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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Due to the vulnerability of pregnant women&#44; their health is considered extremely important all over the world by national and global health authorities&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">1</span></a> Pregnancy makes women prone to significant changes in hemodynamic state such as plasma volume expansion&#44; increase in heart rate and cardiac output and decrease in blood pressure&#46; Pregnancy can be pro-arrhythmic due to fluctuations in sex hormones and increase in stretching of the cardiac chamber walls&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Physiological electrocardiogram &#40;ECG&#41; changes occur in pregnancy such as sinus tachycardia&#44; shift of the electrical axis&#44; small Q wave&#44; inverted T wave and ST-segment depression&#44;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#8211;7</span></a> which can mimic pathologic ones&#46; On the other hand&#44; with regard to the shift in cardiac position due to pressured diaphragm&#44; left axis deviation can occur&#44; especially in the third trimester&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">8&#44;9</span></a> Event rate for cardiac arrhythmias is 166&#47;100 000 in pregnancy-related admissions&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">10</span></a> The incidence of pregnancy induced arrhythmias increases as the fetus develops&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">11&#44;12</span></a> Fortunately&#44; most of the reported arrhythmias during pregnancy are benign and there is no need for intervention&#46; Palpitations&#44; atrial and ventricular premature beats and even life-threatening ventricular arrhythmias are also possible&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">13</span></a> The use of antiarrhythmic drugs is limited due to fetal toxicity&#44; especially during the first trimester&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">14&#44;15</span></a> There are little data regarding electrocardiographic changes in normal pregnancy&#46; The aim of our study is to determine the changes in electrocardiographic indices during normal pregnancy&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">This prospective study was conducted at Tehran University of Medical Sciences&#44; Iran between June and September 2018&#46; Written informed consent was given and the local ethics committee approved the study &#40;ethical code&#58; 94-01-167-28302&#41;&#46; A total of 103 consecutive pregnant women &#40;age range between 18 to 35&#41; in their first trimester routine obstetrics visit were recruited to the study&#44; of whom 96 continued in the study&#46; All of the subjects were completely healthy and free of any cardiovascular diseases&#46; Exclusion criteria were subjects with history of chronic disease&#44; moderate to severe valvular heart diseases&#44; history of sudden cardiac death in first-degree relatives and history of use of heart rate control medications&#46; Standard resting 12-lead surface ECGs were performed using a Schiller AT-104PC machine at the first visit in the first trimester &#40;second month&#41; and were repeated in the third trimester &#40;8th month&#41; again both in a quiet place after 30 minutes of rest&#46; ECGs with too many artifacts were excluded and the remaining ECGs were analyzed with a high-resolution scanner and sent to two separate experienced cardiologists&#46; The average duration of follow up was 6&#177;0&#46;2 months&#46; The indices were reported separately by two cardiologists and in case of discrepancy in results a recheck was performed&#46; The indices were&#58; PR interval&#44; as a marker of atrial conduction&#44; expressed as the time interval between onsets of P wave to beginning of QRS complex was measured in leads with the shortest PR&#59; QT interval&#44; as a marker for duration of ventricular activation and recovery &#40;depolarization and repolarization&#41;&#44; determined as the time duration between beginning of QRS complex and the end of the T wave&#59; QTc &#40;corrected QT interval&#41; was calculated using the Bazett formula&#59; QT dispersion&#44; as a measure of ventricular recovery&#44; determined as variations in QT intervals&#59; the longest QT interval in electrocardiograms was assessed in V2 or V3 or lead 2&#59; JT interval&#44; as an index of ventricular repolarization&#44; measured from terminal point of QRS complex to end of the T wave&#59; RR interval determined as time duration between two sequential QRS complexes&#59; QRS duration measured in the lead with the widest QRS complex&#59; TP segment&#44; as a marker for proper voltage baseline&#44; defined as the isoelectric interval between the end of the T wave and the next P wave&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0020" class="elsevierStylePara elsevierViewall">Continuous variables expressed as mean &#177; standard deviation&#46; The paired sample T test was used to compare qualitative variables&#46; The Pearson correlation coefficient was used for quantitative variables&#46; The Mann-Whitney U test and Kruskal-Wallis H were used for analysis of statistical significance defined when p&#60;0&#46;05&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall">A total of 96 eligible pregnant women entered the study&#46; The average age was 28&#177;4&#46;1 years&#46; 39&#40;40&#46;6&#37;&#41; of patients were primiparous and 19&#40;19&#46;7&#37;&#41; were in their third pregnancy&#46; None had a history of abortion&#46; The mean body mass index was 23&#46;10&#177;1&#46;9 kg&#47;m<span class="elsevierStyleSup">2</span> and 28&#46;01&#177;2&#46;6 kg&#47;m<span class="elsevierStyleSup">2</span> in first and third trimester respectively &#40;p&#60;0&#46;05&#41;&#46; The electrocardiographic indices in the first and third trimester are illustrated in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; None of the electrocardiograms showed signs of arrhythmia&#44; atrioventricular or complete bundle branch block&#44; ischemia&#44; or infarction&#46; Mean QT dispersion was 64&#46;04&#177;3&#46;20 ms and 63&#46;10&#177;2&#46;34 ms in T1 and T3&#44; respectively &#40;p&#61;0&#46;06&#41;&#46; Mean QTc was 384&#46;03&#177;23&#46;2 ms and 393&#46;20&#177;42&#46;48 ms in T1 and T3 respectively &#40;p&#61;0&#46;023&#41;&#46; The positive linear correlation across all electrocardiographic parameters between first and third trimesters is shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; As shown&#44; the correlation was more robust in JT&#44; TP and PR<span class="elsevierStyleUnderline">&#46;</span></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Patients were categorized according to age groups &#40;&#60;30 and &#62;30 years&#41;&#46; Changes in electrocardiographic indices between trimesters according to age groups are depicted in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; No statistically significant difference were observed in QRS duration&#44; RR interval&#44; QT&#44; QT dispersion&#44; PR and TP indices among pregnant women of different age groups &#40;p&#62;0&#46;05&#41;&#46; QT dispersion was 2&#37; higher in participants &#62;30 &#40;p&#62;0&#46;05&#41;&#46; 11 &#40;11&#46;4&#37;&#41; had premature rupture of membranes &#40;PROM&#41; and none had a still birth&#46; Two participants had gestational hypertension&#44; one had gestational diabetes and none had preeclampsia or eclampsia&#46; No significant difference in electrocardiographic indices between both trimesters was observed in PROM &#40;p&#62;0&#46;05&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">Due to the vast hemodynamic burden on the cardiovascular system&#44; correct interpretation of ECG during pregnancy is crucial&#46; The main finding of our study is that the mean RR&#44; PR&#44; TP interval and QT dispersion in surface electrocardiogram decreased significantly between T1 and T3&#46; JT interval and P wave duration also declined but the difference was not statistically significant&#46; QT and QTc increased significantly&#46; However&#44; all of these indices were in normal range in both trimesters&#46; Heart rate in pregnant women increases gradually towards term as stroke volume decreases in order to maintain cardiac output&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> As a result&#44; sinus tachycardia leads to decreasing RR interval&#46; In our study&#44; the mean heart rate in T1 was 83&#46;68 and T3 was 91&#46;83&#46; The approximately 10 beat per minute increase in heart rate was significant and similar to results in other studies&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a> In the present study&#44; PR interval decreased in the third trimester&#46; The shortening of PR indicated acceleration of AV node conduction velocity due to increased sympathetic activity&#46; Despite the fact that QT prolongation can be pro-arrhythmic&#44; the prolongation of the QTc interval during pregnancy does not lead clearly to life-threatening cardiac arrhythmias&#46; However&#44; the risk may increase even when there is not any visible heart disease&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">17</span></a> Our study demonstrated that compared to the first trimester&#44; QT increased significantly in the third trimester&#46; As claimed by Odening and Forbes&#44; progesterone shortens cardiac repolarization and can cause QTc prolongation in pregnancy&#44; although the risk of arrhythmias does not increase&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">18&#44;19</span></a> The increase in mean QTc between T1 and T3 as demonstrated in our study was similar to other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">16&#44;20&#44;21</span></a> However&#44; this change is benign and is a component of the normal electrophysiological state in pregnant women&#46; In a study conducted by Seth et al&#46; on pregnant women with long QT syndrome&#44; the risk of cardiac events decreased during pregnancy&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">22</span></a> QT dispersion is considered as an indicator of the total variability in timing and regional heterogeneity of myocardial repolarization which may be able to predict susceptibility to ventricular arrhythmias&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">17&#44;23&#44;24</span></a> Disturbances in ventricular repolarization occurring in pregnancy can explain the relative prolongation of QT dispersion in T325&#46; The TP interval indicates silent time of cardiac electrical activity&#46; The TP interval in the third trimester reduced significantly&#44; which can be explained by the increased heart rate&#46; In total&#44; based on the literature&#44; the incidence of cardiac arrhythmias would rise during pregnancy due to hemodynamic&#44; autonomic&#44; and hormonal changes and previous cardiovascular abnormalities&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">4&#44;25&#8211;28</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Small sample size and short-term follow up were the main limitation of the study&#59; longer follow up from perinatal to postpartum period would be of great value&#46; A case-control study to compare results in pregnant women with a history of cardiovascular disease is recommended&#46; In addition&#44; some hidden cardiac and systemic diseases may not be diagnosed by routine ECG&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0045" class="elsevierStylePara elsevierViewall">A comparison of results between T1 and T3&#44; mean parameters of electrocardiogram indices showed significant statistical difference&#46; QT dispersion was 2&#37; higher in participants &#62;30&#44; however this was not statistically significant&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Financial disclosure</span><p id="par0050" class="elsevierStylePara elsevierViewall">None</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pregnancy can affect the cardiac conduction system&#44; causing changes to the electrocardiographic indices that may mimic pathologic ones&#46; The aim of this study was to discover these changes in normal pregnant women&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We included 103 healthy pregnant women&#44; aged between 18-35 years&#46; Standard 12-lead electrocardiogram was performed in the first and third trimester and electrocardiographic indices were calculated&#46; The patients were classified in two age categories&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The mean PR interval in trimester one &#40;T1&#41; was 133&#46;36&#177;20&#46;9 ms and in third trimester &#40;T3&#41; was 125&#46;03&#177;22&#46;6ms &#40;p&#61;0&#46;046&#41;&#46; The mean QT in T1 and T3 was 314&#46;21&#177;18&#46;99 ms and 324&#46;02&#177;19&#46;4 ms&#44; respectively &#40;p&#60;0&#46;001&#41;&#46; QRS duration in T1 and T3 was 90&#46;24&#177;28&#46;91 ms and 94&#46;97&#177;10&#46;79 ms&#44; respectively &#40;p&#61;0&#46;027&#41;&#46; Mean of QTc &#40;corrected QT interval&#41; was 384&#46;03&#177;23&#46;2 in T1 and 393&#46;20&#177;42&#46;48 ms in T3 &#40;p 0&#46;023&#41;&#46; The difference in electrocardiogram indices between T1 and T3 was not significant within the two age groups&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">When comparing results between T1 and T3&#44; mean parameters of electrocardiogram indices showed significant statistical differences&#46; This will contribute insight on the approach to a number of pregnant women who complain of palpitations and visit a cardiologist&#46; Although not statistically significant&#44; the QT dispersion was 2&#37; higher in participants over 30 years of age&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction and objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A gravidez pode afetar o sistema de condu&#231;&#227;o card&#237;aca&#44; causando altera&#231;&#245;es nos &#237;ndices eletrocardiogr&#225;ficos que podem simular &#237;ndices patol&#243;gicos&#46; O objetivo deste estudo consistiu em descobrir as altera&#231;&#245;es mencionadas em gr&#225;vidas normais&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Inclu&#237;mos 103 gr&#225;vidas saud&#225;veis&#44; entre 18 e 35 anos&#46; Foi efetuado um eletrocardiograma padr&#227;o de 12 deriva&#231;&#245;es no primeiro e no terceiro trimestres e foram calculados os &#237;ndices eletrocardiogr&#225;ficos&#46; As doentes foram classificadas em duas categorias et&#225;rias&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">O intervalo PR m&#233;dio no trimestre um &#40;T1&#41; foi de 133&#44;36&#177;20&#44;9 milissegundos &#40;ms&#41; e no trimestre tr&#234;s &#40;T3&#41; foi de 125&#44;03&#177;22&#44;6ms &#40;p&#61;0&#44;046&#41;&#46; O QT m&#233;dio no T1 e no T3 foi de 314&#44;21&#177;18&#46;99 ms e de 324&#44;02&#177;19&#44;4 ms&#44; respetivamente &#40;p&#60;0&#44;001&#41;&#46; A dura&#231;&#227;o do QRS no T1 e no T3 foi de 90&#44;24&#177;28&#44;91ms e de 94&#44;97&#177;10&#44;79 ms&#44; respetivamente &#40;p&#61;0&#44;027&#41;&#46; A m&#233;dia do QTc &#40;intervalo QT corrigido&#41; foi de 384&#44;03&#177;23&#44;2 no T1 e de 393&#44;20&#177;42&#44;48 ms no T3 &#40;p 0&#44;023&#41;&#46; A diferen&#231;a entre os &#237;ndices eletrocardiogr&#225;ficos entre o T1 e o T3 n&#227;o foi significativa nos dois grupos et&#225;rios&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A compara&#231;ao dos resultados entre T1 e T3 revelou que os par&#226;metros m&#233;dios dos &#237;ndices eletrocardiogr&#225;ficos apresentaram diferen&#231;as estat&#237;sticas significativas&#46; Tal facto contribui para esclarecer a abordagem de mulheres gr&#225;vidas com queixas de palpita&#231;&#245;es que recorrem a consultas de cardiologia&#46; Embora n&#227;o seja estatisticamente significativo&#44; a dispers&#227;o do QT foi 2&#37; mais elevada nas participantes acima dos 30 anos&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introdu&#231;&#227;o e objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#227;o"
          ]
        ]
      ]
    ]
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        "detalles" => array:1 [
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">bpm&#58; beat per minutes&#59; HR&#58; heart rate&#59; SD&#58; standard deviation&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">All durations and intervals are in milliseconds&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Trimester 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Trimester 3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">p-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&#177;SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&#177;SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR &#40;bpm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P wave duration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#177;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#177;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;060&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PR interval&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">133&#46;36&#177;20&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">125&#46;03&#177;22&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;046&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">QT interval&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">314&#46;30&#177;18&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">324&#46;02&#177;19&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RR interval&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">717&#46;74&#177;91&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">653&#46;43&#177;108&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">JT interval&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">223&#46;97&#177;73&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">229&#46;14&#177;77&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;052&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">QRS duration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&#46;24&#177;28&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94&#46;97&#177;10&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TP segment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">263&#46;84&#177;105&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">234&#46;30&#177;116&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;015&nbsp;\t\t\t\t\t\t\n
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                  """
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Electrocardiographic indices in the first and third trimester&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ECG parameters&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">PR interval&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#46;376&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">QT interval&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;253&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;013&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RR interval&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;302&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;003&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">JT interval&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;945&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">QRS duration&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;004&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TP segment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;502&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#46;8&#177;47&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;235&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">The electrocardiogram indices change in first and third trimester in different age groups&#46;</p>"
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    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
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            0 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "QT dispersion in young ideal&#44; and old aged pregnancies"
                      "autores" => array:1 [
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                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;H&#46; Nikoo"
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                        "tituloSerie" => "Int Cardiovasc Res J"
                        "fecha" => "2014"
                        "volumen" => "8"
                        "paginaInicial" => "24"
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        "texto" => "<p id="par0065" class="elsevierStylePara elsevierViewall">The authors are grateful to Dr&#46; Zahar Tavoli&#44; Dr Zahra Ebrahimi&#44; Dr Mohsen Ghanei and all staffs of obstetric and gynecologic ward for their support&#46;</p>"
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Original Article
Electrocardiographic indices and pregnancy: A focus on changes between first and third trimesters
Índices eletrocardiográficos e gravidez: um foco nas alterações entre o primeiro e o terceiro trimestres
Negar Omidia, Mohammadrafie khorgamib,
Autor para correspondência
rafikhorgami@gmail.com

Corresponding author.
, Farnaz khatamic, Mehrdad Mahalleha
a Cardiac Primary Prevention Research Center, Cardiovascular Disease Research Institute, Tehran Heart Center (THC), Tehran University of Medical Sciences, Tehran, Iran
b Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
c Community Medicine Department, Tehran University of Medical Sciences, Tehran, Iran
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Due to the vulnerability of pregnant women&#44; their health is considered extremely important all over the world by national and global health authorities&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">1</span></a> Pregnancy makes women prone to significant changes in hemodynamic state such as plasma volume expansion&#44; increase in heart rate and cardiac output and decrease in blood pressure&#46; Pregnancy can be pro-arrhythmic due to fluctuations in sex hormones and increase in stretching of the cardiac chamber walls&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Physiological electrocardiogram &#40;ECG&#41; changes occur in pregnancy such as sinus tachycardia&#44; shift of the electrical axis&#44; small Q wave&#44; inverted T wave and ST-segment depression&#44;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#8211;7</span></a> which can mimic pathologic ones&#46; On the other hand&#44; with regard to the shift in cardiac position due to pressured diaphragm&#44; left axis deviation can occur&#44; especially in the third trimester&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">8&#44;9</span></a> Event rate for cardiac arrhythmias is 166&#47;100 000 in pregnancy-related admissions&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">10</span></a> The incidence of pregnancy induced arrhythmias increases as the fetus develops&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">11&#44;12</span></a> Fortunately&#44; most of the reported arrhythmias during pregnancy are benign and there is no need for intervention&#46; Palpitations&#44; atrial and ventricular premature beats and even life-threatening ventricular arrhythmias are also possible&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">13</span></a> The use of antiarrhythmic drugs is limited due to fetal toxicity&#44; especially during the first trimester&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">14&#44;15</span></a> There are little data regarding electrocardiographic changes in normal pregnancy&#46; The aim of our study is to determine the changes in electrocardiographic indices during normal pregnancy&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">This prospective study was conducted at Tehran University of Medical Sciences&#44; Iran between June and September 2018&#46; Written informed consent was given and the local ethics committee approved the study &#40;ethical code&#58; 94-01-167-28302&#41;&#46; A total of 103 consecutive pregnant women &#40;age range between 18 to 35&#41; in their first trimester routine obstetrics visit were recruited to the study&#44; of whom 96 continued in the study&#46; All of the subjects were completely healthy and free of any cardiovascular diseases&#46; Exclusion criteria were subjects with history of chronic disease&#44; moderate to severe valvular heart diseases&#44; history of sudden cardiac death in first-degree relatives and history of use of heart rate control medications&#46; Standard resting 12-lead surface ECGs were performed using a Schiller AT-104PC machine at the first visit in the first trimester &#40;second month&#41; and were repeated in the third trimester &#40;8th month&#41; again both in a quiet place after 30 minutes of rest&#46; ECGs with too many artifacts were excluded and the remaining ECGs were analyzed with a high-resolution scanner and sent to two separate experienced cardiologists&#46; The average duration of follow up was 6&#177;0&#46;2 months&#46; The indices were reported separately by two cardiologists and in case of discrepancy in results a recheck was performed&#46; The indices were&#58; PR interval&#44; as a marker of atrial conduction&#44; expressed as the time interval between onsets of P wave to beginning of QRS complex was measured in leads with the shortest PR&#59; QT interval&#44; as a marker for duration of ventricular activation and recovery &#40;depolarization and repolarization&#41;&#44; determined as the time duration between beginning of QRS complex and the end of the T wave&#59; QTc &#40;corrected QT interval&#41; was calculated using the Bazett formula&#59; QT dispersion&#44; as a measure of ventricular recovery&#44; determined as variations in QT intervals&#59; the longest QT interval in electrocardiograms was assessed in V2 or V3 or lead 2&#59; JT interval&#44; as an index of ventricular repolarization&#44; measured from terminal point of QRS complex to end of the T wave&#59; RR interval determined as time duration between two sequential QRS complexes&#59; QRS duration measured in the lead with the widest QRS complex&#59; TP segment&#44; as a marker for proper voltage baseline&#44; defined as the isoelectric interval between the end of the T wave and the next P wave&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0020" class="elsevierStylePara elsevierViewall">Continuous variables expressed as mean &#177; standard deviation&#46; The paired sample T test was used to compare qualitative variables&#46; The Pearson correlation coefficient was used for quantitative variables&#46; The Mann-Whitney U test and Kruskal-Wallis H were used for analysis of statistical significance defined when p&#60;0&#46;05&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall">A total of 96 eligible pregnant women entered the study&#46; The average age was 28&#177;4&#46;1 years&#46; 39&#40;40&#46;6&#37;&#41; of patients were primiparous and 19&#40;19&#46;7&#37;&#41; were in their third pregnancy&#46; None had a history of abortion&#46; The mean body mass index was 23&#46;10&#177;1&#46;9 kg&#47;m<span class="elsevierStyleSup">2</span> and 28&#46;01&#177;2&#46;6 kg&#47;m<span class="elsevierStyleSup">2</span> in first and third trimester respectively &#40;p&#60;0&#46;05&#41;&#46; The electrocardiographic indices in the first and third trimester are illustrated in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; None of the electrocardiograms showed signs of arrhythmia&#44; atrioventricular or complete bundle branch block&#44; ischemia&#44; or infarction&#46; Mean QT dispersion was 64&#46;04&#177;3&#46;20 ms and 63&#46;10&#177;2&#46;34 ms in T1 and T3&#44; respectively &#40;p&#61;0&#46;06&#41;&#46; Mean QTc was 384&#46;03&#177;23&#46;2 ms and 393&#46;20&#177;42&#46;48 ms in T1 and T3 respectively &#40;p&#61;0&#46;023&#41;&#46; The positive linear correlation across all electrocardiographic parameters between first and third trimesters is shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; As shown&#44; the correlation was more robust in JT&#44; TP and PR<span class="elsevierStyleUnderline">&#46;</span></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Patients were categorized according to age groups &#40;&#60;30 and &#62;30 years&#41;&#46; Changes in electrocardiographic indices between trimesters according to age groups are depicted in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; No statistically significant difference were observed in QRS duration&#44; RR interval&#44; QT&#44; QT dispersion&#44; PR and TP indices among pregnant women of different age groups &#40;p&#62;0&#46;05&#41;&#46; QT dispersion was 2&#37; higher in participants &#62;30 &#40;p&#62;0&#46;05&#41;&#46; 11 &#40;11&#46;4&#37;&#41; had premature rupture of membranes &#40;PROM&#41; and none had a still birth&#46; Two participants had gestational hypertension&#44; one had gestational diabetes and none had preeclampsia or eclampsia&#46; No significant difference in electrocardiographic indices between both trimesters was observed in PROM &#40;p&#62;0&#46;05&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">Due to the vast hemodynamic burden on the cardiovascular system&#44; correct interpretation of ECG during pregnancy is crucial&#46; The main finding of our study is that the mean RR&#44; PR&#44; TP interval and QT dispersion in surface electrocardiogram decreased significantly between T1 and T3&#46; JT interval and P wave duration also declined but the difference was not statistically significant&#46; QT and QTc increased significantly&#46; However&#44; all of these indices were in normal range in both trimesters&#46; Heart rate in pregnant women increases gradually towards term as stroke volume decreases in order to maintain cardiac output&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> As a result&#44; sinus tachycardia leads to decreasing RR interval&#46; In our study&#44; the mean heart rate in T1 was 83&#46;68 and T3 was 91&#46;83&#46; The approximately 10 beat per minute increase in heart rate was significant and similar to results in other studies&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a> In the present study&#44; PR interval decreased in the third trimester&#46; The shortening of PR indicated acceleration of AV node conduction velocity due to increased sympathetic activity&#46; Despite the fact that QT prolongation can be pro-arrhythmic&#44; the prolongation of the QTc interval during pregnancy does not lead clearly to life-threatening cardiac arrhythmias&#46; However&#44; the risk may increase even when there is not any visible heart disease&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">17</span></a> Our study demonstrated that compared to the first trimester&#44; QT increased significantly in the third trimester&#46; As claimed by Odening and Forbes&#44; progesterone shortens cardiac repolarization and can cause QTc prolongation in pregnancy&#44; although the risk of arrhythmias does not increase&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">18&#44;19</span></a> The increase in mean QTc between T1 and T3 as demonstrated in our study was similar to other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">16&#44;20&#44;21</span></a> However&#44; this change is benign and is a component of the normal electrophysiological state in pregnant women&#46; In a study conducted by Seth et al&#46; on pregnant women with long QT syndrome&#44; the risk of cardiac events decreased during pregnancy&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">22</span></a> QT dispersion is considered as an indicator of the total variability in timing and regional heterogeneity of myocardial repolarization which may be able to predict susceptibility to ventricular arrhythmias&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">17&#44;23&#44;24</span></a> Disturbances in ventricular repolarization occurring in pregnancy can explain the relative prolongation of QT dispersion in T325&#46; The TP interval indicates silent time of cardiac electrical activity&#46; The TP interval in the third trimester reduced significantly&#44; which can be explained by the increased heart rate&#46; In total&#44; based on the literature&#44; the incidence of cardiac arrhythmias would rise during pregnancy due to hemodynamic&#44; autonomic&#44; and hormonal changes and previous cardiovascular abnormalities&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">4&#44;25&#8211;28</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Small sample size and short-term follow up were the main limitation of the study&#59; longer follow up from perinatal to postpartum period would be of great value&#46; A case-control study to compare results in pregnant women with a history of cardiovascular disease is recommended&#46; In addition&#44; some hidden cardiac and systemic diseases may not be diagnosed by routine ECG&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0045" class="elsevierStylePara elsevierViewall">A comparison of results between T1 and T3&#44; mean parameters of electrocardiogram indices showed significant statistical difference&#46; QT dispersion was 2&#37; higher in participants &#62;30&#44; however this was not statistically significant&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Financial disclosure</span><p id="par0050" class="elsevierStylePara elsevierViewall">None</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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    "fechaRecibido" => "2020-05-07"
    "fechaAceptado" => "2021-02-25"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1473953"
          "palabras" => array:4 [
            0 => "Pregnancy"
            1 => "Electrocardiogram"
            2 => "Trimester"
            3 => "Palpitations"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec1473952"
          "palabras" => array:4 [
            0 => "Gravidez"
            1 => "Eletrocardiograma"
            2 => "Trimestre"
            3 => "Palpita&#231;&#227;o"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pregnancy can affect the cardiac conduction system&#44; causing changes to the electrocardiographic indices that may mimic pathologic ones&#46; The aim of this study was to discover these changes in normal pregnant women&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We included 103 healthy pregnant women&#44; aged between 18-35 years&#46; Standard 12-lead electrocardiogram was performed in the first and third trimester and electrocardiographic indices were calculated&#46; The patients were classified in two age categories&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The mean PR interval in trimester one &#40;T1&#41; was 133&#46;36&#177;20&#46;9 ms and in third trimester &#40;T3&#41; was 125&#46;03&#177;22&#46;6ms &#40;p&#61;0&#46;046&#41;&#46; The mean QT in T1 and T3 was 314&#46;21&#177;18&#46;99 ms and 324&#46;02&#177;19&#46;4 ms&#44; respectively &#40;p&#60;0&#46;001&#41;&#46; QRS duration in T1 and T3 was 90&#46;24&#177;28&#46;91 ms and 94&#46;97&#177;10&#46;79 ms&#44; respectively &#40;p&#61;0&#46;027&#41;&#46; Mean of QTc &#40;corrected QT interval&#41; was 384&#46;03&#177;23&#46;2 in T1 and 393&#46;20&#177;42&#46;48 ms in T3 &#40;p 0&#46;023&#41;&#46; The difference in electrocardiogram indices between T1 and T3 was not significant within the two age groups&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">When comparing results between T1 and T3&#44; mean parameters of electrocardiogram indices showed significant statistical differences&#46; This will contribute insight on the approach to a number of pregnant women who complain of palpitations and visit a cardiologist&#46; Although not statistically significant&#44; the QT dispersion was 2&#37; higher in participants over 30 years of age&#46;</p></span>"
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            "titulo" => "Introduction and objectives"
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            "titulo" => "Methods"
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            "titulo" => "Results"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A gravidez pode afetar o sistema de condu&#231;&#227;o card&#237;aca&#44; causando altera&#231;&#245;es nos &#237;ndices eletrocardiogr&#225;ficos que podem simular &#237;ndices patol&#243;gicos&#46; O objetivo deste estudo consistiu em descobrir as altera&#231;&#245;es mencionadas em gr&#225;vidas normais&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Inclu&#237;mos 103 gr&#225;vidas saud&#225;veis&#44; entre 18 e 35 anos&#46; Foi efetuado um eletrocardiograma padr&#227;o de 12 deriva&#231;&#245;es no primeiro e no terceiro trimestres e foram calculados os &#237;ndices eletrocardiogr&#225;ficos&#46; As doentes foram classificadas em duas categorias et&#225;rias&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">O intervalo PR m&#233;dio no trimestre um &#40;T1&#41; foi de 133&#44;36&#177;20&#44;9 milissegundos &#40;ms&#41; e no trimestre tr&#234;s &#40;T3&#41; foi de 125&#44;03&#177;22&#44;6ms &#40;p&#61;0&#44;046&#41;&#46; O QT m&#233;dio no T1 e no T3 foi de 314&#44;21&#177;18&#46;99 ms e de 324&#44;02&#177;19&#44;4 ms&#44; respetivamente &#40;p&#60;0&#44;001&#41;&#46; A dura&#231;&#227;o do QRS no T1 e no T3 foi de 90&#44;24&#177;28&#44;91ms e de 94&#44;97&#177;10&#44;79 ms&#44; respetivamente &#40;p&#61;0&#44;027&#41;&#46; A m&#233;dia do QTc &#40;intervalo QT corrigido&#41; foi de 384&#44;03&#177;23&#44;2 no T1 e de 393&#44;20&#177;42&#44;48 ms no T3 &#40;p 0&#44;023&#41;&#46; A diferen&#231;a entre os &#237;ndices eletrocardiogr&#225;ficos entre o T1 e o T3 n&#227;o foi significativa nos dois grupos et&#225;rios&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A compara&#231;ao dos resultados entre T1 e T3 revelou que os par&#226;metros m&#233;dios dos &#237;ndices eletrocardiogr&#225;ficos apresentaram diferen&#231;as estat&#237;sticas significativas&#46; Tal facto contribui para esclarecer a abordagem de mulheres gr&#225;vidas com queixas de palpita&#231;&#245;es que recorrem a consultas de cardiologia&#46; Embora n&#227;o seja estatisticamente significativo&#44; a dispers&#227;o do QT foi 2&#37; mais elevada nas participantes acima dos 30 anos&#46;</p></span>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">bpm&#58; beat per minutes&#59; HR&#58; heart rate&#59; SD&#58; standard deviation&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">All durations and intervals are in milliseconds&#46;</p>"
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">Trimester 1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">p-value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">HR &#40;bpm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">83&#46;68&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">91&#46;83&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">88&#177;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">84&#177;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;060&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">PR interval&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">133&#46;36&#177;20&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">125&#46;03&#177;22&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;046&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">324&#46;02&#177;19&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RR interval&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">717&#46;74&#177;91&#46;14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">653&#46;43&#177;108&#46;45&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">JT interval&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">223&#46;97&#177;73&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">229&#46;14&#177;77&#46;64&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;052&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">QRS duration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&#46;24&#177;28&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94&#46;97&#177;10&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TP segment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">263&#46;84&#177;105&#46;06&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">234&#46;30&#177;116&#46;10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ECG parameters&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">r&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;376&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;253&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;013&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">RR interval&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;302&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;003&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">JT interval&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;945&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">QRS duration&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">TP segment&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">Age group &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">N&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">TP&#42;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&#177;SD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&#177;SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&#177;SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&#177;SD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&#177;SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&#177;SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&#177;SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20-30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;43&#177;17&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;4&#177;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#46;6&#177;114&#46;2&nbsp;\t\t\t\t\t\t\n
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