Journal of electrocardiology
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Studies have shown that between 0.4% and 4% of all 12-lead electrocardiograms (ECGs) are recorded using incorrect electrode positions. Electrode misplacement can cause a misdiagnosis either by concealing a pathology or, on the contrary, by emulating a pathology. Irrespective of this fact, ECG textbooks contain little or no information regarding the effects of electrode misplacement. Moreover, current pedagogic tools, which include physical mannequins, do not allow for the free positioning of electrodes to demonstrate these effects. In recognition of this, an electrode misplacement simulator (EMS) has been developed in this study. ⋯ The EMS has the potential to be used to support researchers in enhancing criteria currently used for detecting electrode misplacement. It could also be used to assist academic staff in teaching the effects of electrode misplacement. In this respect, it is currently being used as part of an undergraduate "Clinical Physiology" degree program at the University of Ulster.
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Of patients who present with ischemic-type chest pain and a negative cardiac troponin T (cTnT) at first medical contact, there are patients at a very early stage of infarction. The aim of this research was to assess heart fatty acid-binding protein (H-FABP), a novel marker of myocyte necrosis, in combination with the 80-lead body surface potential map (BSPM) in the early diagnosis of acute myocardial infarction (AMI). ⋯ In patients with acute ischemic-type chest pain who have a normal cTnT at presentation, the combination of H-FABP and BSPM at first assessment identifies those with early AMI (c-statistic, 0.812; P < .001), thus allowing earlier triage to reperfusion therapy and secondary prevention.
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Case Reports
Asymptomatic pulmonary vein stenosis after cryoballoon catheter ablation of paroxysmal atrial fibrillation.
Pulmonary vein (PV) isolation is an effective treatment option for symptomatic atrial fibrillation. PV stenosis is a well-recognized complication of radiofrequency energy application but has not been observed following cryoballoon ablation. Here, we report a case of asymptomatic PV stenosis associated with cryoballoon PV isolation, illustrating a risk that should be considered when applying this technique.
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For the assessment of patients with chest pain, the 12-lead electrocardiogram (ECG) is the initial investigation. Major management decisions are based on the ECG findings, both for attempted coronary artery revascularization and risk stratification. The aim of this study was to determine if the current 6 precordial leads (V(1)-V(6)) are optimally located for the detection of ST-segment elevation in ST-segment elevation myocardial infarction (STEMI). ⋯ Leads placed on a horizontal strip, in line with leads V(1) and V(2), provided the optimal placement for the diagnosis of anterior and lateral STEMI and appear superior to leads V(3), V(4), V(5), and V(6). This is of significant clinical interest, not only for ease and replication of lead placement but also may lead to increased recruitment of patients eligible for revascularization with none or borderline ST-segment elevation on the initial 12-lead ECG.