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Morita H, Nakagawa K, Ueoka A, Mizuno T, Masuda T, Asada S, Miyamoto M, Kawada S, Nishii N, Nakamura K. Significant delayed conduction and characteristic ventricular tachycardias in patients with cardiac sarcoidosis and electrical storm. J Cardiovasc Electrophysiol 2024; 35:307-316. [PMID: 38105352 DOI: 10.1111/jce.16156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Electrical storm (ES) of ventricular tachyarrhythmias (VTAs) is an important cause of sudden death in patients with cardiac sarcoidosis (CS). VTAs in CS are associated with myocardial scarring and inflammation. However, little is known about the risk factors of ES in patients with CS and VTAs. The objective of this study is to clarify the characteristics and risk factors for the development of ES in patients with CS. METHODS The study population included consecutive 52 patients with CS and sustained VTA. Twenty-five out of 52 patients experienced ES. We evaluated clinical characteristics, imaging modalities, and electrocardiogram (ECG) parameters to determine the risk factors associated with ES. RESULTS Half of the patients experienced VTAs as the initial symptom of sarcoidosis, and eight patients had ES as the initial VTA episode. There were no differences in cardiac imaging abnormalities between patients with and without ES. Among ECG markers, significant QRS fragmentation (odds ratio [OR]: 7.9, p = .01) and epsilon waves (OR: 12.24, p = .02) were associated with ES. Among the ventricular tachycardia (VT) characteristics, multiple morphologies of monomorphic VTs (OR: 10.9, p < .01), short VT cycle lengths (OR: 12.5, p < .01), and polymorphic VT (OR: 13.5, p < .01) were associated with ES. Bidirectional VTs were detected in 10 patients with ES and one patient without ES. Immunosuppressive therapy relieved ES in some patients. CONCLUSIONS ES was common in patients with CS and VTAs. Significant depolarization abnormalities that appeared as QRS fragmentation, epsilon waves, and specific VT characteristics were associated with ES.
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Affiliation(s)
- Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Akira Ueoka
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Tomofumi Mizuno
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Takuro Masuda
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Saori Asada
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Masakazu Miyamoto
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Satoshi Kawada
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Nobuhiro Nishii
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
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2
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Chang E, Daboul R, Hanan A, Abdo M, Poulik J, Eskarous H, Hadjilambris AM, Shehata BM. Revisiting the Newly Modified Criteria for Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVC/D) and Reporting Newly Identified Genes. Fetal Pediatr Pathol 2022; 41:909-918. [PMID: 34854351 DOI: 10.1080/15513815.2021.2008564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia is an inherited cardiomyopathy, characterized by replacement of the RV muscle wall with fibrofatty tissue. The diagnosis is challenging, due to the absence of a unique presentation and a lack of specific reproducible diagnostic criteria. Materials and methods: Slides and additional clinical information including follow up from 16 cases were reviewed. Pediatric criteria of >30% of muscle replacement was used, instead of >40% as used in adults. Results: All 16 cases were confirmed by genetic testing and show ARVC/D. Applying the adult criteria, 7 cases would not have been categorized as ARVC/D. Conclusion: The modified pediatric criteria for ARVC/D should be used for pediatric patients. Better detection will aid in genetic counseling in order to identify those additional family members susceptible to sudden cardiac deaths so they can be followed optimally.
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Affiliation(s)
- Eric Chang
- Children's Hospital of Michigan, Detroit, MI, USA
| | - Rania Daboul
- Children's Hospital of Michigan, Detroit, MI, USA
| | - Abdul Hanan
- Children's Hospital of Michigan, Detroit, MI, USA
| | - Mena Abdo
- Children's Hospital of Michigan, Detroit, MI, USA
| | - Janet Poulik
- Children's Hospital of Michigan, Detroit, MI, USA
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3
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Makhdumi M, Assar MD, Meyer DM, Roberts WC. Cardiac sarcoidosis diagnosed after orthotopic heart transplantation and clinically mimicking arrhythmogenic right ventricular cardiomyopathy. Cardiovasc Pathol 2021; 56:107390. [PMID: 34600147 DOI: 10.1016/j.carpath.2021.107390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 11/15/2022] Open
Abstract
Described herein is a 71-year-old man who underwent orthotopic heart transplant (OHT) for chronic severe heart failure secondary to cardiac sarcoidosis (CS) devoid of non-caseating granulomas but nevertheless characteristic of CS. Clinically, his heart disease had suggested the presence of arrhythmogenic right ventricular cardiomyopathy.
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Affiliation(s)
- Madiha Makhdumi
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas, United States
| | - Manish D Assar
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas, United States; Internal Medicine, Baylor University Medical Center, Dallas, Texas, United States
| | - Dan M Meyer
- Departments of Cardiac Surgery, Baylor University Medical Center, Dallas, Texas, United States; Internal Medicine, Baylor University Medical Center, Dallas, Texas, United States
| | - William C Roberts
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas, United States; Internal Medicine, Baylor University Medical Center, Dallas, Texas, United States.
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Abstract
Arrhythmogenic right ventricular cardiomyopathy, formerly called "arrhythmogenic right ventricular dysplasia," is an under-recognized clinical entity characterized by ventricular arrhythmias and a characteristic ventricular pathology. Diagnosis is often difficult due to the nonspecific nature of the disease and the broad spectrum of phenotypic variations. Therefore, consensus diagnostic criteria have been developed which combine electrocardiographic, echocardiographic, cardiac magnetic resonance imaging and histologic criteria. In 1994, an international task force first proposed the major and minor diagnostic criteria of arrhythmogenic right ventricular cardiomyopathy based on family history, arrhythmias, electrocardiographic abnormalities, tissue characterization, and structural and functional right ventricular abnormalities. In 2010, the task force criteria were revised to include quantitative abnormalities. These diagnostic modalities and the most recent task force criteria are discussed in this review.
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5
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Chang Q, Pan D, Liu R. Unusual Electrocardiographic Findings in a Patient With a Postmyocardial Infarction. JAMA Intern Med 2020; 180:1680-1681. [PMID: 33074317 DOI: 10.1001/jamainternmed.2020.1890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Qinghua Chang
- Cardiovascular Institute, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Dianzhu Pan
- Respiratory Department, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Renguang Liu
- Cardiovascular Institute, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning Province, China
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6
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Willy K, Dechering DG, Reinke F, Bögeholz N, Frommeyer G, Eckardt L. The ECG in sarcoidosis - a marker of cardiac involvement? Current evidence and clinical implications. J Cardiol 2020; 77:154-159. [PMID: 32917454 DOI: 10.1016/j.jjcc.2020.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/30/2020] [Accepted: 06/16/2020] [Indexed: 02/07/2023]
Abstract
Sarcoidosis is a multisystem granulomatous disease of unknown etiology characterized by noncaseating granulomas. Cardiac involvement is often limiting patients' prognosis. Cardiac sarcoidosis can manifest with variant cardiac arrhythmias, of which atrioventricular (AV)-block-related bradycardia and ventricular tachycardias are the most common. Although cardiac sarcoidosis remains a histopathological diagnosis, the significance of imaging modalities, especially cardiac magnetic resonance imaging is increasing rapidly but mainly remains reserved for patients with a high suspicion due to a previous arrhythmia or unknown cardiomyopathy. Thus, there is a need for screening in daily clinical practice so that possible characteristic electrocardiographic (ECG) findings may guide the way to detect the disease. We therefore evaluated the ECG as a potential tool for screening of cardiac sarcoidosis and present different electrophysiological manifestations of cardiac sarcoidosis based on a literature review. The ECG is a valuable tool for screening of cardiac involvement in patients with sarcoidosis. Several parameters have been shown to be associated with cardiac involvement in sarcoidosis such as higher-degree AV-block, QRS complex fragmentation and widening, as well as certain T wave abnormalities that may indicate cardiac involvement, of which the latter two are most promising and specific. However, prospective studies examining a large number of trials are desirable.
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Affiliation(s)
- Kevin Willy
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany.
| | - Dirk G Dechering
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Florian Reinke
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Nils Bögeholz
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Gerrit Frommeyer
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Lars Eckardt
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
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Pérez-Riera AR, Barbosa-Barros R, Daminello-Raimundo R, de Abreu LC, García-Niebla J, de Deus Morais MJ, Nikus K, Marcus FI. Epsilon wave: A review of historical aspects. Indian Pacing Electrophysiol J 2019; 19:63-67. [PMID: 30796961 PMCID: PMC6450822 DOI: 10.1016/j.ipej.2019.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 02/18/2019] [Indexed: 11/28/2022] Open
Abstract
The epsilon wave of the electrocardiogram (ECG) together with fragmented QRS (fQRS), the terminal conduction delay, incomplete right bundle branch block (IRBBB) and complete/advanced RBBB (CRBBB) of peripheral origin are part of a spectrum of ventricular depolarization abnormalities of arrhythmogenic cardiomyopathy(AC). Although the epsilon wave is considered a major diagnostic criterion for AC since 2010 (AC Task Force Criteria), its diagnostic value is limited because it is a sign of the later stage of the disease. It would be more appropriate to say that the epsilon wave is a “hallmark” of AC, but is of low diagnostic sensitivity. Although the epsilon wave has high specificity for AC, it can be present in other pathological conditions. In this update we will cover the nomenclature, association with disease states and electrocardiographic aspects of the epsilon wave.
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Laboratório de Pesquisa e Escrita Científica da Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil.
| | - Raimundo Barbosa-Barros
- Coronary Center of the Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Rodrigo Daminello-Raimundo
- Laboratório de Pesquisa e Escrita Científica da Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
| | - Luiz Carlos de Abreu
- Laboratório de Pesquisa e Escrita Científica da Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
| | - Javier García-Niebla
- Servicios Sanitarios del Área de Salud de El Hierro, Valle del Golfo Health Center, Islas Canarias, Spain
| | - Mauro José de Deus Morais
- Laboratório de Pesquisa e Escrita Científica da Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil; Centro de Ciências da Saúde e Desporto, Universidade Federal do Acre, Rio Branco, Acre, Brazil
| | - Kjell Nikus
- Heart Center, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | - Frank I Marcus
- Sarver Heart Center, The University of Arizona Health Sciences Hospital, Tucson, AZ, USA
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8
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Li KHC, Bazoukis G, Liu T, Li G, Wu WKK, Wong SH, Wong WT, Chan YS, Wong MCS, Wassilew K, Vassiliou VS, Tse G. Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) in clinical practice. J Arrhythm 2018; 34:11-22. [PMID: 29721109 PMCID: PMC5828272 DOI: 10.1002/joa3.12021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/14/2017] [Indexed: 01/01/2023] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is an inherited myocardial disease characterized by fibro-fatty replacement of the right ventricular myocardium, and associated with paroxysmal ventricular arrhythmias and sudden cardiac death (SCD). It is currently the second most common cause of SCD after hypertrophic cardiomyopathy in young people <35 years of age, causing up to 20% of deaths in this patient population. This condition has a male preponderance and is more commonly found in individuals of Italian and Greek descent. To date, there is no single diagnostic test for ARVC/D and the diagnosis is made based on clinical, electrocardiographic, and radiological findings according to the Revised 2010 Task Force Criteria. In this review, we will discuss the mainstay treatment which includes pharmacotherapy, implantable cardioverter-defibrillator insertion for abortion of sudden cardiac death, and in the advanced stages of the disease cardiac transplantation.
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Affiliation(s)
| | - George Bazoukis
- Second Department of CardiologyLaboratory of Cardiac Electrophysiology“Evangelismos” General Hospital of AthensAthensGreece
| | - Tong Liu
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular diseaseDepartment of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Guangping Li
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular diseaseDepartment of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - William K. K. Wu
- Department of Anaesthesia and Intensive CareFaculty of MedicineChinese University of Hong KongHong KongChina
- Li Ka Shing Institute of Health SciencesFaculty of MedicineChinese University of Hong KongHong KongChina
| | - Sunny Hei Wong
- Li Ka Shing Institute of Health SciencesFaculty of MedicineChinese University of Hong KongHong KongChina
- Department of Medicine and TherapeuticsFaculty of MedicineChinese University of Hong KongHong KongChina
| | - Wing Tak Wong
- School of Life SciencesChinese University of Hong KongHong KongChina
| | - Yat Sun Chan
- Department of Medicine and TherapeuticsFaculty of MedicineChinese University of Hong KongHong KongChina
| | - Martin C. S. Wong
- The Jockey Club School of Public Health and Primary CareFaculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Katharina Wassilew
- Department of PathologyRigshospitaletUniversity Hospital of CopenhagenCopenhagenDenmark
| | - Vassilios S. Vassiliou
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
- Royal Brompton Hospital and Imperial College LondonLondonUK
| | - Gary Tse
- Li Ka Shing Institute of Health SciencesFaculty of MedicineChinese University of Hong KongHong KongChina
- Department of Medicine and TherapeuticsFaculty of MedicineChinese University of Hong KongHong KongChina
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9
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Pérez-Riera AR, Barbosa-Barros R, Shenasa M. Electrocardiographic Markers of Sudden Cardiac Death (Including Left Ventricular Hypertrophy). Card Electrophysiol Clin 2017; 9:605-629. [PMID: 29173405 DOI: 10.1016/j.ccep.2017.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Although the electrocardiograph (ECG) was invented more than 100 years ago, it remains the most commonly used test in clinical medicine. It is easy to perform, relatively cheap, and results are readily available. Interpretation, however, needs expertise and knowledge. New data, phenomenon, and syndromes are continually discovered by the ECG. It is important to differentiate between normal and abnormal ECGs first and then try to correlate the findings with clinical pathologies. Furthermore, the ECG is an integral part of the screening model for a variety of conditions such as channelopathies, athletes, preoperative risk profile, and remains the cardiologist's best friend.
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Design of Studies and Scientific Writing Laboratory in the ABC School of Medicine, ABC Foundation, Av. Príncipe de Gales, 821 - Vila Principe de Gales, Santo André, São Paulo 09060-650, Brazil; Ambulatorio de cardiologia do Hospital do Coração, R. Des. Eliseu Guilherme, 147 - Paraiso, São Paulo, São Paulo 04004-030, Brazil
| | - Raimundo Barbosa-Barros
- Coronary Center of the Hospital de Messejana Dr Carlos Alberto Studart Gomes, Av. Frei Cirilo, 3480, Fortaleza, Ceará 60840-285, Brazil
| | - Mohammad Shenasa
- Department of Cardiovascular Services, Heart and Rhythm Medical Group, O'Connor Hospital, 105 North Bascom Avenue, Suite 204, San Jose, CA 95128, USA.
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Siqueira WC, da Cruz SG, Asimaki A, Saffitz JE, Moreira MDCV, Brasileiro G, Rocha LOS. Cardiac sarcoidosis with severe involvement of the right ventricle: a case report. AUTOPSY AND CASE REPORTS 2015; 5:53-63. [PMID: 26894046 PMCID: PMC4757920 DOI: 10.4322/acr.2015.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 11/30/2015] [Indexed: 11/23/2022] Open
Abstract
We present the case of a patient who underwent cardiac transplantation with the diagnosis of idiopathic dilated cardiomyopathy. Once the explanted heart was examined, a type of granulomatous myocarditis compatible with cardiac sarcoidosis was observed. However, there was severe involvement of the right ventricle, with markedly reduced width of the muscular layer and extensive fibrofatty replacement, findings similar to the ones encountered in cases of arrhythmogenic right ventricular cardiomyopathy (ARVC). Confocal immunofluorescence analysis revealed a reduced signal for plakoglobin and desmoplakin at the cardiac intercalated disks. The immunoreactive signal for desmin showed the typical sarcomeric distribution but not a concentrated signal at the intercalated disks, a pattern previously seen in an 11-year-old girl with Carvajal syndrome bearing a C-terminal truncating mutation in the desmoplakin gene. This case illustrates the difficult and challenging work involved in performing a differential diagnosis among idiopathic dilated cardiomyopathy, isolated cardiac sarcoidosis, and ARVC, all of which are clinical entities known to masquerade as one another.
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Affiliation(s)
- Weverton César Siqueira
- Internal Medicine Department - Faculty of Medicine - Federal University of Minas Gerais, Belo Horizonte/MG - Brazil
| | - Samuel Gonçalves da Cruz
- Internal Medicine Department - Faculty of Medicine - Federal University of Minas Gerais, Belo Horizonte/MG - Brazil
| | - Angeliki Asimaki
- Department of Pathology - Beth Israel Deaconess Medical Center - Harvard Medical School, Boston/MA - USA
| | - Jeffrey Ern Saffitz
- Department of Pathology - Beth Israel Deaconess Medical Center - Harvard Medical School, Boston/MA - USA
| | | | - Geraldo Brasileiro
- Pathology and Forensic Department - Faculty of Medicine - Federal University of Minas Gerais, Belo Horizonte/MG - Brazil
| | - Luiz Otávio Savassi Rocha
- Internal Medicine Department - Faculty of Medicine - Federal University of Minas Gerais, Belo Horizonte/MG - Brazil
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PROTONOTARIOS ALEXANDROS, ANASTASAKIS ARIS, TSATSOPOULOU ADALENA, ANTONIADES LOIZOS, PRAPPA EFSTATHIA, SYRRIS PETROS, TOUSOULIS DIMITRIOS, McKENNA WILLIAMJ, PROTONOTARIOS NIKOS. Clinical Significance of Epsilon Waves in Arrhythmogenic Cardiomyopathy. J Cardiovasc Electrophysiol 2015; 26:1204-1210. [DOI: 10.1111/jce.12755] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/20/2015] [Accepted: 07/08/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | - ARIS ANASTASAKIS
- 1 Department of Cardiology; University of Athens Medical School; Athens Greece
| | | | | | - EFSTATHIA PRAPPA
- 2 Department of Cardiology; Evangelismos General Hospital; Athens Greece
| | - PETROS SYRRIS
- Institute of Cardiovascular Science; University College London and The Heart Hospital, University College London Hospitals Trust; London UK
| | - DIMITRIOS TOUSOULIS
- 1 Department of Cardiology; University of Athens Medical School; Athens Greece
| | - WILLIAM J. McKENNA
- Institute of Cardiovascular Science; University College London and The Heart Hospital, University College London Hospitals Trust; London UK
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12
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Peters S. Clinical importance of lead aVR in arrhythmogenic cardiomyopathy. Int J Cardiol 2014; 176:508-9. [DOI: 10.1016/j.ijcard.2014.07.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 07/05/2014] [Indexed: 11/28/2022]
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