eLetters

779 e-Letters

  • Use of the 12 lead ECG to predict lead position during RBBB morphology pacing
    Aditya Kapoor

    Dear Editor

    The case described by Blommaert et al makes interesting reading. Inadvertent left ventricular (LV) pacing following attempted placement of a lead in the right ventricle (RV) is a known occurrence. It is vital to recognise the problem to institute appropriate therapeutic measures, realising however that often right bundle branch block (RBBB) pattern results from normal RV pacing. It would however be in...

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  • Re: National Service Framework – core data set
    J S Birkhead
    Dear Editor

    We thank Lawrance et al for their letter that raises several important points about the implementation of the national audit of myocardial infarction.[1] Until the numerator and denominator can be confidently stated there is little point in producing case fatality data either nationally or locally. The data that they quote in their letter strongly support this view. There is an urgent need to address thi...

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  • National Service Framework – core data set
    Richard A Lawrance

    Dear Editor:

    We read with interest the editorial by Birkhead,[1] concerning the implementation of the National Service Framework core data set for myocardial infarction, and would like to comment on several of the points raised.

    Birkhead emphasises a need for confidence in data collection and its subsequent analysis. The EMMACE study identified 2153 consecutive cases of AMI admitted to 20 adjacent hospita...

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  • No single ECG pattern for Brugada syndrome
    Pedro Brugada
    Dear Editor:

    Nava and coworkers[1] and Martini and coworkers[2] described a single patient with the diagnois of right ventricular dysplasia who, retrospectively analyzed by the same authors, may have suffered from the syndrome of right bundle branch block, ST segment elevation and sudden death, now known as Brugada disease.

    As they have no genetic analysis on that patient (to exclude among others Naxos syndrome) t...

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  • There is not a single typical ECG pattern for the syndrome of sudden death, RBBB, and ST elevation
    Bortolo Martini
    Dear Editor:

    The article by Viskin et al[1] adds some confusion to the definition of "the typical" electrocardiographic pattern associated with the syndrome of sudden death and right bundle branch delay described by Nava and Martini in 1988-1989,[2, 3] by Aihara in 1990, and by Brugada in 1992. As clearly documented,[3] three (and not one as discussed by Viskin et al) of six patients with aborted sudden death showed differe...

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  • Platypnoea-orthodeoxia syndrome: is it so rare?
    F Godart
    Dear Editor:

    We read with interest the article by Kubler et al[1] concerning 3 patients with platypnoea-orthodeoxia syndrome. As reported, this syndrome is infrequent and the diagnosis can be difficult. It is characterised by dyspnoea and arterial hypoxaemia induced by upright position that resolved by recumbency. This is usually the consequence of right-to-left shunt at the atrial level. Such shunting is frequent in...

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  • Re: Coronary endothelial dysfunction after Kawasaki disease
    Masahiro Ishii

    Dear Editor:

    We appreciate the kind comments of Dr Mitani regarding our article in the March 2000 issue of Heart and for sharing their experiences with us.[1]

    In group 1 and 2 patients who had regressed coronary aneurysm after Kawasaki disease, there was significantly more vascular constriction with acetylcholine and poorer dilatation with isosorbide dinitrate at the regressed site, than in group 3 patient...

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  • Application of clinical trial results
    Pitt O Lim

    Dear Editor:

    I read with interest Kübler’s review[1] and Willenheimer and colleagues’ viewpoint[2] on a similar theme about the application of drug trial results in clinical practice, an area that remains controversial.

    Florey’s penicillin trial in the 1940s only involved 8 mice. The mice were inoculated with streptococci and only the four that were treated survived. Such simplistic demonstration of a positive...

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  • Long QT syndromes induced by ecstasy and other recreational drugs
    Magí Farre
    Dear Editor

    The recent article by Ghuran and Nolan is a valuable review about cardiovascular effects of recreational drugs.[1] We would like to provide additional information, not included in the review, about the induction of changes in the QT interval by some recreational substances.

    The long QT syndrome has been associated with the occurrence of ventricular tachyarrhythmias (torsades de pointes). Considering the s...

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  • Creatinine kinase rise post partum
    P Rachael James
    Dear Editor

    In the case report by Sutaria et al (Heart 2000;83:97-98) an acute anterior MI complicated the routine administration of ergometrine after a spontaneous vaginal delivery. A peak creatinine kinase (CK) of 9858 U/l was reported (CK-MB fraction 8%) with the apparent implication that this CK rise reflected solely myocardial damage. The myometrium, however, is a source of CK and childbirth results in six fold...

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