Journal of electrocardiology最新文献

{"title":"First electrocardiographic documentation of alternating bilateral block in pulmonary embolism","authors":"Santiago Obregón-Rosas M.D. ,&nbsp;Jessica Michelle Flores-Guerra M.D. ,&nbsp;Ángel Antonio Montañez-Aguirre M.D. ,&nbsp;Pedro Iturralde-Torres M.D. ,&nbsp;Karina del Valle Zamora M.D.","doi":"10.1016/j.jelectrocard.2025.154057","DOIUrl":"10.1016/j.jelectrocard.2025.154057","url":null,"abstract":"<div><div>Massive pulmonary embolism (PE) classically produces sinus tachycardia or right bundle-branch block (RBBB). We report a 46-year-old woman whose initial electrocardiogram showed simultaneous left and right anterior fascicular block—the first description of bilateral anterior fascicular block. Days later the tracing converted to complete RBBB with left posterior fascicular block (LPFB), a recognised bilateral pattern, documenting the first alternation from bilateral anterior fascicular block to the RBBB + LPFB combination. This sequence suggests diffuse, pressure-induced His–Purkinje injury and may herald haemodynamic collapse; the patient died intra-operatively. Alternating bilateral fascicular patterns could serve as early electrocardiographic warnings in massive PE.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"92 ","pages":"Article 154057"},"PeriodicalIF":1.3,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144489406","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":"Title: “Angular blind spots: Methodological gaps in ECG risk stratification for graves' disease”","authors":"Muhammad Khubaib Iftikhar,&nbsp;Qurat ul ain Iftikhar,&nbsp;Muhammad Hamza","doi":"10.1016/j.jelectrocard.2025.154055","DOIUrl":"10.1016/j.jelectrocard.2025.154055","url":null,"abstract":"","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"91 ","pages":"Article 154055"},"PeriodicalIF":1.3,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144479983","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":"What is the response seen during Para-Hisian pacing?","authors":"Idriz Merovci MD ,&nbsp;Ozcan Ozeke MD ,&nbsp;Dursun Aras MD ,&nbsp;Serkan Topaloglu MD","doi":"10.1016/j.jelectrocard.2025.154044","DOIUrl":"10.1016/j.jelectrocard.2025.154044","url":null,"abstract":"<div><div>The parahisian pacing (PHP) is a key diagnostic maneuver in cardiac electrophysiology, particularly for differentiating retrograde conduction via the atrioventricular node from conduction through a septal accessory pathway. While conceptually straightforward, parahisian pacing interpretation requires detailed understanding of conduction physiology and awareness of potential pitfalls. This case illustrates the diagnostic utility and interpretive complexity of parahisian pacing.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"92 ","pages":"Article 154044"},"PeriodicalIF":1.3,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144489405","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":"Atriofascicular pathway in Ebstein's anomaly: Revisiting the role of preoperative EP studies in pediatrics","authors":"Brock A. Karolcik MD,&nbsp;Lee B. Beerman MD,&nbsp;Christopher W. Follansbee MD,&nbsp;Gaurav Arora MD","doi":"10.1016/j.jelectrocard.2025.154053","DOIUrl":"10.1016/j.jelectrocard.2025.154053","url":null,"abstract":"<div><div>We present a case of a 6-year-old with Ebstein's anomaly (EA) who was found to have a right lateral decremental, antegrade only accessory pathway (AP), presumed atriofascicular AP, during a pre-operative electrophysiology study (EPS) prior to da Silva Cone repair (CR). Atriofascicular APs represent &lt;3 % of APs but have an association with EA. To the best of our knowledge, this is the youngest reported case of EA with an atriofascicular AP. Providers should be aware of this possibility, as CRs are being done at younger ages, and they may be discovered in asymptomatic patients.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"92 ","pages":"Article 154053"},"PeriodicalIF":1.3,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144314320","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":"Another single frontal lead ST-segment elevation pattern in a patient with lateral myocardial infarction: A reverse Aslanger mechanism?","authors":"Emre K. Aslanger ,&nbsp;Fatma Ekici","doi":"10.1016/j.jelectrocard.2025.154054","DOIUrl":"10.1016/j.jelectrocard.2025.154054","url":null,"abstract":"<div><div>The standard ST-elevation (STE) myocardial infarction (MI) criteria require STE in at least two contiguous leads. While this rule enhances specificity, it can reduce sensitivity and may delay recognition of clinically significant infarction patterns. We present a patient with lateral myocardial infarction in whom the initial electrocardiogram (ECG) showed STE confined to a single lead, aVL, not meeting the two‑lead requirement. Coronary angiography revealed multivessel disease with a culprit lesion in the left circumflex artery, successfully treated with percutaneous coronary intervention. This case illustrates a variant of the previously described Aslanger's pattern, with a reverse mechanism, where the ST-vector of lateral infarction is shifted by coexistent subendocardial ischemia, projecting solely onto lead aVL. Recognition of such single‑lead STE patterns is critical for timely diagnosis and treatment. Our findings support a flexible, pathophysiology-based approach to ECG interpretation, as emphasized by the emerging occlusion MI paradigm.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"92 ","pages":"Article 154054"},"PeriodicalIF":1.3,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144307065","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":"Electrocardiogram abnormalities in left bundle branch block and out-of-hospital cardiac arrest","authors":"Niels Saaby Hald MD ,&nbsp;Johannes Riis MD ,&nbsp;Signe Riddersholm MD, PhD ,&nbsp;Troels Yding Pedersen ,&nbsp;Mikkel Porsborg Andersen PhD, MSc ,&nbsp;Claus Graff Msc, PhD ,&nbsp;Christian Torp-Pedersen MD, D.M.Sc ,&nbsp;Peter Søgaard MD, PhD ,&nbsp;Kristian Kragholm MD, PhD ,&nbsp;Christoffer Polcwiartek MD, PhD ,&nbsp;Marc Meller Søndergaard MD","doi":"10.1016/j.jelectrocard.2025.154049","DOIUrl":"10.1016/j.jelectrocard.2025.154049","url":null,"abstract":"<div><h3>Background</h3><div>Left bundle branch block (LBBB) can be a marker of cardiovascular risk. This study investigates how electrocardiogram (ECG) measurements can be utilized in risk stratification of LBBB patients.</div></div><div><h3>Methods</h3><div>Using registry data from the Copenhagen General Practitioners Laboratory, first-time LBBB ECGs were identified from 2001 to 2015. Different ECG parameters were extracted including P-wave duration, PR interval, QRS duration, QRS area, QTc, JTc intervals and heart rate. Data were stratified according to the median values of these parameters (below vs above). The outcome was out-of-hospital cardiac arrest (OHCA), and the crude 5-year risk of OHCA was calculated for each subgroup. Multivariable Cox proportional hazards regression was employed to assess associations of ECG parameters with OHCA.</div></div><div><h3>Results</h3><div>We identified 4644 patients with incident LBBB contributing to a combined 35,113 person-years follow-up (median age 75 [25th - 75th percentiles 66–83] years; male sex, 62 %). Over the study period, all-cause mortality was 50 % and 4 % reached the primary outcome. The crude 5-year risk of OHCA revealed significant associations for QRS duration &gt;150 ms (<em>p</em> = 0.01) and JTc duration &gt;317 ms (<em>p</em> = 0.03). Multivariable analysis showed a higher hazard ratio (HR) for OHCA associated with QRS duration &gt;150 ms (HR 1.41 [95 % CI 1.06–1.88]), QTc duration &gt;464 ms (HR 1.43 [95 % CI 1.08–1.90]), JTc duration &gt;317 ms (HR 1.50 [95 % CI 1.13–2.00]) and heart rate &gt; 72/min (HR 1.48 [95 % CI 1.12–1.97]).</div></div><div><h3>Conclusion</h3><div>This study provides insights into associations between specific ECG parameters and the risk of OHCA in patients with LBBB. This holds the potential for risk stratification and targeted intervention in this population, and individuals with LBBB and these specific ECG abnormalities might benefit from earlier referral to investigation by specialists.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"92 ","pages":"Article 154049"},"PeriodicalIF":1.3,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144329610","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":"Case report: Masked premature ventricular contractions and Intradevice interaction causing ventricular Arrythmias","authors":"Aravinthan Vignarajah MD ,&nbsp;Jose Aguilera MD ,&nbsp;Justin Z. Lee MD","doi":"10.1016/j.jelectrocard.2025.154051","DOIUrl":"10.1016/j.jelectrocard.2025.154051","url":null,"abstract":"<div><div>An implantable cardioverter-defibrillator (ICD) intended to prevent malignant arrhythmias can, in rare cases, precipitate them. We report a 44-year-old man with cardiac sarcoidosis who suffered recurrent polymorphic ventricular tachycardia (VT) and ventricular fibrillation (VF) due to an intradevice timing interaction. Premature ventricular contractions (PVCs) fell within the ICD's post–atrial pacing ventricular blanking period and went undetected (“masked”), resulting in ventricular pacing during the vulnerable period (R-on-T), which triggered VT/VF. Reprogramming the device from DDD to VVI mode prevented further arrhythmias. This case highlights the importance of individualized ICD programming to avoid device-induced arrhythmias.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"92 ","pages":"Article 154051"},"PeriodicalIF":1.3,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144296868","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":"Left ventricular systolic dysfunction screening in muscular dystrophies using deep learning-based electrocardiogram interpretation","authors":"Bauke K.O. Arends ,&nbsp;Peter-Paul M. Zwetsloot ,&nbsp;Pauline S. Heeres ,&nbsp;Wouter A.C. van Amsterdam ,&nbsp;Maarten J. Cramer ,&nbsp;Esther T. Kruitwagen - van Reenen ,&nbsp;Pim van der Harst ,&nbsp;Dirk van Osch ,&nbsp;René van Es","doi":"10.1016/j.jelectrocard.2025.154048","DOIUrl":"10.1016/j.jelectrocard.2025.154048","url":null,"abstract":"<div><h3>Background</h3><div>Routine echocardiographic monitoring is recommended in muscular dystrophy patients to detect left ventricular systolic dysfunction (LVSD) but is often challenging due to physical limitations. This study evaluates whether artificial intelligence-based electrocardiogram interpretation (AI-ECG) can detect and predict LVSD in muscular dystrophy patients.</div></div><div><h3>Methods</h3><div>Patients aged &gt;16 years who underwent an ECG and echocardiogram within 90 days at the University Medical Center Utrecht were included. Patients with Duchenne (DMD), Becker (BMD), limb-girdle muscular dystrophy (LGMD). myotonic dystrophy (MD), and female DMD/BMD carriers, were identified. A convolutional neural network (CNN) was trained on a derivation cohort of patients without muscular dystrophy to detect LVSD and tested on muscular dystrophy patients. A Cox proportional hazards model assessed AI-ECG's predictive value for new-onset LVSD.</div></div><div><h3>Results</h3><div>The derivation cohort included 53,874 ECG-echocardiogram pairs from 30,978 patients, while the muscular dystrophy test set comprised 390 ECG-echo pairs from 390 patients. LVSD prevalence varied from 81.3 % in DMD to 13.4 % in MD. The model achieved an AUROC of 0.83 (0.79–0.87) in the muscular dystrophy test set, with sensitivity 0.87 (0.81–0.93), specificity 0.58 (0.52–0.63), NPV 0.91 (0.86–0.95), and PPV 0.49 (0.43–0.56). AI-ECG predicted new-onset LVSD with an AUROC of 0.72 (0.66–0.78), with AI-ECG probability being a significant predictor.</div></div><div><h3>Conclusions</h3><div>AI-ECG can detect LVSD in muscular dystrophy patients, offering a non-invasive, accessible tool for risk stratification and an alternative to routine echocardiography. It may also predict new-onset LVSD, enabling earlier intervention. Further research should explore external validation, pediatric application, and integration within the clinical care plan.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"92 ","pages":"Article 154048"},"PeriodicalIF":1.3,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144297352","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":"Isolated atrial myopathy and persistent severe cardiac conduction disorders presented as juvenile stroke: A case report","authors":"Zahra Oskoueian,&nbsp;Alireza Heidari-Bakavoli,&nbsp;Vafa Baradaran Rahimi,&nbsp;Zohreh Mahmoodi,&nbsp;Asal Yadollahi","doi":"10.1016/j.jelectrocard.2025.154050","DOIUrl":"10.1016/j.jelectrocard.2025.154050","url":null,"abstract":"<div><div>Myocarditis can be complicated by various conduction abnormalities, including supraventricular and ventricular arrhythmias. It is rare to see conduction disorders as the first and only presentation of myocarditis, which may be reversible or persistent after the acute phase of myocarditis. Here, we present a case of probable myocarditis with preserved right and left ventricular function, isolated atrial cardiomyopathy, and severe conductive disturbances, including sinoatrial node dysfunction, atrial flutter, interatrial block, transient loss of atrial electromechanical activity and persistent complete atrioventricular block in a young woman presented with acute stroke.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"92 ","pages":"Article 154050"},"PeriodicalIF":1.3,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144472366","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":"Elevated frontal QRS-T angle as a predictor of cardiovascular risk in graves' disease: A comparative study","authors":"Zhen Wang ,&nbsp;Jia Xu ,&nbsp;Ting-ting Fan ,&nbsp;A. Juan Gong ,&nbsp;Meng-li Li ,&nbsp;Nin-jun Zhu ,&nbsp;Xiao-chen Wang","doi":"10.1016/j.jelectrocard.2025.154040","DOIUrl":"10.1016/j.jelectrocard.2025.154040","url":null,"abstract":"<div><h3>Backgrounds</h3><div>Graves' disease (GD) is linked to cardiovascular complications, but reliable non-invasive predictors are limited. This study aimed to assess whether the frontal QRS-T (fQRS-T) angle could predict mortality and cardiovascular outcomes in GD patients.</div></div><div><h3>Methods</h3><div>Initially, we conducted a retrospective analysis of electrocardiogram (ECG) parameters from 291 GD patients compared with 96 healthy controls. GD patients were then categorized based on the presence of hyperthyroid heart disease. Using logistic regression, we identified predictors of cardiovascular outcomes. Subsequently, a retrospective cohort study followed 41 patients with an fQRS-T angle ≥90° and 162 controls over five years, assessing all-cause mortality, ventricular fibrillation (VF) and first hospitalization for heart failure (HF).</div></div><div><h3>Results</h3><div>Initial analysis showed that a significantly higher proportion of GD patients had an fQRS-T angle ≥90° compared to healthy controls (<em>p</em> &lt; 0.001). Among GD patients, those with hyperthyroid heart disease were more likely to have an fQRS-T angle ≥90° (p &lt; 0.001). Multivariate logistic regression analysis revealed that age, fQRS-T angle, thyroxine (T4), and platelet were independent predictors of hyperthyroid heart disease. In the cohort study, Kaplan-Meier analysis showed significant differences in all-cause mortality or VF (<em>p</em> &lt; 0.001) and first hospitalization for HF (p &lt; 0.001) between the groups. Multivariate Cox regression analyses shown QRS-T angle ≥90° significantly increased the risk of hospitalization for HF (HR 5.04, 95 % CI 2.59–9.81, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>An increased fQRS-T angle may be associated with elevated cardiovascular risk in patients with GD. These preliminary findings suggest that fQRS-T angle could serve as a hypothesis-generating marker for further prospective research.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"91 ","pages":"Article 154040"},"PeriodicalIF":1.3,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144308066","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}