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What are the main claims of the paper and how important are they?
I know to Prof. Breijo from many years now. It was a delight to see this article, which is an improvement over the already published in IJC by the same author. The main claim is that this is a discovery in the field of Cardiology. Until 2008, this clinical situation was not known as a new electrocardiographic event.
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Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.
Totally new.
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Are the claims properly placed in the context of the previous literature?
Of course, yes.
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Do the results support the claims? If not, what other evidence is required?
Totally Yes
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If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?
Not applicable in this case
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Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?
Not applicable in this case
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Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?
Professor Breijo-Marquez has enough cases to be published in cardiology journals of high impact index.
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Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?
Yes, of course.
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Other Comments:
It is always a pleasure to read the clinical and experimental work from Professor Breijo. Very grateful for that.
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Competing interests:
None
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Invited by the author to review this article? :
Yes -
Have you previously published on this or a similar topic?:
Yes
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References:
The electrical cardiac systole and its alterations. Int J Cardiol. 2010. 13: 201-207
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Experience and credentials in the specific area of science:
Im also a Professor of Cardiology
- How to cite: Zimmerman D .Accelerated atrioventricular stimulation with an early and shortened ventricular repolarization in the same individual. [Review of the article 'Accelerated atrioventricular stimulation with an early and shortened ventricular repolarization in the same individual ' by Breijo-Marquez F].WebmedCentral 2014;5(5):WMCRW003042
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What are the main claims of the paper and how important are they?
This is a case report which claims to report a case with concurrent short PR and QT intervals which is very rare indeed, but according to the first hospitalization ECG (Baseline ECG), the Dx is not 100%, since there is no shortened QT interval in that ECG. The premises about the association of these ECG entities with childhood convulsions or syncopes are not well supported and it can not be claimed acccording to one case.
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Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.
The case (If we consider it concurrent short PR and QT interval) is rare.
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Are the claims properly placed in the context of the previous literature?
No
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Do the results support the claims? If not, what other evidence is required?
It's not an original research, indeed it's just a case report, so not applicable here.
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If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?
No applicable here.
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Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?
Not Applicable...
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Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?
The author have not provided the findings of EPS which could lead to a definitive diagnosis. Also Echocardiography in this case would be helpful.
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Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?
No. It has numerous drawback in terms of reporting a case, for example not very explicit regarding the treatments that the patient received before, etc.
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Other Comments:
The baseline ECG provided here is a supraventricular tachycardia with short PR interval, but the QT interval is not short for sure. It may be considered even prolonged since it’s higher than half of the Q-Q interval as determined in the literature. For sure the first ECG is not Short QT. This imposes some significant doubts on the diagnosis made by authors.
A case report should not have a methods section or Results section. They just have Introduction, Case presentation, discussion and perhaps conclusion. Remove the methods section and combine results with the case report section.
Electroencephalography should be abbreviated as EEG and electrophysiology study is better to be abbreviated as EPS.
The author have reported the patient to be in stupor consciousness state and then provided a GCS score of 15/15, which is impossible. Stupor means that only vigorous and repeated stimuli will arouse the individual, and when left undisturbed, the patient will immediately lapse back to the unresponsive state. A patient in stupor state should have a GCS of at least 12 or less.
The author stated that “Supraventricular tachycardia disappeared by means of the administration of two doses of Adenosine i.v. in bolus, with six mgrs. each one in 1 minute”. Adenosine should be administered very quickly; otherwise it won’t have any effect. So I think the author mean that adenosines were administered “with 1 min interval”, not “each during one minute!!”.
The time of second hospitalization in relation to the first one is not clear within the text. Please elaborate this…
The patient was tested for serum lithium ion level, so he is probably on treatment with lithium pills because of a potential bipolar mood disorder. Psychiatric patients may present with conversion disorder, or may experience occasional panic attacks that may be presented in ECG with a supraventricular tachycardia.
Also if the patient is a person treating for a potential Bipolar mood disorder (considering Lithium testing in this case), It’s very likely to be co-treated with TCAs such as clomipramine, etc. These drugs are demonstrated to develop some ECG changes in some patients. So this should be considered as a differential diagnosis as well.
The findings of EPS study have not provided in this manuscript, since it can provide the exact diagnosis.
Because there is right axis deviation and R/S ratio>1 in V1 in baseline ECG, some congenital diseases such as ASD is suspected for this case. So it’s better to perform an echocardiographic study in this patient. -
Competing interests:
None
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Invited by the author to review this article? :
Yes -
Have you previously published on this or a similar topic?:
No
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References:
None
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Experience and credentials in the specific area of science:
I have enough experience in this field (ECG).
- How to cite: Sepehrvand N .Accelerated atrioventricular stimulation with an early and shortened ventricular repolarization in the same individual[Review of the article 'Accelerated atrioventricular stimulation with an early and shortened ventricular repolarization in the same individual ' by Breijo-Marquez F].WebmedCentral 2014;5(5):WMCRW003041
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What are the main claims of the paper and how important are they?
A more common problem than we can think. Confusion with epileptic episodes are too frequent.
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Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.
Very well exposed in my viewpoint
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Are the claims properly placed in the context of the previous literature?
Yes.
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Do the results support the claims? If not, what other evidence is required?
Yes.
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If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?
Not assessable in this case
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Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?
Not assessable in this case
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Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?
Yes. A statistical explanation would be really nice
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Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?
Of course, yes.
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Other Comments:
Cardiologic to keep in mind when evaluating a patient with such symptoms and this kind of ECG tracing.
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Competing interests:
None
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Invited by the author to review this article? :
No -
Have you previously published on this or a similar topic?:
No
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References:
None
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Experience and credentials in the specific area of science:
Im a cardiologist
- How to cite: Breijo-Marquez F R.I think this is necessary to know.[Review of the article 'Accelerated atrioventricular stimulation with an early and shortened ventricular repolarization in the same individual ' by Breijo-Marquez F].WebmedCentral 2014;5(4):WMCRW003030
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What are the main claims of the paper and how important are they?
The main claim is that short PQ and short QT can be seen rarely in the same inidvidual and a case is presented.
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Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.
Yes. Due to the rare natue of this entity, it has not been thus far reported in the cardiovascular or EP literature.
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Are the claims properly placed in the context of the previous literature?
Yes.
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Do the results support the claims? If not, what other evidence is required?
This is a nice case presentation. Further case reports amy enlighten us as to the mechanism of this rare electrical phenomenon.
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If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?
Not applicable
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Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?
Yes
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Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?
Future case reports would be wonderful.
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Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?
It is in that it reviews a thus far rarely recognized electrical phenomenon.
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Other Comments:
Excellent report.
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Competing interests:
None
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Invited by the author to review this article? :
Yes -
Have you previously published on this or a similar topic?:
No
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References:
None
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Experience and credentials in the specific area of science:
Board Certified Cardiovascualr Physician
- How to cite: Azimi N A.Cardiovascular Physician[Review of the article 'Accelerated atrioventricular stimulation with an early and shortened ventricular repolarization in the same individual ' by Breijo-Marquez F].WebmedCentral 2014;5(3):WMCRW003024
Thank so much for your wwords, Dr Azimi.
Responded by Prof. Francisco R Breijo-Marquez on 31 Mar 2014 09:44:39 AM
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The authors reported a clinical condition featured by the presence of a short PQ interval and a short QT interval in the same patient. This is a rare case relevant to the literature that helps clinicians in their routine.
Yes, this is a rare clinical condition
Yes
Yes
No
Yes
I described in iten 9
Yes, it would be interesting to be presented in an hospital or university
1. The authors should consult keywords in the NLM-Mesh (http://www.nlm.nih.gov/mesh/MBrowser.html);
2. Introduction, 3rd, 4th, 5th and 6th paragraphs do not contain reference, it should be added;
3. Methods: Ethical Committee in Research Protocol should be mentioned;
4. Method: Did the patient present any associated disease? Please clarify it;
5. The authors needs to improve Discussion and take this opportunity to show the importance of their case study.
None
Yes
Yes
Apical ballooning syndrome (Takotsubo Syndrome): case report. do Nascimento CU, Bosso CE, Jorge PH, Vanderlei FM, Ebaid HI, Valenti VE, Vanderlei LC. Int Arch Med. 2013 Apr 18;6(1):12. doi: 10.1186/1755-7682-6-12. A Randomized Trial of the Topical Effect of Antifibrinolytic Epsilon Aminocaproic Acid on Coronary Artery Bypass Surgery Without Cardiopulmonary Bypass. Gurian DB, Meneghini A, de Abreu LC, Murad N, de Matos LL, Pires AC, Valenti VE, Breda JR. Clin Appl Thromb Hemost. 2013 Mar 17. [Epub ahead of print]
Assistant Professor in Faculdade de Filosofia e Ciancias, Universidade Estadual Paulista, UNESP, Marlia