Abstract:
:In patients presenting with signs and symptoms of an acute coronary syndrome (ACS) the combination of multilead ST depression and ST elevation in lead aVR, the electrocardiographic "aVR sign," has been associated with severe left main coronary artery stenosis or diffuse coronary artery disease and a high risk of death. Recent guidelines even suggest that the aVR sign may represent an ST-elevation myocardial infarction (STEMI) equivalent and therefore, an indication for emergent cardiac catheterization and reperfusion. The specificity of the aVR sign for left main disease, however, has been questioned as multiple additional high-risk clinical conditions have also been shown to be associated with the aVR sign. The purpose of this review is to provide a historic background of the aVR sign and to summarize the evolution of our understanding of this important electrocardiographic (ECG) phenomenon. Using two illustrative cases, we wish to highlight the significant risks associated both with under-appreciation of the aVR sign as well as hastily overreacting to the aVR sign.
journal_name
J Electrocardioljournal_title
Journal of electrocardiologyauthors
Gibbs MA,Leedekerken JB,Littmann Ldoi
10.1016/j.jelectrocard.2019.07.014subject
Has Abstractpub_date
2019-01-01 00:00:00pages
121-124eissn
0022-0736issn
1532-8430pii
S0022-0736(19)30548-5journal_volume
56pub_type
杂志文章,评审abstract::Percutaneous radiofrequency catheter ablation (RFCA) has a very high success rate for certain arrhythmias, such as Wolff-Parkinson-White syndrome and idiopathic ventricular tachycardias in the right ventricular outflow tract. These arrhythmias are typically characterized by a single site of arrhythmogenic tissue that ...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1016/s0022-0736(94)80073-1
更新日期:1994-01-01 00:00:00
abstract::Five male patients with chronic stable ventricular arrhythmias underwent a placebo controlled ascending dose study with oral cibenzoline, a new type 1 antiarrhythmic drug. Ambulatory ECG (Holter) recordings and electrophysiologic studies were done while on placebo and on the maximum dose of cibenzoline. Drug toxicity,...
journal_title:Journal of electrocardiology
pub_type: 临床试验,杂志文章
doi:10.1016/s0022-0736(84)80020-5
更新日期:1984-01-01 00:00:00
abstract::Hypertrophic cardiomyopathy (HCM) have been reported to display impaired heart rate variability, although little is known regarding its prognostic value. By using fast Fourier transformation of 24-hour Holter recordings in 73 HCM patients at a stable clinical condition, we computed 4 spectral components: very low freq...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1016/j.jelectrocard.2003.08.005
更新日期:2003-10-01 00:00:00
abstract::Normal pacemaker and defibrillator function can occasionally mimic device malfunction. A thorough understanding of timing cycles and familiarity with company-specific pacing algorithms can often avoid unnecessary confusion. ...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1016/j.jelectrocard.2012.06.006
更新日期:2012-11-01 00:00:00
abstract::Electrocardiographic manifestation mimicking the hyperacute phase of myocardial infarction and the electrical alternans of the elevated ST-segment in association with subarachnoid hemorrhage were reported in two patients with no evidence of heart disease. In both cases the ST-segment changes were transient and there w...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1016/0022-0736(89)90082-4
更新日期:1989-04-01 00:00:00
abstract::An academic 12-lead electrocardiogram (ECG) core laboratory aims to provide the highest possible quality ECG recording, measurement, and storage to aid clinicians in research into important cardiovascular outcomes and to maximize the credibility of scientific results based solely, or in part, on ECG data. This positio...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1054/jelc.2001.22028
更新日期:2001-01-01 00:00:00
abstract::The Electrocardiogram has extensively been used for evaluation and triage of patients with acute chest pain. The clinician admitting a patient with ST elevation acute myocardial infarction should be able to estimate the size and location of the ischemic area at risk, how much of the ischemic myocardium has already und...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1016/j.jelectrocard.2005.01.003
更新日期:2005-04-01 00:00:00
abstract::Frank vectorcardiograms (VCGs) were collected on magnetic tape for 666 normal newborn infants at 1, 6, 12, 24, 36, 48, 60, and 72 hours after birth and analyzed by computers. The final total included 1,337 VCGs for white babies and 413 for blacks. No previous report has been made for the normal neonate with such a lar...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1016/s0022-0736(77)80027-7
更新日期:1977-01-01 00:00:00
abstract:PURPOSE:This study aims to develop a noninvasive atrial remodeling index (RI) to separate patients presenting paroxysmal atrial fibrillation (ParAF) from those with sustained persistent atrial fibrillation (PerAF), that is, AF episodes interrupted 7 days or more after the onset. METHODS:Signal-averaged P-wave duration...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1016/j.jelectrocard.2011.08.005
更新日期:2012-03-01 00:00:00
abstract::A 66-year-old woman with a long history of hypertension had an electrocardiogram with giant negative U waves in left precordial leads despite hypokalemia. This seems to be the first report of giant negative U waves induced by uncontrolled hypertension with hypokalemia. The occurrence of negative U waves in the presenc...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1016/0022-0736(92)90121-f
更新日期:1992-04-01 00:00:00
abstract::We report a case of 54-year-old man who presented to hospital with severe prolonged retrosternal chest pain of anginal nature. Electrocardiogram taken by his general practitioner showed minimal ST elevation in chest leads V1 and V2; there was also marked right axis deviation of P wave (negative in lead I and aVL) and ...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1016/j.jelectrocard.2005.06.036
更新日期:2005-10-01 00:00:00
abstract:BACKGROUND:With increased interest in screening of young people for potential causes of sudden death, accurate automated detection of ventricular pre-excitation (VPE) or Wolff-Parkinson-White syndrome (WPW) in the pediatric resting ECG is important. Several recent studies have shown interobserver variability when readi...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1016/j.jelectrocard.2015.08.006
更新日期:2016-01-01 00:00:00
abstract:BACKGROUND:The use of vectorcardiography (VCG) has regained interest, however, original Frank-VCG equipment is rare. This study compares the measured VCGs with those synthesized from the 12-lead electrocardiogram (ECG) in patients with heart failure and conduction abnormalities, who are candidate for cardiac resynchron...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1016/j.jelectrocard.2015.04.001
更新日期:2015-07-01 00:00:00
abstract::A case of concealed ventricular bigeminy is reported in which the number of sinus QRS complexes intervening between two successive noninterpolated extrasystoles was always uneven. Coupling intervals of manifest extrasystoles to the preceding sinus QRS complexes were almost fixed and much longer than sinus QT intervals...
journal_title:Journal of electrocardiology
pub_type: 杂志文章,评审
doi:10.1016/s0022-0736(96)80100-2
更新日期:1996-10-01 00:00:00
abstract::The sensitivity of an extensive electrocardiographic examination to local cardiac regions was evaluated by comparison with findings in vectorcardiographic leads. Evaluation consisted of comparing QRS areas during different ventricular activation patterns. The ratio of areas from the vector-cardiogram (VCG) and extensi...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1016/s0022-0736(76)80009-x
更新日期:1976-01-01 00:00:00
abstract::Strength-interval curves and conduction times were determined in anesthetized dogs during and following myocardial ischemia using a computerized system capable of determining a 5 point strength-interval curve with conduction times within 20 seconds. At the peak incidence of ligation arrhythmias (5 minutes of ischemia)...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1016/s0022-0736(79)80060-6
更新日期:1979-07-01 00:00:00
abstract:PURPOSE:Recent research has established that a tall R-wave in V1 indicates lateral wall involvement in non-anterior wall myocardial infarction (MI). The objective of this study was to assess the value of the admission electrocardiogram (ECG) to predict R-waves and consequently lateral wall damage in the late phase of n...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1016/j.jelectrocard.2015.02.005
更新日期:2015-07-01 00:00:00
abstract::Sinus rhythm tracings, including sinus tachycardia and bradycardia, are characterized quantitatively by means of an ECG measurement program which has been subjected to rigorous evaluation. The analysis is performed on tracings of short duration (10 sec). The features of regularity and stability are considered for the ...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1016/s0022-0736(76)80063-5
更新日期:1976-04-01 00:00:00
abstract::In treating atrial fibrillation (AF) the goal of ventricular rate reduction is still not determined. An animal model of AF was developed in which the relationship between ventricular rate and the parameters of cardiac function in AF can be studied. To simulate AF, complete heart block was chemically produced on open-c...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1016/s0022-0736(05)80100-1
更新日期:1994-04-01 00:00:00
abstract:BACKGROUND:ECG cable interchange can generate erroneous diagnoses. For algorithms detecting ECG cable interchange, high specificity is required to maintain a low total false positive rate because the prevalence of interchange is low. In this study, we propose and evaluate an improved algorithm for automatic detection a...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1016/j.jelectrocard.2014.08.006
更新日期:2014-11-01 00:00:00
abstract::Two cases of transient hemiblock occurring during the course of acute myocardial infarction are reported. The transient manifestation permits the accurate evaluation of the diagnostic features of the hemiblocks as modified by acute infarction. One case reflects the development of left bundle branch block due to bilate...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1016/s0022-0736(78)80109-5
更新日期:1978-04-01 00:00:00
abstract::A 53-year-old woman with sinus node dysfunction underwent dual-chamber pacemaker implantation through a persistent left superior vena cava draining into the coronary sinus, which was detected at the time of implantation. We managed to fix the ventricular lead in the right ventricular (RV) apex by forming a clockwise l...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1016/j.jelectrocard.2007.05.016
更新日期:2007-11-01 00:00:00
abstract::A His bundle electrogram was obtained in a 70 year old male with syncopal episodes. A split bundle of His deflection was recorded. After the intravenous administration of phentolamine, a marked shortening of the H-H' interval was observed. This signifies an improvement in conduction at the bundle of His level. ...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1016/s0022-0736(78)80147-2
更新日期:1978-10-01 00:00:00
abstract::From a population of 304 patients who were operated on for atrial septal defects, 25 patients with primum defects and 78 patients with secundum defects were studied with regard to the ability of various quantitative axial lead vectorcardiographic (VCG) data to predict the anatomical type of defect. The patients includ...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1016/s0022-0736(75)80023-9
更新日期:1975-01-01 00:00:00
abstract::Recent studies have shown that ventricular myocardium is composed of at least 3 electrophysiologically distinct cell types: epicardial, endocardial, and M cells. Action potentials recorded from epicardial and M cells, unlike those recorded from endocardium, display a spike-and-dome morphology, the result of a prominen...
journal_title:Journal of electrocardiology
pub_type: 杂志文章,评审
doi:10.1016/s0022-0736(99)90074-2
更新日期:1999-01-01 00:00:00
abstract::Extra AV nodal Wenckebach periodicity was diagnosed in seven patients. The most frequent form of this conduction abnormality was an exit block. The underlying block was localized in the sinoatrial junction and in the atria in two patients; the AV junction and the ventricle were the site of the Wenckebach periodicity i...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1016/s0022-0736(81)80003-9
更新日期:1981-07-01 00:00:00
abstract::Drugs with diverse structures and from several therapeutic classes are reported to increase the risk that a patient will experience ventricular tachyarrhythmias (e.g., torsades de pointes [TdP]) during drug therapy. This review discusses the use of preclinical assays to assess the risk that a QT-prolonging drug will c...
journal_title:Journal of electrocardiology
pub_type: 杂志文章,评审
doi:10.1016/j.jelectrocard.2004.08.006
更新日期:2004-01-01 00:00:00
abstract:BACKGROUND:Patients hospitalized for suspected acute coronary syndrome (ACS) are at risk for transient myocardial ischemia. During the "rule-out" phase, continuous ECG ST-segment monitoring can identify transient myocardial ischemia, even when asymptomatic. However, current ST-segment monitoring software is vastly unde...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1016/j.jelectrocard.2017.10.005
更新日期:2018-01-01 00:00:00
abstract::An analytical study was performed to estimate the magnitude of the visual Q wave duration bias produced by pressurized ink round stylus electrocardiographic (ECG) recorders. With a paper speed of 25 mm/sec and the ECG tracing width of 0.25 mm, the visually measured Q waves are on the average 8 msec too short. The corr...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1016/s0022-0736(78)80137-x
更新日期:1978-10-01 00:00:00
abstract::Isomagnetic maps were recorded in normal subjects and in patients with systolic overloading of the right ventricle. The isomagnetic maps examined in this study indicated the instantaneous current source of the heart by applying the "corkscrew rule." The magnetic field recorded by a second derivative gradiometer detect...
journal_title:Journal of electrocardiology
pub_type: 杂志文章
doi:10.1016/s0022-0736(88)80013-x
更新日期:1988-04-01 00:00:00