UNDER THE RADAR: THE CLINICAL IMPORTANCE OF MINOR ECG ANOMALIES IN MAJOR CARDIAC EVENTS

Abstract

In 2008, Professor Breijo-Márquez identified a distinct electrocardiographic pattern featuring a short PR interval and a short QT interval in the same individual, termed the "Decreased Cardiac Electrical Systole." Since then, this pattern has gained clinical relevance, often observed in isolation or in conjunction with other cardiac abnormalities. The PR interval reflects atrial-to-ventricular conduction, with values below 0.120 seconds considered short. The QT interval spans ventricular depolarization and repolarization; while normal ranges vary by source, values below 0.350 seconds are typically considered pathologically short. Both short PR and QT intervals can destabilize cardiac electrical activity, increasing susceptibility to life-threatening arrhythmias, particularly tachyarrhythmias. Despite its clinical importance, the pattern is frequently misinterpreted as normal due to its subtle presentation at standard heart rates and inconsistency in diagnostic criteria. Genetic mutations have been implicated in some cases of short QT syndrome, though definitive identification remains rare. Due to its association with sudden cardiac death and diagnostic ambiguity, heightened awareness and thorough evaluation—including family history—are essential. The current standard of care for high-risk individuals remains the implantation of a cardioverter-defibrillator.