Journal of electrocardiology最新文献

{"title":"Distinct unexpected phenomena with a shared mechanism.","authors":"Esteban González-Torrecilla, Pablo Ávila-Alonso, Alejandro Carta-Bergaz","doi":"10.1016/j.jelectrocard.2026.154443","DOIUrl":"https://doi.org/10.1016/j.jelectrocard.2026.154443","url":null,"abstract":"<p><p>Supernormal phenomena are uncommon findings in routine electrocardiographic evaluation, and both their electrophysiological substrate and their clinical significance remain controversial. We present two cases with electrocardiographic tracings consistent with supernormal excitability in a patient with a dysfunctional epicardial pacemaker, and supernormal conduction in another patient with complete atrioventricular block. In addition to their unexpected nature, both phenomena share a common electrophysiological substrate, which is thought to be mediated, at least in part, by the availability of functional Na + channels during the terminal portion of phase 3 of repolarization, known as the supernormal phase.</p>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"99 ","pages":"154443"},"PeriodicalIF":1.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multicomponent local ventricular electrograms during left bundle branch area pacing.","authors":"Jiabo Shen, Longfu Jiang, Hengdong Li, Hao Wu, Xiaosheng Hu","doi":"10.1016/j.jelectrocard.2026.154444","DOIUrl":"https://doi.org/10.1016/j.jelectrocard.2026.154444","url":null,"abstract":"<p><p>A 63-year-old woman with sick sinus syndrome and recurrent syncope underwent left bundle branch area pacing lead implantation using a continuous pacing and recording technique. Multicomponent local ventricular electrograms were observed during left ventricular septal pacing, nonselective left bundle branch pacing, and selective left bundle branch pacing, challenging the specificity of discrete electrograms for selective capture. Potential mechanisms included overlapping potentials from distinct septal sources and far-field contributions. These findings suggested that selective left bundle branch capture should be confirmed through comprehensive unipolar threshold testing and systematic analysis of output-dependent electrophysiological transitions rather than electrogram morphology alone.</p>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"99 ","pages":"154444"},"PeriodicalIF":1.5,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progressive electrocardiographic remodeling despite Tafamidis therapy in transthyretin amyloid cardiomyopathy (ATTR-CM).","authors":"Lilou Escorbiac, Simon Weeder, Stefan Kääb, Steffen Massberg, Norbert Frey, Fabian Aus dem Siepen, Stéphanie K Schwarting","doi":"10.1016/j.jelectrocard.2026.154440","DOIUrl":"https://doi.org/10.1016/j.jelectrocard.2026.154440","url":null,"abstract":"<p><strong>Background: </strong>Electrocardiographic (ECG) abnormalities are a hallmark of transthyretin amyloid cardiomyopathy (ATTR-CM), yet longitudinal ECG changes under disease-modifying therapy remain poorly characterized.</p><p><strong>Methods: </strong>In this retrospective multicenter study, 140 patients with confirmed ATTR-CM receiving tafamidis underwent serial 12‑lead ECG assessment at baseline and after one year. ECG parameters were analyzed in relation to biomarker-based disease stage, clinical progression, and all-cause mortality. Longitudinal ECG changes were evaluated using Wilcoxon signed rank and McNemar tests. Survival analyses were conducted using Kaplan-Meier estimates and univariable Cox regression.</p><p><strong>Results: </strong>At baseline, PR interval, QRS duration, and QTc were significantly associated with advanced disease stage, whereas QRS voltage and heart rate were not. During follow-up, patients showed clinical progression with worsening functional status despite stable biomarker-based disease stage. Serial ECG assessment demonstrated ongoing electrical remodeling with significant QRS prolongation (109 vs. 114 ms, p < 0.001), increasing conduction disturbances, and a doubling of pacemaker stimulation. These changes occurred independently of disease stage and were confirmed in patients without pacemaker-stimulated rhythm. Longitudinal changes in QRS voltage were inconsistent and depended on the analytic approach. Baseline QRS duration ≥120 ms and markedly prolonged PR interval (>220 ms) were associated with adverse outcome, whereas longitudinal ECG changes were not independently associated with mortality.</p><p><strong>Conclusions: </strong>In ATTR-CM, baseline conduction abnormalities - but not longitudinal ECG changes - were associated with adverse outcomes. Despite tafamidis therapy, ECG abnormalities continued to progress, predominantly reflecting ongoing conduction system involvement independent of biomarker-based disease stage, suggesting that serial ECG assessment may complement disease monitoring rather than risk stratification.</p>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"99 ","pages":"154440"},"PeriodicalIF":1.5,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI-assisted OMI detection in canceled STEMI activations: Diagnostic accuracy is not yet clinical utility.","authors":"Sefa Erdi Ömür, Çağrı Zorlu","doi":"10.1016/j.jelectrocard.2026.154431","DOIUrl":"https://doi.org/10.1016/j.jelectrocard.2026.154431","url":null,"abstract":"","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":" ","pages":"154431"},"PeriodicalIF":1.5,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor: DeepECG.ai: An AI-enhanced ECG analysis platform to bridge the expertise gap from primary care to cardiology.","authors":"I Dewa Gede Hari Wisana, Sari Luthfiyah, Triwiyanto Triwiyanto, Mohammed Ismath","doi":"10.1016/j.jelectrocard.2026.154394","DOIUrl":"https://doi.org/10.1016/j.jelectrocard.2026.154394","url":null,"abstract":"","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":" ","pages":"154394"},"PeriodicalIF":1.5,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148271543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The significance of quantitative electrocardiogram analysis in the diagnosis of fulminant myocarditis among pediatric patients","authors":"Yang Guiming MD,&nbsp;Zheng Liyun MM,&nbsp;Qi Xiaohui BM,&nbsp;Zhao Sheng MM","doi":"10.1016/j.jelectrocard.2026.154355","DOIUrl":"10.1016/j.jelectrocard.2026.154355","url":null,"abstract":"<div><h3>Background</h3><div>The electrocardiogram (ECG) serves a critical function in the diagnosis of fulminant myocarditis(FM). Nevertheless, the utility of qualitative ECG analysis in diagnosing this condition remains limited. To date, there is a lack of published studies investigating the application of quantitative electrocardiogram analysis for the diagnosis of FM in pediatric populations.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study in 79 patients with acute myocarditis (AM). Participants were categorized into FM(26 cases) and non-fulminant myocarditis (NFM) groups(53 cases) according to their clinical manifestations. Comprehensive clinical data and results from auxiliary examinations were systematically gathered. Furthermore, a control group comprising eighty healthy children undergoing routine physical examinations during the same period was included.</div></div><div><h3>Results</h3><div>The FM group demonstrated a significantly higher incidence of ECG abnormalities relative to the NFM group, notably limb lead low voltage trend (LVT) and chest lead LVT(all <em>P</em> &lt; 0.05). Repolarization abnormalities were frequently observed in both the FM and NFM groups. Quantitative ECG analysis revealed that, except for leads III, aVL, aVF, and V1, QRS complex voltage were significantly reduced in the FM group compared to both NFM and control groups (all <em>P</em> &lt; 0.01). Multivariate logistic regression identified prolonged QRS duration and diminished average limb lead voltage as independent predictors of FM.</div></div><div><h3>Conclusion</h3><div>Pediatric patients with FM present with pronounced and severe ECG abnormalities. In pediatric patients with myocarditis, prolongation of QRS duration (&gt;98 ms) or reduction in average limb lead voltage(&lt;0.82mv) serve as critical electrophysiological markers for the early diagnosis of FM.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"96 ","pages":"Article 154355"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147948509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Could this intermittent prominent anterior force be a septal fascicle block?","authors":"Daniel Teixeira de Campos e Barreiro ,&nbsp;Lívia Maria de Paula Castro ,&nbsp;José Nunes de Alencar","doi":"10.1016/j.jelectrocard.2026.154356","DOIUrl":"10.1016/j.jelectrocard.2026.154356","url":null,"abstract":"<div><h3>Background</h3><div>A septal fascicle of the left bundle branch is an anatomical variant present in a substantial number of human hearts. However, the electrocardiographic features of its block remain controversial.</div></div><div><h3>Case summary</h3><div>We describe a case of transitory prominent anterior forces consistent with an intermittent left septal fascicle block, identified on a preoperative ECG of an adult male with a history of diabetes mellitus and systemic hypertension.</div></div><div><h3>Conclusion</h3><div>Clinicians should recognize septal fascicular block as an emerging and underrecognized cause of a prominent R-wave in the right precordial leads, particularly when the pattern is intermittent.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"96 ","pages":"Article 154356"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two distinct ventriculo-atrial relationships during narrow QRS complex tachycardia: What is the mechanism?","authors":"Rongchen Liu MD ,&nbsp;Wentao Gu MD ,&nbsp;Haocheng Ma MD ,&nbsp;Nanqing Xiong MD","doi":"10.1016/j.jelectrocard.2026.154358","DOIUrl":"10.1016/j.jelectrocard.2026.154358","url":null,"abstract":"<div><div>A 65-year-old woman underwent ablation for a short RP narrow complex tachycardia (NCT). EP study showed dual AVN phenomenon and two inducible narrow complex tachycardias showing 1:1 VA relationship, concentric atrial activation but different H-A intervals. RV overdrive pacing failed to entrain the first long RP tachycardia (NCT1) but transformed it to another A-on-V tachycardia (NCT2), excluding the diagnosis of AVRT. Premature atrial contractions (PACs) were delivered for further differential diagnosis. During NCT1, a late PAC was able to advance the following His without resetting of the tachycardia. An early PAC terminated the tachycardia with anterograde slow pathway conduction to the His. Both were inconsistent with fast-slow AVNRT and supported AT as the diagnosis. NCT2 was likely to be diagnosed as AVNRT given the A-on-V pattern and the presence of slow pathway. However, His-synchronous PAC advanced the next H over the slow pathway but failed to advance the following A as well as the subsequent H i.e., tachycardia was not reset. All responses to PACs were repeatable, indicating the mechanism of NCT2 was the same AT with anterograde slow pathway conduction to His. The tachycardia was proved to be para-His AT and ablated without difficulty.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"96 ","pages":"Article 154358"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emphysematous gastritis presenting as a Pseudo–inferior myocardial infarction due to cardiac displacement","authors":"Brandon Rein B.S. OMS-III ,&nbsp;Donya Forohar B.S. OMS-III ,&nbsp;Rakesh Sharma MD ,&nbsp;Adel Hanna MD","doi":"10.1016/j.jelectrocard.2026.154367","DOIUrl":"10.1016/j.jelectrocard.2026.154367","url":null,"abstract":"<div><div>This case explores emphysematous gastritis manifesting as transient inferior ST-segment elevation on electrocardiogram (ECG), mimicking acute myocardial infarction. The patient presented with symptoms and ECG findings initially concerning for inferior wall myocardial infarction. Negative cardiac biomarkers, normal echocardiography, and resolution of ECG abnormalities following gastric decompression supported an extracardiac etiology. Emphysematous gastritis is an uncommon but life-threatening condition, with fewer than 100 cases reported, and no previous description of causing a pseudo-infarction pattern on ECG. This case highlights the importance of recognizing extracardiac causes of ST-segment elevation and integrating clinical context, biomarkers, and imaging to avoid unnecessary invasive cardiac intervention.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"96 ","pages":"Article 154367"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147991729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"QRS notch timing in idiopathic outflow tract premature ventricular complexes","authors":"Abdelaziz Jaouadi MD MBA,&nbsp;Oguzhan Ekrem Turan MD,&nbsp;Resit Yigit Yilancioglu MD,&nbsp;Umut Inevi BSc,&nbsp;Sercan Karaoglan MD,&nbsp;Emin Evren Ozcan MD PhD","doi":"10.1016/j.jelectrocard.2026.154361","DOIUrl":"10.1016/j.jelectrocard.2026.154361","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background and aims&lt;/h3&gt;&lt;div&gt;The precise preprocedural localization of outflow tract premature ventricular contractions (OT-PVCs) remain essential yet challenging, owing to the region's complex and variable anatomy, particularly for left-sided origins. Although numerous electrocardiographic localization algorithms have been proposed, most are constrained by a trade-off between diagnostic accuracy and clinical practicality. QRS notching is a frequently observed but largely overlooked feature in OT-PVCs, and it remains understudied in the context of idiopathic ventricular arrhythmias. This study aims to move beyond a simple analysis of notch distribution across leads by leveraging QRS notching as a functional marker of ventricular activation to enhance site of origin localization.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This retrospective observational study included 105 patients who underwent successful catheter ablation for symptomatic OT-PVCs. The cohort consisted of 57 right ventricular outflow tract (RVOT) and 48 left ventricular outflow tract (LVOT) PVCs. All PVCs exhibited a left bundle branch block morphology with an inferior axis, defined by a dominant R-wave in the inferior leads and a QS complex in leads aVL and aVR. Furthermore, each PVC demonstrated a single, reproducible notch with a duration of ≤20 ms. Notch Timing (NT) was defined as the interval from the earliest onset of the global PVC QRS complex to the nadir of the identifiable notch. When notches were asynchronous across the 12 leads, the timing of the latest-occurring notch was recorded for analysis. The diagnostic performance of the NT criterion for differentiating RVOT from LVOT origins was evaluated and compared against the V2S/V3R index using receiver operating characteristic (ROC) curve analysis, with the area under the curve (AUC) serving as the primary metric of comparison.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of 105 patients (45.6 ± 13.4 years, 55% male), 57 had RVOT and 48 had LVOT PVCs. NT robustly differentiated origins, with RVOT PVCs demonstrating significantly later notches than LVOT PVCs (94.3 ± 15.0 ms vs. 74.5 ± 15.6 ms, &lt;em&gt;p&lt;/em&gt; &lt; 0.001). An NT &gt;80 ms favored an RVOT origin with 87.7% sensitivity and 68.8% specificity (PPV = 76,9%, NPV = 78,1%, AUC 0.838). The diagnostic performance of NT was comparable to the established V2S/V3R index (AUC 0.828). Characteristic lead distribution patterns augmented localization, though extensive notching across both the inferior and lateral precordial leads was not specific for a free-wall RVOT origin.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;This study introduces the first structured framework for QRS notch analysis—defining its characteristics, timing, and distribution—to improve arrhythmia localization. This represents a shift from descriptive morphology to mechanistic interpretation, where a novel notch timing metric robustly discriminates RVOT from LVOT origins by quantifying delayed transeptal conduction.&lt;","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"96 ","pages":"Article 154361"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147972993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}