Journal of electrocardiology最新文献

{"title":"Simple ECG features predict successful catheter ablation of idiopathic premature ventricular contractions with an inferior axis","authors":"Johanna Mueller-Leisse MD, MSc ,&nbsp;Giulia Syrbius ,&nbsp;Henrike Aenne Katrin Hillmann MD ,&nbsp;Joerg Eiringhaus MD ,&nbsp;Stephan Hohmann MD ,&nbsp;Christos Zormpas MD ,&nbsp;Nizar Karfoul MD ,&nbsp;David Duncker MD ,&nbsp;Christian Veltmann MD","doi":"10.1016/j.jelectrocard.2026.154366","DOIUrl":"10.1016/j.jelectrocard.2026.154366","url":null,"abstract":"<div><h3>Background</h3><div>Numerous algorithms predict the origin of idiopathic premature ventricular contractions (PVCs) with an inferior axis using the electrocardiogram (ECG), especially trying to differentiate between PVCs from the left and right ventricular outflow tract (LVOT and RVOT). Although evaluating the PVC origin goes along with evaluating risks and benefits of catheter ablation, this approach is complex for non-electrophysiology (EP) experts and shows limited reliability. As an additional strategy to guide decision-making, we sought to find simple ECG criteria that predict outcome of catheter ablation directly rather than origin.</div></div><div><h3>Methods</h3><div>Patients undergoing catheter ablation of idiopathic PVCs with an inferior axis at our center between 2012 and 2020 were included. Procedural data assessed included complete suppression of the PVC at the end of the procedure, ECG analysis included assessment of Q-, R-, and S-amplitudes, −durations and derived parameters.</div></div><div><h3>Results</h3><div>104 patients (54% male, 54 ± 17 years) were included. Overall ablation success was 81%. Two ECG features – a more leftward PVC axis in the limb leads and an earlier precordial transition in the chest leads - independently predicted ablation failure. Using ROC statistics, we suggest combining the following two criteria to predict ablation success with a positive predictive value of 95% with no major complications: (1) PVC axis ≥ 75° (lead III ≥ (neg) aVR) and (2) TZ-score &gt; 2 (V2 net negative, <em>p</em> &lt; 0.001). If either parameter was not met, success rate was only 60% and major complication rate was 7%. Considering the PVC origin underlying these findings, the two criteria were inversely associated with a parahisian and LV summit origin, while no differences in ablation success or procedural data were observed between RVOT and LVOT origins.</div></div><div><h3>Conclusion</h3><div>While catheter ablation of LVOT and RVOT PVCs show similarly high success rates, two simple ECG criteria based on PVC axis and precordial transition independently predict ablation outcome due to complex PVC foci. These should be considered when evaluating patients with idiopathic PVCs with an inferior axis for catheter ablation.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"96 ","pages":"Article 154366"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148015875","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":"Beyond STEMI and OMI: What does the ST segment really represent?","authors":"Mario J. Mc Loughlin MD","doi":"10.1016/j.jelectrocard.2026.154369","DOIUrl":"10.1016/j.jelectrocard.2026.154369","url":null,"abstract":"","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"96 ","pages":"Article 154369"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148054447","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":"Spatial QRS–T angle and quantified ischemia burden in ischemia with nonobstructive coronary arteries","authors":"Alp Yıldırım ,&nbsp;Muhammet Salih Ateş ,&nbsp;Erdoğan Sökmen","doi":"10.1016/j.jelectrocard.2026.154360","DOIUrl":"10.1016/j.jelectrocard.2026.154360","url":null,"abstract":"<div><h3>Background</h3><div>Ischemia with non-obstructive coronary arteries (INOCA) is increasingly recognized as a clinically relevant entity, yet effective risk stratification remains limited. The spatial QRS–T (sQRS–T) angle integrates global depolarization–repolarization heterogeneity and may reflect ischemic burden more accurately than conventional ECG markers.</div></div><div><h3>Methods</h3><div>This retrospective study included 1432 INOCA patients with reversible perfusion defects on myocardial perfusion scintigraphy (MPS) and no ≥50% epicardial stenosis on angiography. Ischemic burden was quantified as the percentage of left ventricular (LV) myocardium with reversible defects and categorized as &lt;5%, 5–10%, or &gt; 10%. Spatial and frontal QRS–T angles, QT dispersion (QTd), QTc, P-wave dispersion, Tpe interval, and Tpe/QTc ratio were measured on resting ECGs. Echocardiographic indices and routine laboratory markers were also recorded. Severe ischemia (&gt;10% LV) was the primary logistic regression outcome. Four hierarchical multivariable models incorporated ECG, clinical, echocardiographic, and laboratory parameters. ROC analyses with DeLong testing evaluated discrimination.</div></div><div><h3>Results</h3><div>Among 1432 patients, 52.4% had &lt;5% ischemia, 27.9% had 5–10%, and 19.7% had &gt;10%. The sQRS–T angle, QTd, Tpe, and Tpe/QTc increased stepwise across ischemia categories (all <em>p</em> &lt; 0.001). In multivariable models, the sQRS–T angle remained an independent predictor of severe ischemia (OR 1.27 per 10° increase, 95% CI 1.16–1.40; p &lt; 0.001). QTd and Tpe/QTc also retained significance, whereas frontal QRS–T angle, QTc, Tpe interval, and P-wave dispersion did not. The sQRS–T angle showed good discrimination (AUC 0.78), and a combined ECG model integrating sQRS–T angle, QTd, and Tpe/QTc improved performance (AUC 0.83; <em>p</em> = 0.008).</div></div><div><h3>Conclusion</h3><div>The sQRS–T angle is independently associated with MPS-derived ischemic burden in INOCA. A simple ECG-based model combining dispersion markers provides incremental discriminatory value and may help identify patients with a high ischemic burden who require closer follow-up.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"96 ","pages":"Article 154360"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147972967","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":"DeepECG.ai: An AI-enhanced ECG analysis platform to bridge the expertise gap from primary care to cardiology","authors":"Alexis Nolin-Lapalme ,&nbsp;Olivier Tastet ,&nbsp;Achille Sowa ,&nbsp;Jacques Delfrate ,&nbsp;Inès El Adib ,&nbsp;Julianne Morisset ,&nbsp;Ram Ahuja ,&nbsp;Rohan Banerjee ,&nbsp;Marie-Gabrielle Lessard ,&nbsp;Alain Vadeboncoeur ,&nbsp;Robert Avram","doi":"10.1016/j.jelectrocard.2026.154359","DOIUrl":"10.1016/j.jelectrocard.2026.154359","url":null,"abstract":"<div><h3>Background</h3><div>Despite numerous open-source deep learning models for ECG interpretation achieving expert-level performance, the field lacks integrated platforms for systematic model evaluation beyond standard accuracy metrics. Current implementations require substantial computational expertise and fail to assess critical translational aspects including interventional contexts, clinical workflow integration, and real-world robustness. DeepECG.ai addresses this gap by providing a unified platform for comprehensive model testing and deployment.</div></div><div><h3>Methods</h3><div>We developed DeepECG.ai, a web-based platform that integrates with existing clinical ECG systems to deliver AI-powered decision support within just a few clicks. The platform processes 12‑lead ECGs through AI models and delivers clinical recommendations based on the deployed model's focus. Two clinical studies leverage this system: DAISEA-ECG (ongoing), focused on comprehensive analysis in primary care, and HEART-AI (ongoing)<em>,</em> targeting structured cardiology screening.</div></div><div><h3>Results</h3><div>The platform successfully integrates electrophysiological systems across care settings. AI models for comprehensive ECG analysis and structural heart disease prediction are operational on a web-based, secure platform. Both clinical validation studies are active with completed user training and operational data collection infrastructure. Within the first three months of the HEART-AI study (since its launch in April 2025), 29,211 ECGs were analyzed, with inference times under one second per ECG. During this period, 53 users provided consent and actively participated, contributing to the enrollment of 285 patients.</div></div><div><h3>Conclusions</h3><div>We have successfully developed the DeepECG.ai platform that bridges expertise gaps across the healthcare continuum, delivering actionable decision support to both non-specialist and specialist users. This implementation lays a robust foundation for evaluating AI's impact on diagnostic accuracy, workflow efficiency, and patient outcomes.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"96 ","pages":"Article 154359"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147991279","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":"Prevalence and characteristics of normal electrocardiograms in hypertrophic cardiomyopathy","authors":"Arda Guler ,&nbsp;Busra Kuru Gorgulu ,&nbsp;Ozgur Surgit ,&nbsp;Ibrahim Halil Tanboga ,&nbsp;Irem Turkmen ,&nbsp;Sezgin Atmaca ,&nbsp;Hasan Sahin ,&nbsp;Mustafa Can Gundogdu ,&nbsp;Muayad Almasri ,&nbsp;Utku Yartasi ,&nbsp;Dilara Pay ,&nbsp;Gizemnur Coskun ,&nbsp;Dogukan Salduz ,&nbsp;Sinem Aydin ,&nbsp;Nail Guven Serbest ,&nbsp;Aysel Turkvatan Cansever ,&nbsp;Mehmet Karacan ,&nbsp;Gamze Babur Guler","doi":"10.1016/j.jelectrocard.2026.154363","DOIUrl":"10.1016/j.jelectrocard.2026.154363","url":null,"abstract":"<div><h3>Background</h3><div>Hypertrophic cardiomyopathy (HCM) is a genetic heart disease characterized by left ventricular hypertrophy (LVH) in the absence of other causes. More than 90% of patients exhibit abnormalities such as T wave inversion, Q waves, or LVH voltage criteria. However, a small subgroup with milder disease may present with a normal electrocardiogram (ECG), which can delay diagnosis. This study aimed to determine the prevalence and clinical characteristics of HCM patients with a normal ECG and their relationship with indicators of disease severity.</div></div><div><h3>Methods</h3><div>Patients diagnosed with HCM according to European Society of Cardiology (ESC) guideline criteria were retrospectively evaluated. Those with alternative causes of LVH or infiltrative/storage cardiomyopathies were excluded. Abnormal ECG was defined by the presence of atrial fibrillation, conduction block, pathological Q waves, repolarization changes, LVH voltage, low voltage, QTc &gt;460 ms, or QRS &gt;120 ms.</div></div><div><h3>Results</h3><div>Among 682 patients, 11 (1.6%) had completely normal ECGs. The most frequent abnormalities were repolarization changes (82.6%) and LVH voltage criteria (70.2%). Normal ECGs were associated with lower NT-proBNP, lower pulmonary artery pressudre, better right ventricular function, and less frequent late gadolinium enhancement on cardiac magnetic resonance imaging (CMR). The number of ECG abnormalities correlated positively with wall thickness, NT-proBNP, left atrial diameter, pulmonary pressures, and sudden cardiac death (SCD) risk score, but negatively with right ventricular functionand left ventricular ejection fraction.</div></div><div><h3>Conclusion</h3><div>A completely normal ECG was observed in only 1.6% of patients with hypertrophic cardiomyopathy. While a normal ECG substantially lowers the likelihood of HCM, it does not exclude the diagnosis. Despite advances in imaging, the ECG remains a simple, accessible, and indispensable screening tool for early detection.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"96 ","pages":"Article 154363"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147972942","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":"ECG Challenge: Unveiling an Unusual Wide Complex Rhythm","authors":"Nitya Panyala,&nbsp;Akrum Saleh,&nbsp;Harshil Patel","doi":"10.1016/j.jelectrocard.2026.154362","DOIUrl":"10.1016/j.jelectrocard.2026.154362","url":null,"abstract":"","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"96 ","pages":"Article 154362"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148015848","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":"Nightly sleep as a predictor of next-day arrhythmias in ambulatory adults","authors":"Lora Randa BA ,&nbsp;Catherine Lee PhD ,&nbsp;Jing Cheng MD, PhD ,&nbsp;Christina D. Fang MD ,&nbsp;David G. Rosenthal MD ,&nbsp;Emily Wilson BS ,&nbsp;Jeffrey E. Olgin MD ,&nbsp;Gregory M. Marcus MD, MAS","doi":"10.1016/j.jelectrocard.2026.154364","DOIUrl":"10.1016/j.jelectrocard.2026.154364","url":null,"abstract":"<div><h3>Background</h3><div>The frequency of cardiac ectopy, including premature atrial contractions (PACs), premature ventricular contractions (PVCs), non-sustained supraventricular tachycardia (SVT), and non-sustained ventricular tachycardia (NSVT), is clinically relevant, but modifiable risk factors remain poorly understood. Sleep quality influences the risk for atrial fibrillation, but whether sleep might predict the frequency of these even more common arrhythmias is unknown.</div></div><div><h3>Purpose</h3><div>To investigate whether sleep duration, sleep disturbances, and self-rated sleep quality predict next-day common arrhythmias in an ambulatory population.</div></div><div><h3>Methods</h3><div>This was a secondary analysis of the Coffee and Real-time Atrial and Ventricular Ectopy (CRAVE) trial, a randomized, 14-day case-crossover trial of the effects of coffee in 100 healthy volunteers. The current analyses utilized data from a wrist-worn accelerometer to measure sleep duration and disturbances worn concomitantly with a continuously recording electrocardiogram. Participants self-rated sleep quality via daily surveys. Negative binomial and logistic mixed-effects models were used to assess the effect of sleep on cardiac ectopy, adjusting for day of the week and randomization assignment and accounting for repeated measurement correlations within individuals.</div></div><div><h3>Results</h3><div>The frequency of cardiac ectopy was not associated with sleep duration (RR, 0.99; 95% CI, 0.95–1.03), sleep disturbances (RR, 0.99; 95% CI, 0.95–1.03), or sleep quality (RR, 0.97; 95% CI, 0.91–1.04). There were no significant associations between the same predictors and individual counts of PACs or PVCs or episodes of SVT or NSVT.</div></div><div><h3>Conclusion</h3><div>We failed to find evidence of a relationship between objectively quantified sleep and continuous assessment of common arrhythmias the following day in healthy volunteers.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"96 ","pages":"Article 154364"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147991277","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":"Relationship between fragmented QRS and serum fibroblast growth factor-23 in hypertensive patients with left ventricular hypertrophy","authors":"Berkant Bebek MD ,&nbsp;Alpaslan Karabulut MD ,&nbsp;Barış Eser MD ,&nbsp;Abdullah Sarıhan MD ,&nbsp;Abdülmelik Birgün MD ,&nbsp;Muharrem Özden MD ,&nbsp;Mucahit Yetim MD ,&nbsp;Macit Kalçık MD ,&nbsp;Lütfü Bekar MD ,&nbsp;Burak Biter MD","doi":"10.1016/j.jelectrocard.2026.154365","DOIUrl":"10.1016/j.jelectrocard.2026.154365","url":null,"abstract":"<div><h3>Background</h3><div>Hypertensive heart disease is frequently accompanied by left ventricular hypertrophy (LVH) and myocardial fibrosis, which contribute to diastolic dysfunction and adverse cardiovascular outcomes. Fragmented QRS (fQRS) on surface electrocardiography has been associated with myocardial fibrosis and is considered a potential noninvasive marker of myocardial fibrosis. Fibroblast growth factor-23 (FGF-23), a key regulator of mineral metabolism, has been implicated in myocardial remodeling and fibrosis; however, its relationship with fQRS in hypertensive patients with LVH has not been fully elucidated.</div></div><div><h3>Methods</h3><div>In this cross-sectional, single-center study, 265 patients with isolated hypertension and echocardiographically confirmed LVH were enrolled. All participants underwent clinical evaluation, laboratory testing, transthoracic echocardiography, and 12‑lead electrocardiography. Serum FGF-23 levels were measured using a sandwich enzyme-linked immunosorbent assay. Patients were compared according to the presence or absence of fQRS. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the discriminative ability of FGF-23 and left ventricular mass index (LVMI) for predicting fQRS.</div></div><div><h3>Results</h3><div>Fragmented QRS was present in 55 patients (20.8%). Patients with fQRS had significantly higher serum FGF-23 levels compared with those without fQRS (835.1 ± 153.4 vs. 670.7 ± 223.7 pg/mL, <em>p</em> &lt; 0.001). The fQRS-positive group also exhibited higher LVMI and a lower E/A ratio, indicating impaired diastolic function (all <em>p</em> &lt; 0.01). ROC analysis demonstrated that FGF-23 had a moderate ability to predict the presence of fQRS (AUC = 0.734, 95% CI: 0.661–0.808), exceeding that of LVMI (AUC = 0.654, 95% CI: 0.574–0.735).</div></div><div><h3>Conclusions</h3><div>In hypertensive patients with LVH, the presence of fQRS is associated with elevated serum FGF-23 levels, increased LVMI, and impaired diastolic function. These findings suggest a potential link between FGF-23–related pathways and possible myocardial fibrotic remodeling, and support the complementary value of FGF-23 alongside electrocardiographic markers in risk stratification.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"96 ","pages":"Article 154365"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147991278","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":"Development and internal validation of QRSense: A portable tool for manual and structured measurement of electrocardiograms in digital tracings","authors":"Santiago Obregón-Rosas MD ,&nbsp;Ángel Antonio Montañez-Aguirre MD ,&nbsp;José Pablo Navarrete-Punaro ,&nbsp;Viviana Cardoso-Pérez ,&nbsp;Carlos Horta-Hurtado ,&nbsp;Diego García-Almazán ,&nbsp;Isabella Rojas-Bergés ,&nbsp;Diana Elisa Morales-Sánchez ,&nbsp;Fátima Cecilia Hernández-Alcaraz ,&nbsp;José Luis Morales-Rios ,&nbsp;Rafael Bracamonte-Palma","doi":"10.1016/j.jelectrocard.2026.154368","DOIUrl":"10.1016/j.jelectrocard.2026.154368","url":null,"abstract":"<div><h3>Introduction</h3><div>Manual electrocardiogram (ECG) measurement entails inter-observer variability that affects clinical reproducibility. QRSense was developed as an open-source, offline digital tool to standardize this process.</div></div><div><h3>Objective</h3><div>To describe the technical characteristics and to evaluate the measurement agreement and reproducibility of QRSense compared with conventional manual measurement.</div></div><div><h3>Methods</h3><div>A client-side web application based on HTML5 Canvas was developed for vector-based measurements without automation. Subsequently, a cross-sectional concordance study was conducted using 50 consecutively selected ECG tracings. Eight independent observers measured QRS duration and voltage, divided into two groups of four observers each (four using QRSense and four using manual methods). Agreement between methods was assessed with Bland–Altman analysis (bias and 95% limits of agreement) and Lin's Concordance Correlation Coefficient (CCC) as the primary metric of exact agreement.</div></div><div><h3>Results</h3><div>Excellent exact agreement was observed for both parameters: Lin's CCC was 0.9527 for QRS voltage and 0.9221 for QRS duration. Bland–Altman analysis showed a negligible mean bias of +0.0482 mV for voltage (95% limits of agreement: −0.0958 to +0.1922 mV) and a small bias of −1.32 ms for duration (95% limits of agreement: −16.24 to +13.59 ms), without proportional trends across the measurement range.</div></div><div><h3>Conclusion</h3><div>QRSense is a valid and reliable tool. It offers measurement agreement comparable to expert human measurement and supports reproducible quantification of ECG parameters, facilitating the standardization and auditability of electrocardiographic data for research and clinical practice.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"96 ","pages":"Article 154368"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147991741","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 electrophysiologic continuum of occlusion myocardial infarction","authors":"Anton P.M. Gorgels MD, PhD FESC","doi":"10.1016/j.jelectrocard.2026.154271","DOIUrl":"10.1016/j.jelectrocard.2026.154271","url":null,"abstract":"<div><div>Acute coronary syndromes used to be classified according to the presence or absence of ST elevation (ST Elevation Myocardial Infarction, STEMI and Non ST Elevation Myocardial Infarction, NSTEMI). The latter contained STEMI-equivalents, indicating severe ischemia in the setting of critical stenoses in the coronary arteries. To combine both STEMI and STEMI equivalent patterns a new term was coined, i.e. occlusion myocardial infarction (OMI). OMI contains also more recently recognized patterns, among others the Aslanger pattern, South African flag pattern, precordial swirl sign, Northern pattern. Memorizing independent ECG patterns however is difficult and understanding the pathophysiology, leading to ischemic ECG changes, may be more helpful in recognizing acute ischemic syndromes. In the following a unifying system is proposed, combining the different ECG expressions of acute coronary syndromes. It is based on the concept of transmural (endo to epicardial) voltage differences and of the vectorial properties of the electrical activity of the heart. It is realized that the model of the ventricular gradient and ST vector changes during myocardial ischemia, as presented here, is a simplification and will not cover all aspects of the electrical phenomenology in myocardial ischemia and all reported OMI presentations, Nevertheless it may provide a theoretical framework that grounds the OMI concept, and a better oversight of the different ST-T presentations of acute ischemic syndromes.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"96 ","pages":"Article 154271"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147941718","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}