Volume 11, Issue 6, Pages (June 2014)

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Volume 11, Issue 6, Pages 1047-1054 (June 2014) Procainamide infusion in the evaluation of unexplained cardiac arrest: From the Cardiac Arrest Survivors with Preserved Ejection Fraction Registry (CASPER) Riyaz Somani, PhD, MRCP, Andrew D. Krahn, MD, Jeffrey S. Healey, MD, Vijay S. Chauhan, MD, David H. Birnie, MD, Jean Champagne, MD, Shubhayan Sanatani, MD, Paul Angaran, MD, Robert M. Gow, MD, Santabhanu Chakrabarti, MD, Brenda Gerull, MD, Raymond Yee, MD, Allan C. Skanes, MD, Lorne J. Gula, MD, Peter Leong-Sit, MD, George J. Klein, MD, Michael H. Gollob, MD, Mario Talajic, MD, Martin Gardner, MD, Christopher S. Simpson, MD Heart Rhythm Volume 11, Issue 6, Pages 1047-1054 (June 2014) DOI: 10.1016/j.hrthm.2014.03.022 Copyright © 2014 Heart Rhythm Society Terms and Conditions

Figure 1 Schematic representation of the high intercostal space (HICS) lead position used during provocative testing. Heart Rhythm 2014 11, 1047-1054DOI: (10.1016/j.hrthm.2014.03.022) Copyright © 2014 Heart Rhythm Society Terms and Conditions

Figure 2 Sequential ECGs (standard lead position) taken during provocative testing with procainamide in a 68-year-old man who had previously experienced an unexplained cardiac arrest. At baseline, the ST segments in the anterior precordial leads are within normal limits. With infusion of procainamide, >1 mm coved ST-segment elevation 20 ms after the end of the QRS in leads V1–V2 is seen at 20 minutes, consistent with a positive result. Subsequent infusion of isoproterenol resulted in the characteristic resolution of ST-segment elevation. Heart Rhythm 2014 11, 1047-1054DOI: (10.1016/j.hrthm.2014.03.022) Copyright © 2014 Heart Rhythm Society Terms and Conditions

Figure 3 Overall working diagnoses reached in the 174 subjects undergoing a procainamide challenge after integration of all baseline clinical testing, genetic studies, and clinical follow-up. ARVC = arrhythmogenic right ventricular cardiomyopathy; CPVT = catecholaminergic polymorphic ventricular tachycardia; DCM = dilated cardiomyopathy; ERS = early repolarization syndrome; LQTS = long QT syndrome; SQTS = short QT syndrome; VF = ventricular fibrillation. Heart Rhythm 2014 11, 1047-1054DOI: (10.1016/j.hrthm.2014.03.022) Copyright © 2014 Heart Rhythm Society Terms and Conditions