[CRT-FORUM] 59E 4 years old girl, with a Dilated Cardiomiopathy. Dr. de la Paz

[CRT-INFO]

DR PEREZ RIERA , THANKS YOU FOR YOUR CLEAR AND EXACT ECG ANALYSIS AND
YOUR MANAGEMENT PROPOSAL ,

DR PEDRO
> Dear Dr Pedro de la Paz
> ECG ANALYSIS
> 1) Very short PRi interval: < 90 ms in children since the onset of P 
> up to the onset of QRS. It represents the time the stimulus takes to 
> go from the SA node until reaching the ventricles: 120 ms to 200 ms in 
> adult. In children between 3 to 8yo the normal average of PR interval 
> is 130ms (0.13 s) Maximal normal limit 160 ms for rates between 80 and 
> 120 bpm.
>
> 2) Wider QRS complex: ?100 ms
>
> 3) Thickening or notch at the onset of QRS complex: DELTA wave 
> duration=30mm.
>
> 4) Unaltered P-J interval (distance between P wave onset until J 
> point) (normal value = 180 to 260 ms.)
>
> 5) Unaltered P-Z interval (distance between P wave onset until R 
> apex.) Normal value = 150 to 230 ms.
>
> 6) Secondary alterations of ventricular repolarization (ST-T): 
> depending on aberrant depolarization.
>
> 7) Type B WPW of Rosembaum classification: anomalous pathway between 
> the right atrium and right ventricle (Galhanger points 3, 2 or 4: 
> right lateral or right anterior), similar QRS pattern to LBBB, 
> negative QRS predominance in right precordial leads leads and pure R 
> waves in left leads I, VL, V5-V6.
>
> 8) Anomalous pathway located on Lindsay's IV region: negative delta 
> wave in VR, SÂQRS not shifted (inferior QRS axis) transition zone in 
> V3 on precordial leads. Ventricular activation in the horizontal plane 
> of right lateral pre-excitation.
>
> 9) Anomalous pathway on Gallagher's point 3.
>
> 10) WPW Type I of European classification
>
> 11) Frequent premature atrial contractions
>
> Management Proposal:
> 1) Genetic testing in proband and familial screening
> 2) RFCA: Radiofrequency Catheter Ablation because LBBB similar 
> pattern: elimination of dessicronization, and easy approach
> 3) Pharmacological approach for CHF
> 4) Clinical observation for a few times.
>
> Resynchronization is not necessary.
>
> All the best for all
> Andrés Ricardo Pérez Riera.MD
> Chief of electrovectorcardiographic sector. ABC’s Medical School, ABC 
> Foundation, Santo André, São Paulo, Brazil Riera at uol.com.br


-- 
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee