Journal of electrocardiology最新文献

{"title":"Traces of cardioprotection behind the uncertainty of the de winter pattern","authors":"Malekrah Alireza ,&nbsp;Asgary Nader ,&nbsp;Fattahian Alireza ,&nbsp;Bagheri Babak ,&nbsp;Ghoreishi Bahare","doi":"10.1016/j.jelectrocard.2025.154056","DOIUrl":"10.1016/j.jelectrocard.2025.154056","url":null,"abstract":"<div><h3>Introduction</h3><div>Although de Winter syndrome is equivalent to STEMI, the cause of ST depression rather than ST elevation is still unknown. This study aimed to investigate the mechanisms underlying the de Winter pattern by comparing ECG and imaging findings between patients exhibiting this pattern and those with typical anterior STEMI.</div></div><div><h3>Methods</h3><div>This study was conducted from January 2019 to December 2022 on 967 patients diagnosed with anterior MI. 30 patients were diagnosed with the de Winter pattern, and each patient was matched with 4 patients in the anterior STEMI group. Patients underwent primary PCI, and their characteristics were examined in two groups.</div></div><div><h3>Results</h3><div>Approximately 3 % of patients with anterior MI showed a de Winter pattern. 67 % of the cases in the de Winter group and 62 % in the control group were male (<em>P</em>-value = 0.6). Multivessel disease was more prevalent in de Winter patients (60 % vs. 38 %; <em>P</em>-value = 0.03). Well-developed collaterals were present in 20 % of de Winter cases and 26 % of AMI (<em>P</em>-value = 0.5). There was no significant difference in the wall motion score index between the two groups(1.9 de Winter vs. 1.97 AMI; P-value = 0.3).Malignant arrhythmias (7 % vs. 27 %; P-value = 0.01) and in-hospital mortality (3 % vs. 18 %; P-value = 0.04) occurred less frequently in de Winter patients.</div></div><div><h3>Conclusion</h3><div>Based on the indirect evidence of the more extensive occurrence of non-lethal ischemia in the de Winter group, along with the better outcomes in these patients, we can consider preconditioning as a possible underlying cause of the de Winter ECG pattern.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"92 ","pages":"Article 154056"},"PeriodicalIF":1.3,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144563469","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":"Mobile health apps for QT interval measurement: A systematic review","authors":"Fabian A. Chavez-Ecos ,&nbsp;Leonardo J. Uribe-Cavero ,&nbsp;Rodrigo Chavez-Ecos ,&nbsp;Sebastián Arias-Arias ,&nbsp;Miguel A. Chavez-Gutarra ,&nbsp;Renee Montesinos-Segura ,&nbsp;Kiara Camacho-Caballero","doi":"10.1016/j.jelectrocard.2025.154041","DOIUrl":"10.1016/j.jelectrocard.2025.154041","url":null,"abstract":"<div><h3>Background</h3><div>The QT interval, which reflects ventricular electrical activity, is a key marker for assessing the risk of life-threatening ventricular arrhythmias and sudden cardiac death. Mobile health applications (mHAs) have recently been developed to facilitate QTc measurement; however, these apps show considerable variation in quality and functionality, and many need clinical validation.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and evaluated QTc-focused mHAs across Apple iOS, Google Play, and Microsoft Store. Eligible apps that incorporated validated QTc correction formulas, such as Bazett, Fridericia, or Framingham, were available in English or Spanish. Quality and functionality were assessed using the Mobile App Rating Scale (MARS) and IMS criteria.</div></div><div><h3>Results</h3><div>Of the 88 initially identified apps, 12 met the inclusion criteria. The highest MARS and functionality scores were achieved by “EP QTc by EP Studios,” noted for its range of QTc correction formulas, followed by “QTc-Calculator by Marian Stiehler.” Overall, apps showed significant variability in quality, indicating a lack of standardized features across platforms.</div></div><div><h3>Conclusion</h3><div>This review highlights the variability in QTc-focused mHAs and the need for rigorous evaluation. Although these apps could enhance arrhythmia monitoring, few meet the standards necessary for clinical practice, emphasizing the importance of validation before integration into healthcare settings.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"92 ","pages":"Article 154041"},"PeriodicalIF":1.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144570814","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":"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}