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Vol. 71. Issue 7.
Pages 579 (July 2018)
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Vol. 71. Issue 7.
Pages 579 (July 2018)
ECG Contest
DOI: 10.1016/j.rec.2017.12.020
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Response to ECG, June 2018
Respuesta al ECG de junio de 2018
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Juan Caro-Codón
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juancarocd@gmail.com

Corresponding author:
, Ángel M. Iniesta Manjavacas, Mar Moreno Yangüela
Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
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Rev Esp Cardiol. 2018;71:48810.1016/j.rec.2017.12.019
Juan Caro-Codón, Ángel M. Iniesta Manjavacas, Mar Moreno Yangüela
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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.T587M). 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).

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References
[1]
I.S. Chattha, R.W. Sy, R. Yee, et al.
Utility of the recovery electrocardiogram after exercise: a novel indicator for the diagnosis and genotyping of long QT syndrome?.
Heart Rhythm., 7 (2010), pp. 906-911
[2]
R.W. Sy, C. Van Der Werf, I.S. Chattha, et al.
Derivation and validation of a simple exercise-based algorithm for prediction of genetic testing in relatives of LQTS probands.
Circulation., 124 (2011), pp. 2187-2194
Copyright © 2017. Sociedad Española de Cardiología
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