Effects of lying position on p-wave dispersion in patients with heart failure

It was the aim of this study to investigate the effects of the right lateral decubitus, left lateral decubitus and supine lying position on P-wave dispersion [PWD] in patients with heart failure [HF]. Seventeen patients with HF whose ejection fraction was <35% were included in the study. Right lateral decubitus, left lateral decubitus and supine electrocardiogram [ECG] recordings were obtained. The recordings for each of the three positions were taken after the patients had maintained each position for 30 min to ensure a stabilized hemodynamic position. For the baseline recording, in supine position, there was no 30-min waiting period before the ECG. After the right lateral decubitus position, there was a statistically significant reduction in the longest P-wave duration [100.0 +/- 14.5 and 84.7 +/- 16.2 ms; p = 0.001] and a significant decrease in PWD [41.7 +/- 8.0 and 24.1 +/- 7.1 ms; p < 0.0001]. After the left lateral decubitus position, there was no significant change between the baseline PWD values [41.7 +/- 8.0 and 40.2 +/- 9.7 ms; p = 0.606]. After the supine position, there was no significant change between the baseline PWD values [41.7 +/- 8.0 and 39.7 +/- 9.4 ms; p = 0.427]. Our study revealed that patients' PWDs and maximum P-wave durations were lower in the right lateral decubitus lying position than in other positions. The clinical implication of this study needs to be further explored

An Iatrogenically Unmasked Life Threatening Disease: Brugada Syndrome

Brugada syndrome is a life threatening disease that is usually overlooked during emergency service admissions. It is characterized by typical electrocardiography resembling right bundle branch block, static or dynamic ST-segment elevation in leads V 1-3. There is familial tendency in some cases. A majority of patients have a structurally normal heart and are likely to remain asymptomatic, however they may present to emergency departments with syncope and various serious arrhythmias. Therefore it is crucially important for emergency medicine physicians not to omit this potential diagnosis. Herein we report a case with Brugada syndrome which was iatrogenically unmasked after propafenone administration for atrial fibrillation.