.4Department of Internal Medicine (Cardiology), Taipei Medical University Hospital, Taiwan I n t r o d u c t i o n : The purpose focuses on the Signal Average ECG (SAECG) and Heat- Rate Variability (HRV) in Mitral Valve Prolapse Syndrome (MVPS) and nomlal (N) Talwanese
$61
Materials a n d m e t h o d s : There were 115 N, and 53 MVPS documented by Echocat-diogram, recruited from 2001 to 2004. A Siemens Elema Megacatt® ECG machine was used to ~ecord ECG data. The time domain pat-ameters used in SAECG were fQRSD, LAS40 and RMS40, whereas in HRV were SDNN, RMSSD, SDSD, NN50, and pNN50. Results a n d c o n c l u s i o n : 'I1]ere is no statistically significant difference between all N and MVPS in all pat-ameters (1) Time Domain SAECG There is a significant difference between female N and female MVPS only in LAS40(N: 29.67 ±7.32 vs MVPS: 32.73 ± 9.91, p 0.038). (2) Time Domain HRV
SDNN
RMSSD
SDSD
NN50
pNN50
Nomlal female 44.58±35.96 41.36±35.96 97.73+30.47 45.38±55.86 15.03±19.14 MVPS female 34.18±12.63 28.33±17.00 17.61±14.88 27.55±35.76 8.44±10.94 P 0.0"21 0.016 0.093 0.039 0.0"23 p < 0.03 statisticallysignificant.
P7-03 REVERSE REMODELLING AFTER CARDIAC R E S Y N C H R O N I Z A T I O N THERAPY: E A R L Y A N D L O N G - T E R M ECHOCARDIOGRAPHIC FINDINGS Kuan Hung Yeh, Chun Chieh Wang, Ming Shien Wen, San~ou Yeh, Fun Chung Lin, Delon Wu. Second Section of CardiologN Chang Gung
Memorial Hospital, Taoyucgt, Taiwan A i m : To use echocat-diography to determine the early and long term effects of cardiac resynchro~ization therapy (CRT) on left ventriculat- (LV) function and reverse remodelling. Methods: Eight patients with ejection fraction < 35% and intraven triculat- conduction delay (IVCD) ~eceived CRT since March, 2002. The underlying heart disease was dilated cat-diomyopathy in 6 patients and ischemic cat-diomyopathy in 2 patients. Six patients were in sinus rhythm and 2 patients were in chronic atrial fibrillation. Echocat-diographic mea surements were compared before implantation, 1 week (early), and 1 yeat (long term) after implantation. Paired btest was used for comparison and p < 0.05 was thought statistically significant. Results: The dut-ation of long tern1 follow up was 418±210 days.
Before (1) Early (2) Long term (3) (1) vs. (9) (1) vs. (3) (?) vs. (3)
LVEF (%)
EDD (ram)
ESD (mm)
EDV (ml)
ESV (ml)
LA (cm2)
MR (%)
21.4 t9.6 24.1 t9.6 31.0 ±13.2 0.003 0.006 0.13
69.3 ±7.3 60.5 ±7.5 59.0 ±9.1 0.15 0.13 0.14
54.5 ±8.1 51.8 ±8.4 49.1 ±9.5 0.001 0.009 0.10
170.1 +39.5 161.4 ±46.1 153.3 ±49.7 0.30 0.03 0.004
135.3 ±44.1 125.3 ±48.3 107.0 ±48.5 0.06 0.0005 0.0"2
26.2 t9.9 25.1 ±10.1 24.9 t9.3 0.09 0.53 0.95
93.2 ±11.0 90.8 ±14.2 21.5 ±14.5 0.21 0.47 0.69
C o n c l u s i o n s : CRT improves LVEF immediately after implantation, The benefit in LVEF persists for more than one year. CRT induces ~verse remodeling and reduces LV cavity size in the tong term follow up.
P7-04 I O N I C M E C H A N I S M S U N D E R L Y I N G T H E Q T P R O L O N G A T I O N IN TYPE I DIABETIC RABBIT HEARTS Yiqiang Zhang, Jingxiong Wang, Zhiguo Wang. From the Department of
Medicine, Universitg de MontMal, and the Research Centre, Montreal Heart Institute, 5000 Bela~lger East, Montreal, Quebec HIT 1C8, Canada B a c k g r o u n d : In type I diabetes mellitus, the major metabolic disturbances include reduced insulin level and increased plasma glucose level. Clinic studies have shown that about 30% of diabetic patients have prolonged QT interval which can potentially lead to ventriculat- a~-hytlmdas and
POSTER SESSION P7
Electrophysiology and Pacing P7-01 ACCURATELY DIFFERENTIATING TREMOR-INDUCED PSEUDO-VENTRICULAR TACHYCARDIA BY A NEW STEPWISE ELECTROCARDIOGRAPHIC ALGORITHM Chun Yao Huan~ 1, Din E. Shan2, Chao Hung Lal 1, Man Cal Fong 1, Po Shun Huang 1, Hsien Hao Huang 3, C h e m ~ n Chiang 1,4, Shing Jong Lin 1'4. Division of CardiologN Department of MedicineZ;
Division of General Neurology, The Neurological Institute2, Department of Emergency Medicine3; Taipei Veterans General Hospital and National Yang-Ming University4, Taipei, Taiwcgt I n t r o d u c t i o n : Tremor4nduced electrocardiographic artifacts are prone to be misinterpreted as ventricular tachycardia (VT). We would like to find out the electrocardiographic criteria and to assemble an electrocardiographic algoritlnn showing diagnostic efficacies toidentify tremor4nduced pseudo VT. M e t h o d s : 118 patients presented with muscle tremor were e~rolled. 36 electrocardiograms showing tremor induced pseudo VT as well as 60 electrocardiograms documented as VTs were eraoiled. The reviewers were asked to apply the commonly used criteria for wide QRS complex tachy cardia differentiation, including Brugada criteria, to tell true VT from pseudo VT. Likewise, the possible clues for pseudo VT differentiation mentioned in previous case reports: Regular notches superimposed on the wide QRS like complex; and the new criteria developed by omselves: Small tiny regular or irregular spikes within the wide QRS like complex; and one of the frontal leads may present nomlal P and QRS wave, will also be examined. Finally, the diagnostic efficacy of a new stepwise elec trocardiog~-am algoritlnn including: 1) One of the frontal lead may show normal R QRS waves; 2) Small tiny irregular or regular spikes superim posed on the wide QRSqike complex; 3) Regular notches superimposed on the wide QRS like complex; and 4) Brugada criteria, would also be tested. Results: All the criteria, including Brugada criteria, originally designed to different VT within wide QRS tachycardia, couldn't provide satisfied differentiation power for us to recogilize the existence of pseudo VT. However, our new stepwise algorithm may effectively facilitate their differentiation. C o n c l u s i o n s : By keeping Ngh level of suspicion, meticulous clinical observation, as well as utilizing out new stepwise electrocardiographic algoritlml, pseudo VTs could be accurately and instantly recogitized within electrocardiograms D~sented with wide QRS tachyarrhytlmdas.
P7-02 T H E T I M E - D O M A I N SIGNAL.AVERAGE E C G A N D H E A R T RATE V A R I A B I L I T Y IN M I T R A L VALVE P R O L A P S E S Y N D R O M E A N D NORMAL TAIWANESE Kuan~ Min~ Yan~ 1, Gen Wang Yang 1, Chun Cheng Lin 1, Chih Ming Chen 2, I n g ~ a n g Yang3, Ten Fang Yang 1,4. 1Graduate
Institute of Medical Informatics, Taipei Medical University, Taiwan. 2Department of Electrical Engineering, National Taiwcgt University of Science and Technolog3; Taiwan. 3Department of Internal Medicine, Jen-Chi General Hospital, Taiwan.4Department of Internal Medicine (Cardiology), Taipei Medical University Hospital, Taiwan I n t r o d u c t i o n : The purpose focuses on the Signal Average ECG (SAECG) and Heat- Rate Variability (HRV) in Mitral Valve Prolapse Syndrome (MVPS) and nomlal (N) Talwanese
$61
Materials a n d m e t h o d s : There were 115 N, and 53 MVPS documented by Echocat-diogram, recruited from 2001 to 2004. A Siemens Elema Megacatt® ECG machine was used to ~ecord ECG data. The time domain pat-ameters used in SAECG were fQRSD, LAS40 and RMS40, whereas in HRV were SDNN, RMSSD, SDSD, NN50, and pNN50. Results a n d c o n c l u s i o n : 'I1]ere is no statistically significant difference between all N and MVPS in all pat-ameters (1) Time Domain SAECG There is a significant difference between female N and female MVPS only in LAS40(N: 29.67 ±7.32 vs MVPS: 32.73 ± 9.91, p 0.038). (2) Time Domain HRV
SDNN
RMSSD
SDSD
NN50
pNN50
Nomlal female 44.58±35.96 41.36±35.96 97.73+30.47 45.38±55.86 15.03±19.14 MVPS female 34.18±12.63 28.33±17.00 17.61±14.88 27.55±35.76 8.44±10.94 P 0.0"21 0.016 0.093 0.039 0.0"23 p < 0.03 statisticallysignificant.
P7-03 REVERSE REMODELLING AFTER CARDIAC R E S Y N C H R O N I Z A T I O N THERAPY: E A R L Y A N D L O N G - T E R M ECHOCARDIOGRAPHIC FINDINGS Kuan Hung Yeh, Chun Chieh Wang, Ming Shien Wen, San~ou Yeh, Fun Chung Lin, Delon Wu. Second Section of CardiologN Chang Gung
Memorial Hospital, Taoyucgt, Taiwan A i m : To use echocat-diography to determine the early and long term effects of cardiac resynchro~ization therapy (CRT) on left ventriculat- (LV) function and reverse remodelling. Methods: Eight patients with ejection fraction < 35% and intraven triculat- conduction delay (IVCD) ~eceived CRT since March, 2002. The underlying heart disease was dilated cat-diomyopathy in 6 patients and ischemic cat-diomyopathy in 2 patients. Six patients were in sinus rhythm and 2 patients were in chronic atrial fibrillation. Echocat-diographic mea surements were compared before implantation, 1 week (early), and 1 yeat (long term) after implantation. Paired btest was used for comparison and p < 0.05 was thought statistically significant. Results: The dut-ation of long tern1 follow up was 418±210 days.
Before (1) Early (2) Long term (3) (1) vs. (9) (1) vs. (3) (?) vs. (3)
LVEF (%)
EDD (ram)
ESD (mm)
EDV (ml)
ESV (ml)
LA (cm2)
MR (%)
21.4 t9.6 24.1 t9.6 31.0 ±13.2 0.003 0.006 0.13
69.3 ±7.3 60.5 ±7.5 59.0 ±9.1 0.15 0.13 0.14
54.5 ±8.1 51.8 ±8.4 49.1 ±9.5 0.001 0.009 0.10
170.1 +39.5 161.4 ±46.1 153.3 ±49.7 0.30 0.03 0.004
135.3 ±44.1 125.3 ±48.3 107.0 ±48.5 0.06 0.0005 0.0"2
26.2 t9.9 25.1 ±10.1 24.9 t9.3 0.09 0.53 0.95
93.2 ±11.0 90.8 ±14.2 21.5 ±14.5 0.21 0.47 0.69
C o n c l u s i o n s : CRT improves LVEF immediately after implantation, The benefit in LVEF persists for more than one year. CRT induces ~verse remodeling and reduces LV cavity size in the tong term follow up.
P7-04 I O N I C M E C H A N I S M S U N D E R L Y I N G T H E Q T P R O L O N G A T I O N IN TYPE I DIABETIC RABBIT HEARTS Yiqiang Zhang, Jingxiong Wang, Zhiguo Wang. From the Department of
Medicine, Universitg de MontMal, and the Research Centre, Montreal Heart Institute, 5000 Bela~lger East, Montreal, Quebec HIT 1C8, Canada B a c k g r o u n d : In type I diabetes mellitus, the major metabolic disturbances include reduced insulin level and increased plasma glucose level. Clinic studies have shown that about 30% of diabetic patients have prolonged QT interval which can potentially lead to ventriculat- a~-hytlmdas and