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 3 – (A) Presence of myocardial infarction area in the inferior wall, with QRS vectorcardiographic loop onset oriented upwardly and to the left. (B) Aspect of a large myocardial infarction area from V1 to V6 and its respective loop in the transverse plane, with anomalous activation of the septum and exaggerated backward rotation, followed by deformation of the QRS loop. In the transverse plane, the QRS loops showed a counterclockwise rotation, with the ECD beginning posteriorly and ending anteriorly, with the main difference between the groups being the ECD position. In BrS type 1 patients (Figure 6D) we see a counterclockwise rotation of the terminal QRS segment, J point and onset of the ST segment around the medial portion, resembling a “nose” in profile. The ECD position was in the right quadrant in all BrS patients and its duration was significantly longer. A greater than or equal to 30 ms ECD had 100% sensitivity and 77% specificity to diagnose Brugada syndrome. The BrS group showed a break at the end of the QRS loop right after the ECD, which resembled a “nose”, right before the onset of the T-wave loop. This “nose” pattern was present in all the BrS type 1 patients. In the ER pattern 9,25 (Figure 10) we see a clockwise rotation (terminal portion of the QRS) of the same segments, resembling a “fishhook”. In all the ER cases the ECD position 90