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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The article by N&#250;&#241;ez-Gil et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> published online ahead of print on March 31&#44; 2015 in the <span class="elsevierStyleItalic">Journal</span>&#44; describes a 73-year-old woman&#44; with a previously implanted VVIR permanent pacemaker for the management of sick sinus&#47;bradycardia-tachycardia syndrome&#44; who suffered an episode of Takotsubo syndrome &#40;TTS&#41;&#46; The authors provided eight serial electrocardiograms &#40;ECGs&#41;&#44; commencing with an ECG recorded prior to the admission with TTS&#44; and ending with an ECG acquired at follow-up 16 months later&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> Recently a new ECG correlate of TTS was reported&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> characterized by transient low voltage QRS complexes &#40;LVQRS&#41; and transient attenuation of the amplitude of the QRS complexes &#40;AQRS&#41;&#44; involving all or various sets of ECG leads&#46; However in the present study only ECG leads V1&#8211;V6 were reported&#44; but often LVQRS and AQRS with TTS are detected only in the limb leads&#46; Indeed the ECG limb leads are more reflective of TTS involving the apical myocardium &#40;as in the present case&#41;&#44; representing the frontal plane or the longitudinal cardiac axis&#44; rather than the precordial leads&#44; which reflect the electrophysiological changes at the cross-sectional plane&#46; It would be appreciated if the authors could provide data on the ECG limb leads of their patient&#46; The transient LVQRS and AQRS are attributed to myocardial edema in patients with TTS&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> and involve the ECG in the presence of both intrinsic ventricular activity and with permanent pacemaker&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0010" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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Letter to the Editor
Pacemaker electrocardiogram in a patient with Takotsubo syndrome
Eletrocardiograma num doente com síndrome de Takotsubo e pacemaker
John E. Madiasa,b
a Icahn School of Medicine at Mount Sinai, New York, NY, United States
b Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, United States
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The article by N&#250;&#241;ez-Gil et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> published online ahead of print on March 31&#44; 2015 in the <span class="elsevierStyleItalic">Journal</span>&#44; describes a 73-year-old woman&#44; with a previously implanted VVIR permanent pacemaker for the management of sick sinus&#47;bradycardia-tachycardia syndrome&#44; who suffered an episode of Takotsubo syndrome &#40;TTS&#41;&#46; The authors provided eight serial electrocardiograms &#40;ECGs&#41;&#44; commencing with an ECG recorded prior to the admission with TTS&#44; and ending with an ECG acquired at follow-up 16 months later&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> Recently a new ECG correlate of TTS was reported&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> characterized by transient low voltage QRS complexes &#40;LVQRS&#41; and transient attenuation of the amplitude of the QRS complexes &#40;AQRS&#41;&#44; involving all or various sets of ECG leads&#46; However in the present study only ECG leads V1&#8211;V6 were reported&#44; but often LVQRS and AQRS with TTS are detected only in the limb leads&#46; Indeed the ECG limb leads are more reflective of TTS involving the apical myocardium &#40;as in the present case&#41;&#44; representing the frontal plane or the longitudinal cardiac axis&#44; rather than the precordial leads&#44; which reflect the electrophysiological changes at the cross-sectional plane&#46; It would be appreciated if the authors could provide data on the ECG limb leads of their patient&#46; The transient LVQRS and AQRS are attributed to myocardial edema in patients with TTS&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> and involve the ECG in the presence of both intrinsic ventricular activity and with permanent pacemaker&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0010" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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2020 Outubro 12 8 20
2020 Setembro 50 18 68
2020 Agosto 20 4 24
2020 Julho 37 12 49
2020 Junho 33 12 45
2020 Maio 33 8 41
2020 Abril 33 14 47
2020 Maro 41 7 48
2020 Fevereiro 77 67 144
2020 Janeiro 42 7 49
2019 Dezembro 27 6 33
2019 Novembro 27 9 36
2019 Outubro 19 5 24
2019 Setembro 22 6 28
2019 Agosto 22 4 26
2019 Julho 41 10 51
2019 Junho 25 9 34
2019 Maio 30 7 37
2019 Abril 16 11 27
2019 Maro 23 14 37
2019 Fevereiro 33 15 48
2019 Janeiro 15 4 19
2018 Dezembro 23 13 36
2018 Novembro 26 4 30
2018 Outubro 37 19 56
2018 Setembro 35 11 46
2018 Agosto 13 11 24
2018 Julho 20 5 25
2018 Junho 23 4 27
2018 Maio 23 9 32
2018 Abril 41 8 49
2018 Maro 37 7 44
2018 Fevereiro 25 10 35
2018 Janeiro 11 4 15
2017 Dezembro 32 10 42
2017 Novembro 13 6 19
2017 Outubro 16 8 24
2017 Setembro 19 7 26
2017 Agosto 25 12 37
2017 Julho 13 7 20
2017 Junho 22 17 39
2017 Maio 29 6 35
2017 Abril 9 1 10
2017 Maro 20 23 43
2017 Fevereiro 18 11 29
2017 Janeiro 24 3 27
2016 Dezembro 11 4 15
2016 Novembro 16 2 18
2016 Outubro 23 8 31
2016 Setembro 11 2 13
2016 Agosto 15 4 19
2016 Julho 5 6 11
2016 Junho 2 4 6
2016 Maio 8 0 8
2016 Abril 9 1 10
2016 Maro 9 10 19
2016 Fevereiro 50 27 77
2016 Janeiro 74 55 129
2015 Dezembro 53 47 100
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