Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2018;71:579 - Vol. 71 Num.07 DOI: 10.1016/j.rec.2017.12.020

Response to ECG, June 2018

Juan Caro-Codón a,, Ángel M. Iniesta Manjavacas a, Mar Moreno Yangüela a

a Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain

Refers to

Free articleECG, June 2018
Juan Caro-Codón, Ángel M. Iniesta Manjavacas, Mar Moreno Yangüela
Rev Esp Cardiol. 2018;71:488
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Article

The correct solution is number 3. The Figure shows a clearly prolonged QT interval in lead II, both at rest and in early and late recovery. Patients with type 1 long QT syndrome (LQTS1) have a significantly longer QTc interval in early recovery than those with type 2 long QT syndrome, and this difference disappears at about minute 4 of recovery.1 Thus, prolonged QTc interval at the start of recovery can specifically identify patients with LQTS1 (response 4 incorrect), whereas both genotypes have a prolonged QTc in late recovery.2 In the present case, the clinical diagnosis was confirmed after a mutation was found in the genetic study in exon 15 of the KCNQ1 gene (c.1760C > T p.T587 M). No electrocardiographic or echocardiographic findings supported a diagnosis of right ventricular arrhythmogenic cardiomyopathy (response 1 incorrect). The bifid and irregular T waves present in the trace, which occasionally appear in long QT syndrome, should not be confused with nonconducted P waves (response 2 incorrect).

Figure.

Corresponding author: juancarocd@gmail.com

Bibliography

1. Chattha IS, Sy RW, Yee R, et al. Utility of the recovery electrocardiogram after exercise: a novel indicator for the diagnosis and genotyping of long QT syndrome?. Heart Rhythm. 2010;7:906-11.
2. Sy RW, Van Der Werf C, Chattha IS, et al. Derivation and validation of a simple exercise-based algorithm for prediction of genetic testing in relatives of LQTS probands. Circulation. 2011;124:2187-94.

1885-5857/© 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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