EDITED BY: The z.f Mohammad Shenasa, MD Mark E Josephson, MD N.A Mark Estes III, MD ECG HANDBOOK of Cont emporary Challenges FOREWORD BY: Hein J.J Wellens, MD THE ECG HANDBOOK OF CONTEM PORARY CHALLENGES THE ECG HANDBOOK OF CONTEM PORARY CHALLENGES EDITORS Mohammad Shenasa, MD Mark E Josephson, MD N.A Mark Estes III, MD © 2015 Mohammad Shenasa, Mark E Josephson , N.A Mark Estes III Cardiotext Publishing, LLC 3405 W 44th Street Minneapolis, Minnesota 55410 USA www.cardiotextpublishing.com Any updates to this book may be found at: www.cardiotextpublishing.com/ ecg-handbook-of-contemporary-challenges Comments, inquiries, and requests for bulk sales can be directed to the publisher at: info@cardiotextpublishing.com All righ ts reserved No part of this book may be reproduced in any form or by any means without the prior permission of the publisher All trademarks, service marks, and trade names used herein are the property of their respective owners and are used only to identify the products or services of those owners This book is intended for educational purposes and to furth er general scientific and medical knowledge, research, and understanding of the conditions and associated treatments discussed herein This book is not intended to serve as and should not be relied upon as recommending or promoting any specific diagnosis or method of treatment for a particular condition or a particular patient It is the reader’s responsibility to determine the proper steps for diagnosis and the proper course of treatment for any condition or patient, including suitable and appropriate tests, medications or medical devices to be used for or in conjunction with any diagnosis or treatment Due to ongoing research, discoveries, modifications to medicines, equipment and devices, and changes in government regulations, the information contained in this book may not reflect the latest standards, developments, guidelines, regulations, products or devices in the field Readers are responsible for keeping up to date with th e latest developments and are urged to review th e latest instructions and warnings for any medicine, equipment or medical device Readers should consult with a specialist or contact the vendor of any medicine or medical device where appropriate Except for the publisher’s website associated with this work, the publisher is not affiliated with and does not sponsor or endorse any websites, organizations or other sources of information referred to herein The publisher and the authors specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the conten ts of this book Unless otherwise stated, all figures and tables in this book are used courtesy of the authors Library of Congress Con trol Number: 2015931353 ISBN: 978-1-935395-88-1 Printed in The United States of America CONTENTS Cont ribut ors vii Foreword xi Preface xiii Abbreviat ions xv Chapt er 1: Normal Electrocardiograms Today Galen Wagner Chapt er 2: ECG Manifestations of Concealed Conduction 13 Mohammad-Reza Jazayeri Chapt er 3: P-Wave Indices and the PR Interval—Relation to Atrial Fibrillation and Mortality 27 Konstantinos N Aronis and Jared W Magnani Chapt er 4: The Athlete’s Electrocardiogram 47 Yousef Bader, Mark S Link, and N.A Mark Estes III Chapt er 5: Electrocardiographic Markers of Arrhythmic Risk and Sudden Cardiac Death in Pediatric and Adolescent Patients 63 Edward P Walsh and Dominic J Abrams Chapt er 6: Electrocardiographic Markers of Sudden Cardiac Death in Different Substrates 83 Mohammad Shenasa and Hossein Shenasa Chapt er 7: Electrocardiographic Markers of Arrhythmic Events and Sudden Death in Channelopathies 107 Sergio Richter, Josep Brugada, Ramon Brugada, and Pedro Brugada Chapt er 8: Early Repolarization Syndrome: Its Relationship to ECG Findings and Risk Stratification 125 Arnon Adler, Ofer Havakuk, Raphael Rosso, and Sami Viskin Chapt er 9: Diagnostic Electrocardiographic Criteria of Early Repolarization and Idiopathic Ventricular Fibrillation 135 Mélèze Hocini, Ashok J Shah, Pierre Jaïs, and Michel Haïssaguerre Chapt er 10: Prevalence and Significance of Early Repolarization ( a.k.a Haïssaguerre or J-Wave Pattern/ Syndrome) 143 Victor Froelicher Chapt er 11: T-Wave Alternans: Electrocardiographic Characteristics and Clinical Value 155 Stefan H Hohnloser Chapt er 12: Electrocardiographic Markers of Phase and Phase Atrioventricular Block and Progression to Complete Heart Block 163 John M Miller, Rahul Jain, and Eric L Krivitsky Chapt er 13: Myocardial Infarction in the Presence of Left Bundle Branch Block or Right Ventricular Pacing 171 Cory M Tschabrunn and Mark E Josephson v vi CONTENTS Chapt er 14: T-Wave Memory 179 Henry D Huang, Mark E Josephson, and Alexei Shvilkin Chapt er 15: Electrocardiographic Markers of Progressive Cardiac Conduction Disease 191 Vincent Probst and Hervé Le Marec Chapt er 16: Sex- and Ethnicity-Related Differences in Electrocardiography 197 Anne B Curtis and Hiroko Beck Chapt er 17: Electrocardiograms in Biventricular Pacing 203 John Rickard, Victor Nauffal, and Alan Cheng Chapt er 18: Effect of Cardiac and Noncardiac Drugs on Electrocardiograms: Electrocardiographic Markers of Drug-Induced Proarrhythmias ( QT Prolongation, TdP, and Ventricular Arrhythmias) 213 Chinmay Patel, Eyad Kanawati, and Peter Kowey Index 223 CONTRIBUTORS Ed it o r s Mohammad Shenasa, MD, FACC, FHRS, FAHA, FESC Attending Physician, Department of Cardiovascular Services, O’Conner Hospital; Heart & Rhythm Medical Group, San Jose, California N.A Mark Estes III, MD, FACC, FHRS, FAHA, FESC Professor of Medicine, Tufts University School of Medicine; Director, New England Cardiac Arrhythmia Center, Tufts Medical Center, Boston, Massachusetts Mark E Josephson, MD, FACC, FHRS, FAHA Chief, Cardiovascular Medicine Division; Director, Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Beth Israel Deaconess Medical Center; Herman C Dana Professor of Medicine, Harvard Medical School, Boston, Massachusetts Co n t r ib u t o r s Dominic J Abrams, MD, MRCP Assistant Professor of Pediatrics, Harvard Medical School; Director, In herited Cardiac Arrhythmia Program, Boston Children’s Hospital, Boston, Massachusetts Josep Brugada, MD, PhD Chairman, Cardiovascular Center; Professor, Fundacio Clinic; Medical Director, Hospital Clinic, Barcelona, Spain Pedro Brugada, MD, PhD Heart Rhythm Management Center, Cardiovascular Center, Free University of Brussels, Brussels, Belgium Arnon Adler, MD Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel Konstantinos N Aronis, MD Senior Resident, Department of Medicine, Boston University Medical Center, Boston, Massachusetts Ramon Brugada, MD, PhD Dean of Faculty of Medicine, Reial Academia de Medicinia de Catalunya, Barcelona, Spain Alan Cheng, MD Associate Professor of Medicine; Director, Arrhythmia Device Service, John Hopkins Hospital, Baltimore, Maryland Yousef Bader, MD Senior Fellow in Clinical Cardiac Electrophysiology, Tufts Medical Center, Division of Cardiac Electrophysiology; Instructor in Medicine, Tufts University School of Medicine, Boston, Massachusetts Anne B Curtis, MD, FACC, FHRS, FACP, FAHA Charles and Mary Bauer Professor and Chair, UB Distinguished Professor, Department of Medicine, School of Medicine and Biomedical Scien ces, University of Buffalo, Buffalo, New York Hiroko Beck, MD Assistant Professor, Clinical Cardiac Electrophysiology, University of Buffalo, Buffalo, New York vii viii CONTRIBUTORS Victor Froelicher, MD, FACC, FAHA, FACSM Professor of Medicine, Department of Cardiovascular Medicine, Stanford University, Stan ford, California Michel Hạssaguerre, MD Hơpital Cardiologique du Haut-Lévêque and the Un iversité Victor Segalen Bordeaux II, Bordeaux, France Ofer Havakuk, MD Tel Aviv Medical Center, Cardiology Department, Tel Aviv, Israel Mélèze Hocini, MD Hôpital Cardiologique du Haut-Lévêque and the Un iversité Victor Segalen Bordeaux II, Bordeaux, France Stefan H Hohnloser, MD Professor of Medicine and Cardiology, J.W Goethe University, Department of Cardiology, Division of Clinical Electrophysiology, Frankfurt, Germany Henry D Huang, MD Clin ical Electrophysiology Fellow, Harvard-Thorndike Arrh ythmia Institute, Harvard Medical School; Beth Israel Deaconess Medical Center, Boston, Massachusetts Rahul Jain, MD, MPH Assistant Professor, Indiana University School of Medicine; Cardiac Electrophysiology Service, VA Hospital, Indianapolis, Indiana Pierre Jaïs, MD Department of Rhythmologie, Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France Mohammad-Reza Jazayeri, MD, FACC, FAHA Director of Electrophysiology, Laboratory and Arrhythmia Service, Heart and Vascular Center, Bellin Health Systems, Inc., Green Bay, Wisconsin Eyad Kanawati, MD Cardiovascular Disease Fellow, Department of Cardiology, Lankenau Medical Center, Wynnewood, Pennsylvania Peter Kowey, MD, FACC, FAHA, FHRS Professor of Medicine and Clinical Pharmacology, Jefferson Medical College; William Wikoff Smith Chair in Cardiovascular Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania Eric L Krivitsky, MD Electrophysiologist, Chattanooga Heart Institute, Chattanooga, Tennessee Hervé Le Marec, MD, PhD Professor of Cardiology, Director of L’institut du thorax, Nantes University Hospital, Nantes, France Mark S Link, MD Professor of Medicine, Tufts University School of Medicine; Co-Director, Cardiac Electrophysiology and Pacemaker Laboratory; Director, Center for the Evaluation of Heart Disease in Athletes, Boston, Massachusetts Jared W Magnani, MD, MS Assistant Professor, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts John M Miller, MD Professor of Medicine, Indiana University School of Medicine; Director, Clinical Cardiac Electrophysiology, Indianapolis, Indiana Victor Nauffal, MD Postdoctoral Fellow, Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland Chinmay Patel, MD, FACC Clinical Cardiac Electrophysiologist, Pinnacle Health Cardiovascular Institute, Harrisburg, Pennsylvania Vincent Probst, MD, PhD Professor of Cardiology, Director of the Cardiologic Department, L’institut du thorax Nantes University Hospital, Nantes, France Sergio Richter, MD Associate Professor of Medicine and Cardiology, Department of Electrophysiology, Heart Center – University of Leipzig, Leipzig, Germany CONTRIBUTORS John Rickard, MD, MPH Assistant Professor of Medicine Electrophysiology, John H opkins University, Baltimore, Maryland Raphael Rosso, MD Atrial Fibrillation Service, Director, Cardiology Department, Tel Aviv Medical Center, Tel Aviv, Israel Ashok J Shah, MD Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France Hossein Shenasa, MD Attending Physician, Department of Cardiovascular Services, O’Conner Hospital; Heart & Rhythm Medical Group, San Jose, California Alexei Shvilkin, MD Assistant Clinical Professor of Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts ix Cory M Tschabrunn, CEPS Principal Associate of Medicine, Harvard Medical School; Technical Director, Experimental Electrophysiology, Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts Sami Viskin, MD Associate Professor of Cardiology, Sackler School of Medicine, Tel-Aviv University; Director, Cardiac Hospitalization, Sourasky Tel-Aviv Medical Center, Tel Aviv, Israel Galen S Wagner, MD Associate Professor of Medicine, Department of Cardiology, Division of Department of Medicine, Duke University, Durham, North Carolina Edward P Walsh, MD, FHRS Professor of Pediatrics, Harvard Medical School; Chief, Cardiac Electrophysiology Service, Boston Children’s Hospital, Boston, Massachusetts ... intended The ECG Handbook of Contemporary Challenges © 2015 Mohammad Shenasa, Mark E Josephson, N.A Mark Estes III Cardiotext Publishing, ISBN: 978-1-935395-88-1 203 204 T he ECG Handbook of Contemporary. .. T he ECG Handbook of Contemporary Challenges trials of CRT have demonstrated superior benefit of CRT at wider QRS durations.33–37 In a meta-analysis of large, randomized controlled trials of CRT,...THE ECG HANDBOOK OF CONTEM PORARY CHALLENGES THE ECG HANDBOOK OF CONTEM PORARY CHALLENGES EDITORS Mohammad Shenasa, MD Mark E Josephson,