[SCD-FORUM] 65E 心电图预测心脏猝死

[SCD Symposium]

65E 心电图预测心脏猝死
亲爱的同道：
首先致以我的问候！！！
对此次论坛组织者、此次大型论坛、此次引人注目的 
科学交流致以热烈祝贺，
对于Andriy Vorotniak医生有关“心悸”和Brugada综合征的 
评论，以及建议，在不断发展的医疗背景下，心脏病 
学专家和内科医师应该致力编写一份可预测心脏猝死 
的心电图特点的列表，恐怕这些标准预测心脏猝死的 
敏感性很低。此外，我们还没有解决同一个患者连续 
心电图心前区导联变异性大的问题，而这在现今的医 
院心电图档案中是十分明显的。 “咨询诊所”中监 
测到的常规连续心电图显示心电图和心电图间V1—V6 
导联的振幅和形态差别甚大。在再现性如此差的情况 
下如何能依靠心电图来预测心脏猝死（多半是参考是 
胸前导联）呢？根据以往公布的一些关于Brugada综合 
征的经验，I型的特征表现可以在一部分患者身上、 
且只有在V1—V3胸导联定标时才发现，并非常规放置 
的胸导电极位置）我相信我们应该首先强调我们所有 
病人的心电图都能适当被记录，这样至少解决同一个 
患者连续心电图记录再现性差的问题。这是我们开始 
研究“预测心脏猝死的心电图特点”之前所必需的。

向各位致以热烈的问候。



致
John E. Madias, MD, FACC, FAHA,
心脏病学教授
纽约大学Mount Sinai医学院
心脏科 Elmhurst医学中心
e-mail::madias at nychhc.org

Sergio Dubner医生
科委会主席
Edgardo Schapachnik医生
组委会主席

潘佳君译 王玲洁校

65E ECG predictors of SCD. Dr. Madias
Dear colleagues:
Greetings!!!
Big  congratulations to the Organizers (!!!), for this magnificent
symposium, a scientific interaction, to which we have started becoming
addictive.
Regarding the comment of Dr. Andriy Vorotniak, on the "palpitations"
and Brugada syndrome, and his suggestion that we should work toward
compiling a list of ECG predictors of SCD, for us cardiologists and
physicians working in the ambulatory medicine setting, I am afraid that
many od such criteria may turn out to have a low sensitivity for SCD.
Besides, we have not as yet resolved the problem of the marked
variability in the precordial component of serial ECGs of individual
patients, as it is apparent nowadays in hospital elecronic ECG files.
Routine perusal of serial ECGs of patients evaluated in "consult rounds"
discloses massive differences from ECG to ECG in the amplitude and
morphology of V1-V6 leads. How one could rely on ECG predictors of SCD
(often depending on the precordial leads) when the eproducibility is so
poor? In addition experience has alrready been published that for
Brugada syndrome the characteristic type I pattern was seen in some
patients only when, other than the conventional V1-V3 thoracic
electrode positioning was employed, something not expected to be
available in routine standard ECG recordings. I beleive we should start
from insisting that the ECGs obtained in ALL our patients are recorded
appropriately, so that at least we resolve the problem of the poor
reproducibility in serial ECG recordings in the same patients. This  
is a prerequisite before we start delving into the matter of "ECG  
predictors
of SCD".


    Warmest Regards to ALL

Sincerely,

John E. Madias, MD, FACC, FAHA,
Professor of Medicine (Cardiology)
Mount Sinai School of Medicine
of the New York University,
Cardiology Division,
Elmhurst Hospital Center
e-mail::madias at nychhc.org

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee