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Time course of electrocardiographic changes in transient left ventricular ballooning syndrome
Johan Bennett1, Bert Ferdinande, Peter Kayaert
1Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium.
Insights
Electrocardiogram (ECG) changes in transient left ventricular ballooning syndrome (TLVBS) typically resolve within one month, though some T wave inversions persist longer. Most patients normalize corrected QT intervals by 14 days.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Diagnostics
Background:
- Transient left ventricular ballooning syndrome (TLVBS) is a condition with poorly defined electrocardiographic (ECG) evolution.
- Understanding the temporal ECG changes is crucial for diagnosis and management.
Purpose of the Study:
- To comprehensively describe the time course of ECG abnormalities in TLVBS patients.
- To establish the typical duration and resolution patterns of specific ECG findings.
Main Methods:
- Retrospective analysis of serial ECGs from 139 TLVBS patients over a 14-year period.
- ECGs were analyzed from acute presentation up to 1-year follow-up, correlated with symptom onset time.
Main Results:
- ST segment elevation resolved by 1 month in all patients.
- T wave inversion persisted in 17% of patients at 6-12 months.
- Corrected QT (QTc) interval prolongation occurred in 86% acutely, normalizing by day 14.
Conclusions:
- Early ECG findings in TLVBS can mimic ST-elevation myocardial infarction.
- Most ECG changes, including QTc prolongation, resolve within weeks to a month.
Background:
We sought to describe, for the first time, in detail the time course of electrocardiographic (ECG) changes in transient left ventricular ballooning syndrome (TLVBS) from acute onset until 1 year after presentation.
Methods:
The serial ECGs of all patients identified with TLVBS who presented to our cardiology department from August 1998 to August 2012 were analyzed, from admission to 1-year follow-up, with respect to time from onset of symptoms.
Results:
In total, 145 TLVBS episodes were identified in 139 patients. In 53% of patients, ST segment elevation was present in the first 3h after symptom onset, after which there was a steady decline with complete resolution in all patients by 1 month. The presence of T wave inversion (TWI), with or without ST segment depression, was most prevalent between day 1 (60%) and day 30 (71%) from symptom onset, with 17% of patients still exhibiting TWI after 6 to 12 months. At 1 year, approximately 80% of patients had no significant residual ST-T wave changes. In 86% of patients, there was prolongation of the corrected QT (QTc) interval in the acute phase, with normalization of all QTc intervals by day 14.
Conclusions:
During the early phase, ECG mimics acute ST elevation myocardial infarction with initial regional ST segment elevation progressing to T wave inversion with or without ST depression. In the majority of patients, significant QTc interval prolongation occurs in the early phase, normalizing by day 14.
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