• 2018-07
  • 2019-04
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    Discussion The rate of ERP in young, healthy men in northeastern Thailand was 10.3%. This is higher than the rate reported in the US (3.3–6.1%) [12]. In the US report, the mean age of the study population was 45 years, which was older than the age of subjects in our study. Another report from the UK with a mean patient age of 25 years indicated an ERP prevalence of 15.2%, which is comparable with this study [13]. Thus, the prevalence of ERP may be high in younger subjects and low in older subjects. Our ERP subjects differed significantly in a number of ways from those with a low or no J-point elevation. As also reported by others, ERP subjects had slower naloxone hydrochloride manufacturer rates and shorter QTc durations [14] (Table 2). Other important factors in the univariate logistic analysis included body weight, BMI, systolic blood pressure, diastolic blood pressure, QTc duration, and the Sokolow–Lyon index. Lean subjects may have a high Sokolow–Lyon index. After adjusting for confounders and other factors, BMI was not an independent factor, while the Sokolow–Lyon index was the only independent risk factor for ERP, with an adjusted odds ratio of 1.090 (Table 3). A previous report also found that the Sokolow–Lyon index was a predictor of ERP [12]. Our study population differed from previous study populations in some important respects; our study enrolled only healthy subjects who were assumed to be at low risk of cardiac arrest by virtue of their age, while subjects in the Framingham and H2K studies had comorbidities, such as hypertension [12]. Most ERPs in this study were detected by lateral leads in young, healthy men that were considered to be at low risk for cardiac arrest [15]. Brugada ECG was found in 11 of 29 subjects in the ERP group (37.9%), mostly in the lateral leads of ERP ECGs. The Brugada ECG pattern was found in only 2 of these subjects (6.9%) using standard ECGs, and both had the non-type 1 pattern (Table 5). When high intercostal leads were used, the Brugada ECG pattern was found in 11 subjects (37.9%), most of whom had the non-type 1 pattern. The degrees and lead locations of type 1 Brugada ECG were comparable between subjects with ERP and subjects with a J-point elevation of less than 0.1mV in the inferolateral leads (Tables 5 and 6). In the present study, ERP was detected mostly by the lateral leads, and one-third of subjects showed the non-type 1 Brugada ECG pattern upon high ICS lead placement. Both lateral ERPs and non-type 1 Brugada ECGs are considered benign and have a low risk of sudden death [15]. These subjects, however, should be aware of developing the type 1 Brugada ECG pattern, which could increase the risk of a serious arrhythmia in subjects taking class 1 anti-arrhythmic agents or psychotropic drugs and in those with an electrolyte abnormality. In addition, these subjects may have a higher risk of developing BS in the future, and close follow-up as well as avoidance of modulating factors is recommended.
    Conflict of interest
    Acknowledgments This study was supported by TRF grants from the Senior Research Scholar Grant, Thailand Research Fund grant number RTA5580004, and the Higher Education Research Promotion and National Research University Project of Thailand, Office of the Higher Education Commission, Thailand, through the Health Cluster (SHeP-GMS), Khon Kaen University. The authors gratefully thank Prof. James A. Will (University of Wisconsin, USA) for his kind review of the manuscript.
    Introduction Cardiac resynchronization therapy (CRT) is an effective treatment for patients with New York Heart Association (NYHA) class III–IV heart failure with impaired systolic failure. CRT improves exercise capacity and quality of life in addition to reducing heart failure hospitalizations and overall mortality. However, large CRT trials have not included patients with severe heart failure such as those dependent on intravenous inotropic drugs [1–3]. Furthermore, the 2012 ACCF/AHA/HRS Focused Update of the 2008 Guidelines for Device-Based Therapy includes no mention of CRT for patients with non-ambulatory NYHA class IV (NAHF) [4]. As previously reported, the long-term survival of patients with NAHF varies according to patient population and the application of devices and medical therapy [5–7]. In the REMATCH trial [7], the six-month mortality rate in the optimal medical therapy cohort was 61%. While occasionally described as beneficial in patients with NAHF, CRT is not generally used as a “rescue therapy” for such patients. Furthermore, cardiac transplantation and left ventricular assist devices (LVADs) are not common therapies, especially in elderly patients. Therefore, we retrospectively assessed the effectiveness and safety of CRT for patients with NAHF.