ABC | Volume 113, Nº1, July 2019

Review Article Pastore et al ECG/VCG in the current clinical practice Arq Bras Cardiol. 2019; 113(1):87-99 Figure 4 – Aspects of the VCG loops in the Inferior MI (in Fig. 3A of the previous item, note the QRS loop onset upwardly in the frontal plane, with more than 30 ms duration [15 comets]); in Figure 4A – LASFB, observe the QRS loop onset downwardly (through the posterior-inferior division), with counterclockwise rotation and the major portion of the loop oriented upwardly and to the left; and in Figure 4B - LASFB + inferior MI, the association of the two entities; note that the QRS loop in the frontal plane is directed upwardly, with clockwise rotation, and after 30 ms it changes its orientation, with counterclockwise rotation characterizing the LASFB. was in the left quadrant, with a shorter duration. In 100% of the ER patients, the final portion of the QRS loop showed a fishhook pattern. Characteristic electro-vectorcardiographic aspects of the type 1 Brugada syndrome (see Figure 6D): transverse plane: QRS loop onset with counterclockwise rotation; ECD began posteriorly and ended anteriorly and in the right quadrant in all BrS patients; BrS showed a “break” at the end of the QRS loop after the ECD, in the terminal segment of the QRS loop, resembling a “nose”, right before the T wave loop onset; this “nose” pattern was present in all type 1 BrS patients, but in none of ER patients. A very important arrhythmogenic pathology, the arrhythmogenic right ventricle cardiomyopathy (ARVC), has an almost definitive assessment tool in the electro- vectorcardiographic diagnosis. The end-conduction delay with low voltage and long duration to the right (forward or slightly backwards) characterizes the phenomenon with great accuracy, with the differential diagnosis being very important, since this pathology may lead to severe arrhythmias. (Figure 11) 91