Journal of electrocardiology最新文献

{"title":"Alternating bundle branch block with alternating PR interval","authors":"Sudipta Mondal (MD, DM, PDF-EP),&nbsp;Anubhav Chatterjee (MBBS),&nbsp;Tapan Kr Matia (MD, DrNB),&nbsp;Nadeem Afroz Muslim (MD, DM)","doi":"10.1016/j.jelectrocard.2025.154108","DOIUrl":"10.1016/j.jelectrocard.2025.154108","url":null,"abstract":"<div><div>A sexagenarian man presented to the emergency department with one episode of syncope. The electrocardiogram (ECG) revealed an alternating bundle branch block with alternating PR interval. Cardiac biomarkers were negative, and the echocardiogram revealed a structurally normal heart. What is the mechanism?</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154108"},"PeriodicalIF":1.2,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145046527","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":"Interatrial block predicts left atrial appendage thrombus in nonvalvular atrial fibrillation","authors":"Elmas Kaplan MD ,&nbsp;Firdevs Aysenur Ekizler MD ,&nbsp;Halenur Saribas MD ,&nbsp;Omac Tufekcioglu MD","doi":"10.1016/j.jelectrocard.2025.154112","DOIUrl":"10.1016/j.jelectrocard.2025.154112","url":null,"abstract":"<div><h3>Background</h3><div>Interatrial block (IAB) is an electrocardiographic manifestation of atrial conduction delay and structural remodeling. While it has been linked to atrial fibrillation (AF) and thromboembolic events, its potential role in predicting left atrial appendage (LAA) thrombus formation remains underexplored. This study aimed to investigate the association between IAB and the presence of LAA thrombus in patients with nonvalvular AF (NVAF) or atrial flutter referred for rhythm control procedures.</div></div><div><h3>Methods</h3><div>In this retrospective observational study, 750 patients with NVAF who underwent transesophageal echocardiography (TEE) prior to catheter ablation or cardioversion were evaluated. P-wave parameters were measured from digitally amplified 12‑lead ECGs, and IAB was defined according to current consensus criteria. Patients were stratified by the presence of LAA thrombus, and multivariate logistic regression was used to identify independent predictors.</div></div><div><h3>Results</h3><div>LAA thrombus was detected in 10.8 % of patients. Those with thrombus were older and had higher thromboembolic risk scores, more frequent history of stroke, and lower left ventricular ejection fraction (LVEF). Interatrial block was observed in 85.2 % and advanced IAB in 44.4 % of patients with thrombus. In multivariate analysis, IAB (OR: 2.698; <em>p</em> = 0.008), larger LA diameter, lower LVEF, and greater P-wave dispersion were independently associated with thrombus presence.</div></div><div><h3>Conclusion</h3><div>IAB is independently associated with LAA thrombus in NVAF patients and may serve as a noninvasive marker to identify individuals at higher thromboembolic risk, potentially guiding the need for TEE before rhythm control.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154112"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144997606","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":"A case of diagnostic challenge: Wide QRS complex tachycardia caused by rare etiologies.","authors":"Lifang Xu, Honglin Ni, Zhicheng Gao, Xianchao Sun","doi":"10.1016/j.jelectrocard.2025.154095","DOIUrl":"10.1016/j.jelectrocard.2025.154095","url":null,"abstract":"<p><p>Rapid atrioventricular nodal non-reentrant tachycardia (DAVNNT) with intraventricular differential conduction-induced wide QRS tachycardia (WCT) is often misdiagnosed as ventricular tachycardia (VT) due to its distinctive atrioventricular conduction characteristics, making timely and accurate diagnosis and treatment challenging. This case report describes a 42-year-old female patient who presented with recurrent palpitations, with a dynamic electrocardiogram documenting a WCT that mimicked VT. Esophageal electrophysiological studies revealed a 1:2 atrioventricular conduction pattern. Intracardiac electrophysiological examination confirmed the diagnosis of DAVNNT, which was successfully treated with radiofrequency ablation. This case highlights that WCT with fewer P waves than QRS complexes can occur in DAVNNT, similar to VT. By logical inference a 1:2 atrioventricular conduction pattern, together with suspected interpolated ventricular or junctional premature contractions exhibiting variable QRS morphology, may serve as key diagnostic clues for DAVNNT.</p>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"92 ","pages":"154095"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804238","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":"Utility of the surface electrocardiogram RP interval cutoff for diagnosis of atrioventricular nodal reentrant tachycardia.","authors":"Nan Shi, Iris Liu, George Klein, Pavel Antiperovitch","doi":"10.1016/j.jelectrocard.2025.154094","DOIUrl":"10.1016/j.jelectrocard.2025.154094","url":null,"abstract":"<p><p>Slow-fast or typical atrioventricular nodal reentrant tachycardia (AVNRT) is the most common cause of paroxysmal supraventricular tachycardia (SVT). A surface electrocardiogram (ECG) V1 RP interval of less than or equal to 90 ms has been cited as an upper cut-off for maximum RP observed in AVNRT. This criterion was defined using ventriculoatrial (VA) time measured from intracardiac electrograms (EGMs), namely the interval from the onset of QRS to the rapid deflection of the atrial electrogram at the high right atrial (HRA) electrode. Specifically, this was considered at the limit of the shortest one can observe in atrioventricular reentrant tachycardia (AVRT), hence indicating a diagnosis of AVNRT. In this study, we analyzed surface ECGs during tachycardia onset from 200 electrophysiology study (EPS)-confirmed cases of SVT, of which 142 (71 %) were diagnosed as AVNRT. We report that an RP interval ≤ 90 ms demonstrated improved diagnostic performance over ≤70 ms cutoff (≤90 ms: sensitivity of 97.2 % [95 % CI: 93.0-99.2] and specificity of 96.6 % [95 % CI: 88.1-99.6]; ≤70 ms: sensitivity 81.7 % [95 % CI: 74.3-87.7], specificity 98.3 % [95 % CI: 90.8-99.9]). Using a 90 ms RP threshold would reduce the false negative rate from 13 % to 2 %, potentially improving the accuracy of surface ECG-based SVT diagnosis. Overall, our findings support the use of ECG V1 RP ≤ 90 ms cutoff as a diagnostic marker of typical AVNRT.</p>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"92 ","pages":"154094"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816762","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":"U wave manifesting in alternating beats: The bigeminal U wave.","authors":"Francesco Luzza, Francesco Catanzariti, Michela Navarra, Pietro Pugliatti","doi":"10.1016/j.jelectrocard.2025.154092","DOIUrl":"10.1016/j.jelectrocard.2025.154092","url":null,"abstract":"<p><p>The U wave is a deflection of the electrocardiogram whose genesis and clinical significance are yet unclear. It usually appears at the end of each ventricular complex in a selected lead. This study presents a unique case where the U wave appeared exclusively in beat-to-beat alternating cardiac cycles, so as to give rise to a pattern of \" bigeminal U wave\". Moreover, the presence of the U wave appeared to be related to the previous duration of the cardiac cycle correlating with lengthening of the cardiac cycle, while it did occur after shortening of the cardiac cycle. We can hypothesize that prolonged action potentials in ventricular M cells might contribute to this phenomenon.</p>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"92 ","pages":"154092"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804239","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":"Electrocardiographic P-wave peak time predicts significant ischemia in INOCA patients: A pilot study","authors":"Muhammet Salih Ateş ,&nbsp;Erdoğan Sökmen","doi":"10.1016/j.jelectrocard.2025.154105","DOIUrl":"10.1016/j.jelectrocard.2025.154105","url":null,"abstract":"<div><h3>Background</h3><div>Ischemia with non-obstructive coronary arteries (INOCA) represents a diagnostic and therapeutic challenge, often related to coronary microvascular dysfunction (CMD). Identifying non-invasive electrocardiographic markers that predict ischemia in this population remains a clinical priority. P-wave peak time (PWPT), reflecting atrial conduction delay, has been linked to ischemic pathophysiology.</div></div><div><h3>Methods</h3><div>This retrospective, observational study included 444 patients who underwent coronary angiography with normal epicardial arteries followed by SPECT myocardial perfusion imaging (MPI) due to persistent anginal symptoms. Patients were classified into three groups based on the percentage of reversible left ventricular ischemia: &lt;5 %, 5–10 %, and &gt; 10 %. P-wave indices—including PWPT in leads DII and V1—were measured digitally by two independent observers. Multivariate logistic regression identified independent predictors of &gt;10 % ischemia. ROC analysis assessed the discriminative power of PWPT.</div></div><div><h3>Results</h3><div>PWPT-DII and PWPT-V1 were significantly prolonged in patients with &gt;10 % ischemia (63 ± 8 ms and 58 ± 9 ms, respectively) compared to patients with &lt;5 % ischemia (55 ± 7 ms and 50 ± 8 ms; both <em>p</em> &lt; 0.001). PWPT-DII yielded an AUC of 0.82 (95 % CI 0.77–0.86), outperforming PWPT-V1 (AUC 0.76). In multivariate models, PWPT-DII (OR 1.15, 95 % CI 1.08–1.23), PWPT-V1 (OR 1.10, 95 % CI 1.03–1.17), age, diabetes mellitus, and E/e' ratio emerged as independent predictors of significant ischemia.</div></div><div><h3>Conclusions</h3><div>Prolonged PWPT, particularly in lead DII, was observed to be independently associated with myocardial ischemia in INOCA. Incorporating PWPT into standard ECG interpretation may aid in risk stratification and early identification of CMD in patients with normal coronary angiograms but ongoing ischemic symptoms.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"92 ","pages":"Article 154105"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008301","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":"Clinically useful evaluation of reconstruction techniques and use of Einthoven's Law.","authors":"Jonas L Isaksen, Dominik Linz, Jørgen K Kanters","doi":"10.1016/j.jelectrocard.2025.154090","DOIUrl":"10.1016/j.jelectrocard.2025.154090","url":null,"abstract":"","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"92 ","pages":"154090"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812033","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":"An elderly woman with bradycardia and progressive repolarization abnormalities","authors":"Kapil Rajendran ,&nbsp;Arun Jude Alphonse ,&nbsp;Vinayakumar Desabandhu","doi":"10.1016/j.jelectrocard.2025.154109","DOIUrl":"10.1016/j.jelectrocard.2025.154109","url":null,"abstract":"<div><div>We report an elderly woman who presented with cardiac arrest due to complete heart block. She developed progressive T-wave inversions in leads V3–V6 due to pacinginduced cardiac memory, accompanied by marked QTc prolongation. These repolarization abnormalities occurred despite normal electrolytes and non-obstructive coronary angiography and culminated in polymorphic ventricular tachycardia. This case highlights cardiac memory as an underrecognized proarrhythmic substrate in bradyarrhythmia and the importance of serial ECG monitoring to detect evolving repolarization changes and mitigate arrhythmic risk.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154109"},"PeriodicalIF":1.2,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933788","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 hypertrophy in the automatic electrocardiogram report and mortality risk","authors":"Gabriela Miana Paixão MD,PhD ,&nbsp;Nathalia Coelho de Castro Nunes MD, MSc ,&nbsp;Milena Soriano Marcolino MD, PhD ,&nbsp;Emilly Malveira MSc ,&nbsp;Paulo Rodrigues Gomes MSc ,&nbsp;Peter W. Macfarlane DSc, FRCP ,&nbsp;Antonio Luiz Pinho Ribeiro MD, PhD","doi":"10.1016/j.jelectrocard.2025.154107","DOIUrl":"10.1016/j.jelectrocard.2025.154107","url":null,"abstract":"<div><h3>Introduction</h3><div>Left ventricular hypertrophy (LVH) is associated with complex structural changes in the myocardium, which may alter the electrocardiogram (ECG). The ECG is the initial test for patients with suspected heart disease. Electrocardiographic criteria for LVH diagnosis have a low sensitivity compared to the echocardiogram (ECHO). The advent of tele-ECG and the availability of automatic analysis systems have made the large-scale use of electrocardiography possible. However, there are only a few studies on the prevalence and prognosis of LVH automatically detected in the ECG.</div></div><div><h3>Objective</h3><div>To evaluate the association between the Glasgow program score for LVH in the ECG and overall mortality in an electronic cohort of primary care patients in Brazil.</div></div><div><h3>Methods</h3><div>Patients from the CODE (Clinical Outcomes in Digital Electrocardiology) cohort, older than 18 years, who underwent digital ECG recording from 2010 to 2017, were included. The University of Glasgow Automated ECG Interpretation program was used to analyze the ECGs. ECG LVH was classified into definite LVH if the LVH-Glasgow score was≥6.3, probable LVH if the score was between 5.0 and 6.3, possible LVH if the score was between 4.0 and 5.0, and no LVH if the score was &lt;4.0. To assess the relationship between the LVH-Glasgow score and mortality, Cox regression adjusted for age, sex, and comorbidities was used.</div></div><div><h3>Results</h3><div>The CODE database included 1,558,415 patients, with 1,389,331 patients over 18 years old. Technically unsatisfactory ECGs that could compromise the analysis were excluded. The Glasgow program automatically excludes the diagnosis of LVH if LBBB, WPW, or pacemaker rhythm have been detected before the tests for LVH are undertaken. The prevalence of an abnormal LVH-Glasgow score (≥4.0) was 18.5 %. At a median follow-up of 3.47 years, the general population's all-cause mortality rate was 2.68 %. After multivariate adjustment, the presence of definite LVH had a higher risk of overall mortality (95 % CI; HR 1.64 (1.59–1.69)); probable LVH (95 % CI; HR 1.18 (1. 14-1.23)) and possible LVH (95 % CI; HR 1.09 (1.05–1.13)) were also associated with increasing risk of death.</div></div><div><h3>Conclusions</h3><div>The LVH-Glasgow score can be a prognostic tool in ECG analysis. In this population, a higher score was associated with a higher risk of overall mortality.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154107"},"PeriodicalIF":1.2,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144997607","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":"Evaluation of Tp-e interval, Tp-e/QT and Tp-e/QTc ratios in patients with hypertensive crisis","authors":"Mesut Tomakin ,&nbsp;Ali Aygun ,&nbsp;Ibrahim Caltekin ,&nbsp;Adem Koksal ,&nbsp;Rahime Sahin Turan ,&nbsp;Mehmet Seyfettin Sarıbas","doi":"10.1016/j.jelectrocard.2025.154097","DOIUrl":"10.1016/j.jelectrocard.2025.154097","url":null,"abstract":"<div><h3>Background</h3><div>Hypertensive crisis (HC) is recognized as a contributing factor in the development of cardiac arrhythmias. This study aims to assess Tp-e interval, Tp-e/QT (TQR), and Tp-e/QTc (TQcR) ratios in patients experiencing hypertensive urgency and emergency, in order to evaluate the potential risk of ventricular arrhythmias.</div></div><div><h3>Methods</h3><div>A prospective study was conducted involving HC patients admitted to a tertiary hospital's emergency department between June 1, 2022, and June 30, 2024. Patients were categorized into three groups: hypertensive emergency, hypertensive urgency, and control group. Data collected included demographic characteristics, vital signs, laboratory results, and electrocardiography (ECG) parameters such as Tp-e interval, TQR, and TQcR.</div></div><div><h3>Results</h3><div>Among the 235 eligible patients, 57 % were female and 43 % male. The hypertensive urgency group included 130 patients, the emergency group 45, and the control group 60. Statistically significant differences in Tp-e, TQR, and TQcR values were observed across all groups (<em>p</em> &lt; 0.001). These metrics demonstrated moderate positive correlations with both systolic and diastolic blood pressures.</div></div><div><h3>Conclusion</h3><div>Increased Tp-e, TQR, and TQcR values identified in HC patients suggest a heightened risk for ventricular arrhythmias. These findings support the routine evaluation of these ECG.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154097"},"PeriodicalIF":1.2,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989804","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}