Editorial comment
The electrocardiogram in the age of three-dimensional mapping: What is the secret of its youth?
Eletrocardiograma na era do mapeamento tridimensional. Qual o segredo da sua juventude?
Pedro Silva Cunha
Unidade de Eletrofisiologia e Pacing, Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
Read
3177
Timeswas read the article
1466
Total PDF
1711
Total HTML
Share statistics
array:25 [ "pii" => "S2174204919300534" "issn" => "21742049" "doi" => "10.1016/j.repce.2019.03.001" "estado" => "S300" "fechaPublicacion" => "2019-02-01" "aid" => "1343" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2019" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "dis" "cita" => "Rev Port Cardiol. 2019;38:93-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 426 "formatos" => array:3 [ "EPUB" => 65 "HTML" => 204 "PDF" => 157 ] ] "Traduccion" => array:2 [ "en" => array:20 [ "pii" => "S0870255117308272" "issn" => "08702551" "doi" => "10.1016/j.repc.2018.06.010" "estado" => "S300" "fechaPublicacion" => "2019-02-01" "aid" => "1346" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2019;38:83-91" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1422 "formatos" => array:3 [ "EPUB" => 103 "HTML" => 779 "PDF" => 540 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Premature ventricular contractions of the right ventricular outflow tract: Upward displacement of the ECG unmasks ST elevation in V1 associated with the presence of low voltage areas" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "83" "paginaFinal" => "91" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Extrasistolia ventricular da camara de saída do ventrículo direito. ECG efetuado no segundo espaço intercostal revela supradesnivelamento do segmento ST que se associa com a presença de baixa voltagem no mapa electroanatómico" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1292 "Ancho" => 1500 "Tamanyo" => 202883 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">12-lead electrocardiogram (ECG) of four different patients comparing the tracings with V1 and V2 in the standard and high positions. From left to right, in the first patient V1 does not change, the PVC loses R in V1 and V2 in the second ICS. In the second patient the upper ECG displays ST elevation in V1, in the third patient ST elevation with rSr’ pattern and in the fourth patient an rSr’ pattern without ST elevation. ICS: intercostal space; PVC: premature ventricular contraction.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Leonor Parreira, Rita Marinheiro, Pedro Carmo, Pedro Amador, Tiago Teixeira, Diogo Cavaco, Francisco Costa, Katya Reis-Santos, Pedro Adragão" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Leonor" "apellidos" => "Parreira" ] 1 => array:2 [ "nombre" => "Rita" "apellidos" => "Marinheiro" ] 2 => array:2 [ "nombre" => "Pedro" "apellidos" => "Carmo" ] 3 => array:2 [ "nombre" => "Pedro" "apellidos" => "Amador" ] 4 => array:2 [ "nombre" => "Tiago" "apellidos" => "Teixeira" ] 5 => array:2 [ "nombre" => "Diogo" "apellidos" => "Cavaco" ] 6 => array:2 [ "nombre" => "Francisco" "apellidos" => "Costa" ] 7 => array:2 [ "nombre" => "Katya" "apellidos" => "Reis-Santos" ] 8 => array:2 [ "nombre" => "Pedro" "apellidos" => "Adragão" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S217420491930056X" "doi" => "10.1016/j.repce.2018.06.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217420491930056X?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117308272?idApp=UINPBA00004E" "url" => "/08702551/0000003800000002/v6_201912041757/S0870255117308272/v6_201912041757/en/main.assets" ] "pt" => array:20 [ "pii" => "S0870255119300137" "issn" => "08702551" "doi" => "10.1016/j.repc.2019.01.003" "estado" => "S300" "fechaPublicacion" => "2019-02-01" "aid" => "1343" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "dis" "cita" => "Rev Port Cardiol. 2019;38:93-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 794 "formatos" => array:3 [ "EPUB" => 93 "HTML" => 515 "PDF" => 186 ] ] "pt" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Comentário editorial</span>" "titulo" => "Eletrocardiograma na era do mapeamento tridimensional. Qual o segredo da sua juventude?" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "93" "paginaFinal" => "95" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "The electrocardiogram in the age of three‐dimensional mapping: What is the secret of its youth?" ] ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 731 "Ancho" => 905 "Tamanyo" => 60445 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Imagem radioscópica, em incidência Oblíqua Anterior Direita (OAD) a 30°, com a visualização de contraste no ventrículo direito, permitindo a identificação (delineada a branco) da região da Válvula Tricúspide (seta), Região Apical do Ventrículo Direito (A) e Câmara de Saída do Ventrículo direito (B). Pode observar‐se também a presença de eletrocateter de Cardioversor‐Desfibrilhador de fixação ativa, cuja ponta se encontra na região septal supero‐mediana (Silva Cunha P., Oliveira M.).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pedro Silva Cunha" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Pedro" "apellidos" => "Silva Cunha" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204919300534" "doi" => "10.1016/j.repce.2019.03.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204919300534?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255119300137?idApp=UINPBA00004E" "url" => "/08702551/0000003800000002/v6_201912041757/S0870255119300137/v6_201912041757/pt/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2174204919300492" "issn" => "21742049" "doi" => "10.1016/j.repce.2018.05.014" "estado" => "S300" "fechaPublicacion" => "2019-02-01" "aid" => "1339" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2019;38:97-101" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1065 "formatos" => array:3 [ "EPUB" => 116 "HTML" => 739 "PDF" => 210 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Pericarditis – clinical presentation and characteristics of a pediatric population" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "97" "paginaFinal" => "101" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Pericardite – apresentação e características numa população pediátrica" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Catarina Perez-Brandão, Conceição Trigo, Fátima F. Pinto" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Catarina" "apellidos" => "Perez-Brandão" ] 1 => array:2 [ "nombre" => "Conceição" "apellidos" => "Trigo" ] 2 => array:2 [ "nombre" => "Fátima F." "apellidos" => "Pinto" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S0870255117308818" "doi" => "10.1016/j.repc.2018.05.017" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117308818?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204919300492?idApp=UINPBA00004E" "url" => "/21742049/0000003800000002/v1_201904100624/S2174204919300492/v1_201904100624/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S217420491930056X" "issn" => "21742049" "doi" => "10.1016/j.repce.2018.06.008" "estado" => "S300" "fechaPublicacion" => "2019-02-01" "aid" => "1346" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2019;38:83-91" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 897 "formatos" => array:3 [ "EPUB" => 96 "HTML" => 641 "PDF" => 160 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Premature ventricular contractions of the right ventricular outflow tract: Upward displacement of the ECG unmasks ST elevation in V1 associated with the presence of low voltage areas" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "83" "paginaFinal" => "91" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Extrasistolia ventricular da camara de saída do ventrículo direito. ECG efetuado no segundo espaço intercostal revela supradesnivelamento do segmento ST que se associa com a presença de baixa voltagem no mapa electroanatómico" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1347 "Ancho" => 1314 "Tamanyo" => 147517 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Three-dimensional electroanatomical voltage maps of the RVOT. (A): A patient with normal voltage map; (B): a patient with an LVA extending into the RVOT. Pink and red dots indicate the successful ablation site and yellow dots indicate the His bundle. Note that the ablation site lies within the LVA in the second patient. LVA: low voltage area; RVOT: right ventricular outflow tract.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Leonor Parreira, Rita Marinheiro, Pedro Carmo, Pedro Amador, Tiago Teixeira, Diogo Cavaco, Francisco Costa, Katya Reis-Santos, Pedro Adragão" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Leonor" "apellidos" => "Parreira" ] 1 => array:2 [ "nombre" => "Rita" "apellidos" => "Marinheiro" ] 2 => array:2 [ "nombre" => "Pedro" "apellidos" => "Carmo" ] 3 => array:2 [ "nombre" => "Pedro" "apellidos" => "Amador" ] 4 => array:2 [ "nombre" => "Tiago" "apellidos" => "Teixeira" ] 5 => array:2 [ "nombre" => "Diogo" "apellidos" => "Cavaco" ] 6 => array:2 [ "nombre" => "Francisco" "apellidos" => "Costa" ] 7 => array:2 [ "nombre" => "Katya" "apellidos" => "Reis-Santos" ] 8 => array:2 [ "nombre" => "Pedro" "apellidos" => "Adragão" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255117308272" "doi" => "10.1016/j.repc.2018.06.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117308272?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217420491930056X?idApp=UINPBA00004E" "url" => "/21742049/0000003800000002/v1_201904100624/S217420491930056X/v1_201904100624/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "The electrocardiogram in the age of three-dimensional mapping: What is the secret of its youth?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "93" "paginaFinal" => "95" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Pedro Silva Cunha" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Pedro Silva" "apellidos" => "Cunha" "email" => array:1 [ 0 => "psilvacunha@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidade de Eletrofisiologia e Pacing, Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eletrocardiograma na era do mapeamento tridimensional. Qual o segredo da sua juventude?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 731 "Ancho" => 905 "Tamanyo" => 60849 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Fluoroscopic image of the right ventricle (outlined in white) in right anterior oblique view at 30° with contrast, showing the tricuspid valve (arrow), the right ventricular apex (A) and the right ventricular outflow tract (B). An active fixation cardioverter-defibrillator lead is also visible, with its tip in the upper-mid septal region (Silva Cunha P, Oliveira M).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">When approaching a patient diagnosed with a ventricular tachyarrhythmia, a systematic search should be made for structural heart disease (the most common etiology being coronary disease), since this has important prognostic and therapeutic implications.</p><p id="par0010" class="elsevierStylePara elsevierViewall">There is, however, a subgroup of patients who develop ventricular tachycardia in structurally normal hearts. This is known as idiopathic ventricular tachycardia and is estimated to account for up to 10% of cases of ventricular tachycardia.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Two types of treatment are available for these patients: pharmacological and catheter ablation (or both simultaneously). Since these arrhythmias are focal, they are readily amenable to treatment with catheter ablation, with high success rates.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Since the first description in the early 1980s of tachycardia originating in the right ventricular outflow tract (RVOT) by Buxton et al. <a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a>, our understanding of idiopathic ventricular tachycardias has increased greatly. Lerman et al. published a series of studies<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">4–6</span></a> on the pathophysiological mechanisms involved, showing that most tachycardias originating in the RVOT are sensitive to adenosine, and that the most likely electrophysiological mechanisms are delayed afterpotentials and delayed afterdepolarizations mediated by catecholaminergic stimulation and triggered activity associated with intracellular calcium overload.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Given the intracellular nature of their pathophysiology, it is logical that such tachycardias can be induced in the electrophysiological laboratory by administration of isoprenaline, aminophylline or atropine and rapid pacing, but rarely if ever by programmed ventricular stimulation.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Outflow tract tachycardias, mainly located in the myocardium of the right and left ventricular outflow tracts, are a subgroup of idiopathic ventricular tachycardias. In 80-90% of them the right ventricular outflow tract is the origin of the arrhythmia.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The prognosis is generally favorable, although physicians should be aware that some cases develop into left ventricular dysfunction (tachycardia-induced myopathy),<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">10</span></a> and malignant variants have occasionally been described.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">11</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">An essential element of the diagnosis is careful analysis of the electrocardiogram (ECG), which can provide an accurate localization of the arrhythmia's origin in the left or right ventricular outflow tract (according to the morphology of the QRS complex in the right precordial leads) and even the segment of the tract.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The impressive advances in the technology now at the disposal of cardiologists make a detailed knowledge of anatomy of prime importance.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Viewed from the frontal aspect of the chest, the right ventricle is the most anteriorly situated cardiac chamber because it is located immediately behind the sternum. The cavity of the right atrium is anterior, while the left atrium is the most posteriorly situated chamber. In contrast to the near conical shape of the left ventricle, the right ventricle is more triangular in shape.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">13</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Both right and left ventricles can be described in terms of three component parts: inlet (inflow tract), apical trabecular, and outlet (outflow tract).<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">14</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">These three parts can be identified in <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>, in which one region (B) can be observed virtually separate from the rest of the right ventricle: the RVOT (infundibulum).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">This issue of the <span class="elsevierStyleItalic">Journal</span> includes a study by Parreira et al.,<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">16</span></a> which, although based on a small patient population, is interesting and useful from a clinical standpoint. The authors studied 18 patients with more than 10 000 premature ventricular contractions (PVCs)/24 hours during Holter recording, probably originating from the RVOT, and analyzed the correlation between electrocardiographic findings and the results of electroanatomical voltage mapping during electrophysiological study.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Before the electrophysiological study, patients underwent a conventional ECG followed by a second ECG in which the frontal plane leads V1 and V2 were placed in the second intercostal space, in closer proximity to the RVOT as explained above, in order to obtain more precise data on its electrical activity.</p><p id="par0075" class="elsevierStylePara elsevierViewall">In over a third of patients the second ECG showed ST-segment elevation that correlated with the presence of low voltage areas in the RVOT.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Several studies have shown that an ECG obtained in a higher position than normal (in the second or third intercostal space) helps detect right ventricular alterations, and may, for example, increase diagnostic sensitivity in cases of suspected Brugada syndrome.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">15</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The study by Parreira et al. did not completely rule out structural heart disease, since not all patients underwent cardiac magnetic resonance imaging to exclude the presence of regional myocardial fibrosis. Even so, the study is important for identifying regional pathological alterations on the ECG that were confirmed by the detection of low voltage areas on three-dimensional electroanatomical mapping in patients with apparently normal hearts.</p><p id="par0090" class="elsevierStylePara elsevierViewall">This finding suggests that in many published cases of right ventricular tachycardias considered to be idiopathic, i.e. in apparently normal hearts, structural abnormalities do in fact exist at a very early stage, but are not identified because of a lack of sufficiently sensitive diagnostic instruments.</p><p id="par0095" class="elsevierStylePara elsevierViewall">It should be noted that the presence of ST-segment changes and low voltage areas did not correlate with rates of acute ablation success or of recurrence.</p><p id="par0100" class="elsevierStylePara elsevierViewall">It would have been interesting if the authors had addressed the question of whether there is a minimum anatomical area of low voltage that correlates with the ECG alterations, by presenting the total areas measured.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Despite these methodological limitations (plus the fact that two different mapping systems were used), we would encourage the authors to continue this line of investigation.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Cunha PS. Eletrocardiograma na era do mapeamento tridimensional. Qual o segredo da sua juventude?. Rev Port Cardiol. 2019;38:93–95.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 731 "Ancho" => 905 "Tamanyo" => 60849 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Fluoroscopic image of the right ventricle (outlined in white) in right anterior oblique view at 30° with contrast, showing the tricuspid valve (arrow), the right ventricular apex (A) and the right ventricular outflow tract (B). An active fixation cardioverter-defibrillator lead is also visible, with its tip in the upper-mid septal region (Silva Cunha P, Oliveira M).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0085" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radiofrequency catheter ablation of ventricular tachycardia in patients without structural heart disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L.S. Klein" 1 => "H.T. Shih" 2 => "F.K. Hackett" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1992" "volumen" => "85" "paginaInicial" => "1666" "paginaFinal" => "1674" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1572025" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0090" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanism, diagnosis, and treatment of outflow tract tachycardia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B.B. Lerman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/nrcardio.2015.121" "Revista" => array:6 [ "tituloSerie" => "Nat Rev Cardiol" "fecha" => "2015" "volumen" => "12" "paginaInicial" => "597" "paginaFinal" => "608" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26283265" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0095" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Right ventricular tachycardia: clinical and electrophysiologic characteristics" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.E. Buxton" 1 => "H.L. Waxman" 2 => "F.E. Marchlinski" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Circulation" "fecha" => "1983" "volumen" => "68" "paginaInicial" => "917" "paginaFinal" => "927" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6137291" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0010782413003089" "estado" => "S300" "issn" => "00107824" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0100" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanism of repetitive monomorphic ventricular tachycardia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B.B. Lerman" 1 => "K. Stein" 2 => "E.D. Engelstein" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Circulation" "fecha" => "1995" "volumen" => "92" "paginaInicial" => "421" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7634458" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0105" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adenosine-sensitive ventricular tachycardia: evidence suggesting cyclic AMP-mediated triggered activity" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B.B. Lerman" 1 => "L. Belardinelli" 2 => "G.A. West" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1986" "volumen" => "74" "paginaInicial" => "270" "paginaFinal" => "280" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3015453" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0110" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Response of nonreentrant catecholamine-mediated ventricular tachycardia to endogenous adenosine and acetylcholine. Evidence for myocardial receptor-mediated effects" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B.B. Lerman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1993" "volumen" => "87" "paginaInicial" => "382" "paginaFinal" => "390" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8425287" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0115" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventricular tachycardia in the absence of structural heart disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K. Srivathsan" 1 => "S.J. Lester" 2 => "C.P. Appleton" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Indian Pacing Electrophysiol J" "fecha" => "2005" "volumen" => "5" "paginaInicial" => "106" "paginaFinal" => "121" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16943951" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0120" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic ventricular tachycardia: diagnosis and management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. Badhwar" 1 => "M. Scheinman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cpcardiol.2006.10.002" "Revista" => array:6 [ "tituloSerie" => "Curr Probl Cardiol" "fecha" => "2007" "volumen" => "32" "paginaInicial" => "7" "paginaFinal" => "43" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17197289" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0125" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How to recognise and manage idiopathic ventricular tachycardia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Brugada" 1 => "D.P. Diez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "ESC Council Cardiol Practice e-J" "fecha" => "2010" "volumen" => "8" "paginaInicial" => "26" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0130" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term outcome of verapamil-sensitive sustained left ventricular tachycardia in patients without structural heart disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T. Ohe" 1 => "N. Aihara" 2 => "S. Kamakura" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "1995" "volumen" => "25" "paginaInicial" => "54" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7798526" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0135" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The "short-coupled" variant of right ventricular outflow ventricular tachycardia: a not-so-benign form of benign ventricular tachycardia?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Viskin" 1 => "R. Rosso" 2 => "O. Rogowski" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Card Electrophysiol" "fecha" => "2005" "volumen" => "16" "paginaInicial" => "912" "paginaFinal" => "916" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0140" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Classification of ventricular extrasystoles according to form" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.B. Rosenbaum" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Electrocardiol" "fecha" => "1969" "volumen" => "2" "paginaInicial" => "289" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4189497" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0145" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anatomy, echocardiography, and normal right ventricular dimensions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.Y. Ho" 1 => "P. Nihoyannopoulos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/hrt.2005.077875" "Revista" => array:7 [ "tituloSerie" => "Heart" "fecha" => "2006" "volumen" => "92" "numero" => "Suppl. 1" "paginaInicial" => "i2" "paginaFinal" => "i13" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16543598" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0150" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac anatomy: what the electrophysiologist needs to know" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.A. Cabrera" 1 => "D. Sánchez-Quintana" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/heartjnl-2011-301154" "Revista" => array:6 [ "tituloSerie" => "Heart" "fecha" => "2013" "volumen" => "99" "paginaInicial" => "417" "paginaFinal" => "431" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23355600" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0155" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Brugada syndrome diagnosed from the ECG leads in the high intercostal spaces: searching for answers from a higher source?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Kumar" 1 => "J.M. Kalman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jce.13016" "Revista" => array:6 [ "tituloSerie" => "J Cardiovasc Electrophysiol" "fecha" => "2016" "volumen" => "27" "paginaInicial" => "944" "paginaFinal" => "946" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27221147" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0160" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Premature ventricular contractions of the right ventricular outflow tract: upward displacement of the ECG unmasks ST elevation in V1 associated with the presence of low voltage areas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L. Parreira" 1 => "R. Marinheiro" 2 => "P. Carmo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Rev Port Cardiol." "fecha" => "2019" "volumen" => "38" "numero" => "2" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003800000002/v1_201904100624/S2174204919300534/v1_201904100624/en/main.assets" "Apartado" => array:4 [ "identificador" => "9917" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003800000002/v1_201904100624/S2174204919300534/v1_201904100624/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204919300534?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 5 | 10 |
| 2024 October | 38 | 28 | 66 |
| 2024 September | 31 | 22 | 53 |
| 2024 August | 32 | 28 | 60 |
| 2024 July | 39 | 27 | 66 |
| 2024 June | 35 | 21 | 56 |
| 2024 May | 28 | 18 | 46 |
| 2024 April | 25 | 33 | 58 |
| 2024 March | 35 | 25 | 60 |
| 2024 February | 26 | 21 | 47 |
| 2024 January | 32 | 28 | 60 |
| 2023 December | 31 | 35 | 66 |
| 2023 November | 49 | 28 | 77 |
| 2023 October | 29 | 15 | 44 |
| 2023 September | 22 | 18 | 40 |
| 2023 August | 23 | 20 | 43 |
| 2023 July | 20 | 13 | 33 |
| 2023 June | 20 | 10 | 30 |
| 2023 May | 45 | 32 | 77 |
| 2023 April | 17 | 4 | 21 |
| 2023 March | 49 | 17 | 66 |
| 2023 February | 37 | 23 | 60 |
| 2023 January | 14 | 14 | 28 |
| 2022 December | 38 | 21 | 59 |
| 2022 November | 51 | 28 | 79 |
| 2022 October | 32 | 24 | 56 |
| 2022 September | 20 | 39 | 59 |
| 2022 August | 20 | 24 | 44 |
| 2022 July | 23 | 41 | 64 |
| 2022 June | 24 | 29 | 53 |
| 2022 May | 26 | 32 | 58 |
| 2022 April | 19 | 38 | 57 |
| 2022 March | 34 | 37 | 71 |
| 2022 February | 21 | 36 | 57 |
| 2022 January | 25 | 30 | 55 |
| 2021 December | 30 | 29 | 59 |
| 2021 November | 21 | 39 | 60 |
| 2021 October | 30 | 40 | 70 |
| 2021 September | 21 | 30 | 51 |
| 2021 August | 19 | 39 | 58 |
| 2021 July | 21 | 26 | 47 |
| 2021 June | 17 | 22 | 39 |
| 2021 May | 33 | 33 | 66 |
| 2021 April | 53 | 27 | 80 |
| 2021 March | 33 | 19 | 52 |
| 2021 February | 32 | 17 | 49 |
| 2021 January | 21 | 16 | 37 |
| 2020 December | 15 | 7 | 22 |
| 2020 November | 20 | 15 | 35 |
| 2020 October | 14 | 14 | 28 |
| 2020 September | 20 | 8 | 28 |
| 2020 August | 16 | 7 | 23 |
| 2020 July | 12 | 13 | 25 |
| 2020 June | 8 | 16 | 24 |
| 2020 May | 18 | 5 | 23 |
| 2020 April | 14 | 7 | 21 |
| 2020 March | 17 | 10 | 27 |
| 2020 February | 27 | 39 | 66 |
| 2020 January | 15 | 15 | 30 |
| 2019 December | 21 | 4 | 25 |
| 2019 November | 10 | 2 | 12 |
| 2019 October | 14 | 4 | 18 |
| 2019 September | 11 | 9 | 20 |
| 2019 August | 15 | 8 | 23 |
| 2019 July | 20 | 8 | 28 |
| 2019 June | 19 | 28 | 47 |
| 2019 May | 26 | 13 | 39 |
| 2019 April | 26 | 25 | 51 |
| 2019 March | 7 | 8 | 15 |
Show all
