[SCD-FORUM] 130E Dr. Xia's case (No. 105) Dr. Li Zhang's comments

[SCD Symposium]

Dear Dr. Yunlong Xia:
  Following I would like to provide my comments re. the ECGs of your patients, hoping to get some feedback from you, and from the world ECG master Dr. Perez Riera and from any of the experts and colleagues. 
>From the ECGs you provided, I see three major problems in this case.
1. Severe sinus node, intra-atrial and AV conduction abnormalities as you described in the case report. 
2. Several ECG signs suggest the presence of the RV cardiomyopathy in addition to the severe conduction defects. If the inverted deflection 150 ms after QRS is a retrograded  P  wave  in V1, the small deflection 30-40 ms after QRS in D II, III, aVL, aVF and V3-6 could be the epsilon wave or isolated AF post QRS. SAECG will help to determine whether late potential is positive. 
3.  A marked  QT  prolongation (QTc 540 ms) during atropine test is seen in  ECG tracing named Yunlong 2. 

With family hx of SCD of several members in the paternal side, recurrent syncopal episodes and evidence of multi-chamber involvement, I wish she could have an ICD for SCD prevention. 

Thank you so much for sharing this interesting case with us,
Li Zhang, MD