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Date of download: 6/3/2016 Copyright © The American College of Cardiology. All rights reserved. From: Local Depolarization Abnormalities Are the Dominant Pathophysiologic Mechanism for Type 1 Electrocardiogram in Brugada Syndrome: A Study of Electrocardiograms, Vectorcardiograms, and Body Surface Potential Maps During Ajmaline Provocation J Am Coll Cardiol. 2010;55(8):789-797. doi:10.1016/j.jacc.2009.11.033 ECG, VCG, and BSPM Lead Placement Electrode positions for the modified electrocardiogram (ECG) (black circles), vectorcardiogram (VCG) leads (blue circles) and body surface potential map (BSPM) leads (red circles) used during the ajmaline provocation tests, BSPM leads selected as right and left precordial (squares). DRL = driven right leg electrode; F = left leg electrode; H = Frank lead; I = Frank lead; L = left arm electrode; M = Frank lead; R = right arm electrode. Figure Legend:
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Date of download: 6/3/2016 Copyright © The American College of Cardiology. All rights reserved. From: Local Depolarization Abnormalities Are the Dominant Pathophysiologic Mechanism for Type 1 Electrocardiogram in Brugada Syndrome: A Study of Electrocardiograms, Vectorcardiograms, and Body Surface Potential Maps During Ajmaline Provocation J Am Coll Cardiol. 2010;55(8):789-797. doi:10.1016/j.jacc.2009.11.033 ECG, VCG, and BSPM Parameters Simultaneously recorded electrocardiogram (ECG), vectorcardiogram (VCG), and body surface potential map (BSPM) parameters at baseline and peak ajmaline effect in a patient with Brugada syndrome with SCN5a mutation. (A) ECG: Note the type 1 ECG at peak ajmaline effect. Vertical lines indicate time intervals. (B) Late potentials: root mean square filtered signal from reconstructed Frank, left and right precordial leads. Note the prolongation of right precordial filtered QRS duration (fQRSD), particularly at peak ajmaline effect. Shown are: onset/offset fQRSD (vertical lines), duration of terminal low-amplitude signal <40 μV (LAS40), and root mean square voltage of signal in terminal 40 ms (RMS40). (C) VCG: QRS T loop in frontal, sagittal, and transverse planes. Note the terminal conduction slowing in the spatial QRS loop (transverse plane), particularly at peak ajmaline effect, along with rightward axis deviation (double arrowhead). Dashes: 2-ms intervals; black arrows (single arrowhead): QRS loop direction. Nondipolar content: body surface (D) QRS T integral maps. Note the modest QRS T integral change from baseline to peak ajmaline effect. Shown are positions of the sternum and vertebral column at the top of the map, positions of the QRS T integral extremes (+ and −), and corresponding nondipolar content values. Figure Legend:
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Date of download: 6/3/2016 Copyright © The American College of Cardiology. All rights reserved. From: Local Depolarization Abnormalities Are the Dominant Pathophysiologic Mechanism for Type 1 Electrocardiogram in Brugada Syndrome: A Study of Electrocardiograms, Vectorcardiograms, and Body Surface Potential Maps During Ajmaline Provocation J Am Coll Cardiol. 2010;55(8):789-797. doi:10.1016/j.jacc.2009.11.033 ECG, Late Potentials, and J-Amplitude (A) Three-dimensional representation of P-QRS-T complex in lead V 1 during ajmaline provocation test in a patient with Brugada syndrome (BrS). Note PR interval and P-wave prolongation during ajmaline infusion, J/ST-segment elevation, and rather constant QT interval. Shown are: signal amplitude (colors), start/stop moment of ajmaline infusion, and type 1 ECG at peak ajmaline effect. (B) Three-dimensional representation of the root mean square filtered signal at the end of the QRS complex in lead V 1 during ajmaline infusion in a BrS patient. Note the development of late potentials separating from the QRS complex during ajmaline infusion. Shown are: signal amplitude (colors), and start/stop moment of ajmaline infusion. (C) Relationship between maximal J amplitude in right precordial leads and the difference in duration of filtered QRS complex (fQRSD) between right and left precordial leads. Figure Legend:
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