Journal of electrocardiology最新文献

{"title":"Use of ST/HR hysteresis decreases false positive rate in exercise electrocardiography test of middle-aged asymptomatic women","authors":"Miro Enroth ,&nbsp;Harri Sievanen ,&nbsp;Tuikku Tuula-Maria Agnes Asikainen ,&nbsp;Jari Viik","doi":"10.1016/j.jelectrocard.2024.153820","DOIUrl":"10.1016/j.jelectrocard.2024.153820","url":null,"abstract":"<div><h3>Background</h3><div>Exercise electrocardiography (ECG) is a common diagnostic and prognostic method for the detection of coronary artery disease (CAD). However, its accuracy in asymptomatic women has not been comprehensively investigated and the diagnostic criteria may require refinements. This study evaluated the performance of ECG-derived ST/HR-index, ST/HR hysteresis and ST-segment depression parameters among asymptomatic middle-aged women.</div></div><div><h3>Methods</h3><div>108 women (mean age 56 ± 4 years) performed exercise ECG test on treadmill until exhaustion three times within a nine-month period. False-positive rates of maximum ST/HR-index, ST/HR hysteresis, and ST-segment depression values measured from 12 leads at peak exercise and after one-minute recovery were evaluated with recommended diagnostic partition values. Repeatability was assessed with intraclass correlation (ICC) and Bland-Altman plot analysis.</div></div><div><h3>Results</h3><div>False-positive rate was lower for all variables when a two‑lead configuration was used instead of a single‑lead configuration. Using a two‑lead configuration, ST/HR hysteresis (0–1.9 %) and ST-segment depression after one-minute recovery (0–2.8 %) had lower false-positive rates compared to ST/HR index (3.7–20.4 %) and ST-segment depression at peak exercise (9.3–27.8 %). ICC values indicated moderate repeatability for ST/HR hysteresis while ST/HR index, ST-segment at peak exercise, and ST-segment after one-minute recovery had moderate-to-good repeatability. Bland-Altman analysis indicated poor repeatability for all evaluated ECG variables.</div></div><div><h3>Conclusion</h3><div>In asymptomatic middle-aged women, practitioners should prefer the use of ST/HR hysteresis and ST-segment after one-minute recovery over the conventional ST-segment depression at peak exercise or ST/HR index, and evaluate the ECG data from a two‑lead configuration instead of single‑lead.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"87 ","pages":"Article 153820"},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590628","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":"Chest pain and AI interpretation: The essential role of clinical judgment and quality data","authors":"Marco Biasin MD ,&nbsp;Sara Lomi MD ,&nbsp;Laura Pagani MD,&nbsp;Gabriele Facci MD,&nbsp;Davide Betta MD,&nbsp;Giovanni Morani MD","doi":"10.1016/j.jelectrocard.2024.153823","DOIUrl":"10.1016/j.jelectrocard.2024.153823","url":null,"abstract":"<div><div>Chest pain is a common and complex condition in emergency departments, often complicating the diagnostic process due to its wide range of potential causes. This case report presents a 72-year-old man with chest pain and ST-segment elevation on ECG, initially suggestive of acute coronary syndrom. AI-assisted ECG analysis reinforced this suspicion; however, angiography revealed patent coronary arteries. When his symptoms persisted, further investigation uncovered a pneumothorax. Additional evaluation identified a digitization error affecting the AI interpretation. This case underscores the importance of a comprehensive clinical approach for chest pain and highlights the need for quality data input and alternative imaging, such as thoracic ultrasound, for accurate and timely differential diagnoses.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"87 ","pages":"Article 153823"},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621826","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 prolongation is associated with associated with adverse cardiac remodeling in hypertrophic cardiomyopathy","authors":"Hernan L. Vera-Sarmiento ,&nbsp;Talha Tanriverdi ,&nbsp;David Hurtado-de-Mendoza ,&nbsp;Sanjay Sivalokanathan ,&nbsp;Ramses Ramirez Damera ,&nbsp;Dolores Ketty ,&nbsp;Daiyin Lu ,&nbsp;Stefan Zimmerman ,&nbsp;Sunil Sinha ,&nbsp;Melvin Scheinman ,&nbsp;M. Roselle Abraham","doi":"10.1016/j.jelectrocard.2024.153818","DOIUrl":"10.1016/j.jelectrocard.2024.153818","url":null,"abstract":"<div><h3>Background</h3><div>Signal-averaged electrocardiogram (SAECG) records myocardial depolarization, and can detect inhomogeneous/slow conduction in fibrotic myocardium, which promotes reentrant ventricular arrhythmias (VAs). Hypertrophic cardiomyopathy (HCM) is associated with a high prevalence of cardiac fibrosis and VAs, but abnormal SAECG has low predictive power for VAs. We hypothesized that HCM-specific structural/electrical remodeling underlies this result.</div></div><div><h3>Methods</h3><div>We tested our hypothesis by retrospectively studying HCM patients (n = 73) who underwent transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) imaging within 12 months of SAECG and 12‑lead ECG. Patients were divided into 2 groups (normal-SAECG, abnormal-SAECG) based on filtered-QRS duration (<em>fQRS</em>d), root-mean-square-voltage (<em>RMS40</em>) and low-amplitude (&lt;40 μV) signal of terminal 40 ms of filtered-QRS (late potentials)<em>.</em> Abnormal SAECG was defined as <em>fQRS</em>d <em>&gt;</em> <em>114</em> <em>ms, RMS40</em> <em>&lt;</em> <em>20</em> μ<em>V</em> or <em>LAS40</em> <em>&gt;</em> <em>38</em> <em>ms.</em></div></div><div><h3>Results</h3><div>Abnormal SAECG was seen in ∼50 % of HCM patients (37/73). In the abnormal-SAECG group, 78 % (n = 29) only had prolonged <em>fQRS</em>d<em>,</em> and 22 % (n = 8) had prolonged <em>fQRS</em>d plus late potentials (<em>RMS40</em> <em>&lt;</em> <em>20</em> μV or <em>LAS40</em> <em>&gt;</em> <em>38</em> <em>ms)</em>. Mean <em>fQRS</em>d and <em>LAS40</em> were significantly higher in the abnormal-SAECG group. The abnormal-SAECG group had significantly larger LA size, lower global-LV longitudinal systolic strain/strain rate and early-diastolic strain rate by TTE; higher LV-mass index (LVMI) and LV-scar burden by CMR; higher prevalence of repolarization abnormalities on 12‑lead ECG. LVEF and adverse outcomes (VT/VF, heart failure, death) were similar in the 2 groups. Univariate analysis showed that <em>fQRS</em>d is positively correlated with LVMI, LV-scar mass, and negatively correlated with global-LV early diastolic strain rate.</div></div><div><h3>Conclusions</h3><div>In HCM, abnormal SAECG is associated with greater structural/electrical LV-remodeling, reflecting a severe global myopathy.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"87 ","pages":"Article 153818"},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study on the feasibility of distinguishing ventricular and pre-excited arrhythmia rhythms by a new algorithm","authors":"Honglin Ni ,&nbsp;Qingcheng Wang ,&nbsp;Zhiyong Wang ,&nbsp;Wenbo Xu ,&nbsp;Xiaowei Pan ,&nbsp;Jianfang Zhu ,&nbsp;Zhe Liu ,&nbsp;Weixun Cai","doi":"10.1016/j.jelectrocard.2024.153817","DOIUrl":"10.1016/j.jelectrocard.2024.153817","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The differentiation and diagnosis of ventricular tachycardia (VT) and pre-excited tachycardia (PXT) remains a challenging task, especially when typical AV dissociation is not present. The purpose of this article is to study the feasibility of a new theoretical algorithm for identifying ventricular arrhythmias (VA) and pre-excited arrhythmias (PA) rhythms (which can be used to distinguish VT from PXT, etc.).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Method&lt;/h3&gt;&lt;div&gt;This study involved the deduction of a new algorithm by combining knowledge of cardiac anatomy, vectorcardiography, and cardiac electrophysiology. The new algorithm evaluated the diagnostic value through intracardiac electrophysiology in 205 cases of VA and PA. The new algorithm diagnoses VA based on the following 4-step process:&lt;ul&gt;&lt;li&gt;&lt;span&gt;1.&lt;/span&gt;&lt;span&gt;&lt;div&gt;The QRS complex in leads II, III, and aVF shows a unidirectional R wave, and lead aVR shows a QS pattern.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;2.&lt;/span&gt;&lt;span&gt;&lt;div&gt;S waves are predominant in two or more of leads I, aVF, and V6.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;3.&lt;/span&gt;&lt;span&gt;&lt;div&gt;Lead V2 shows ≥3 phase waves or returning branch notching (note: returning branch refers to the band of QRS complexes returning to the baseline).&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;4.&lt;/span&gt;&lt;span&gt;&lt;div&gt;Lead V5 shows a negative wave in the initial portion or returning branch notching.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;/ul&gt;&lt;/div&gt;&lt;div&gt;If none of these criteria are met, the diagnosis is PA. The diagnostic value of the new algorithm is compared with the Steurer algorithm and the Vereckei algorithm (diagnosed based on the QRS waveform characteristics of the two algorithms during electrophysiological verification, excluding the diagnosis of atrioventricular dissociation).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The new algorithm showed significant advantages in terms of AUC value (0.83 vs. 0.61 vs. 0.57), sensitivity (83.6 % vs. 23.3 % vs. 24.8 %), and accuracy (82.9 % vs. 48.3 % vs. 46.3 %) compared to the Steurer algorithm and Vereckei algorithm based on QRS waveform characteristics for diagnosing VA (137 cases) and PA (68 cases). This indicates that the new algorithm is more accurate in identifying idiopathic VA. While there was a significant difference in specificity between the New algorithm and Steurer algorithm (82.3 % vs. 98.5 %, &lt;em&gt;p&lt;/em&gt; &lt; 0.05), the difference with Vereckei algorithm (82.3 % vs. 89.7 %) was not significant.&lt;/div&gt;&lt;div&gt;In the New algorithm, the sensitivity and specificity for each step are as follows:&lt;ul&gt;&lt;li&gt;&lt;span&gt;-&lt;/span&gt;&lt;span&gt;&lt;div&gt;Step 1: Sensitivity 34.3 %, Specificity 94.1 %.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;-&lt;/span&gt;&lt;span&gt;&lt;div&gt;Step 2: Sensitivity 24.1 %, Specificity 98.5 %.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;-&lt;/span&gt;&lt;span&gt;&lt;div&gt;Step 3: Sensitivity 18.3 %, Specificity 100 %.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;-&lt;/span&gt;&lt;span&gt;&lt;div&gt;Step 4: Sensitivity 6.6 %, Specificity 89.7 %.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;/ul&gt;&lt;/div&gt;&lt;div&gt;Step 1 had the highest AUC value, indicating the best overall diagnostic performan","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"87 ","pages":"Article 153817"},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142561047","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":"Variability of the PR intervals in Wenckebach atrioventricular block","authors":"S. Serge Barold MD ,&nbsp;Harry G. Mond MD","doi":"10.1016/j.jelectrocard.2024.153815","DOIUrl":"10.1016/j.jelectrocard.2024.153815","url":null,"abstract":"<div><div>The duration of the PR intervals in atypical Wenckebach atrioventricular block before and after a non-conducted P wave can exhibit a wide range of values and patterns. Understanding the different or at times puzzling manifestations of Wenckebach atrioventricular block in terms of its PR intervals can avoid diagnostic errors, especially the erroneous more serious diagnosis of Mobitz type II atrioventricular block.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"87 ","pages":"Article 153815"},"PeriodicalIF":1.3,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501626","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 correlates of cardiac magnetic resonance findings in women with myocardial infarction with non-obstructive coronary arteries","authors":"Mitchell Pleasure BA ,&nbsp;Vita N. Jaspan MD ,&nbsp;Olivia Liu BA ,&nbsp;Emilie Lin ,&nbsp;Raymond Y. Kwong MD MPH ,&nbsp;Julia Huang BS ,&nbsp;Anais Hausvater MD ,&nbsp;Tara Sedlak MD ,&nbsp;Hayder Hashim MD ,&nbsp;Caitlin Giesler MD ,&nbsp;Kevin R. Bainey MD ,&nbsp;Aun-Yeong Chong MD ,&nbsp;Bobak Heydari MD MPH ,&nbsp;Mobeen Ahmed MD ,&nbsp;Nathaniel R. Smilowitz MD MS ,&nbsp;Harmony R. Reynolds MD","doi":"10.1016/j.jelectrocard.2024.153813","DOIUrl":"10.1016/j.jelectrocard.2024.153813","url":null,"abstract":"<div><h3>Background</h3><div>Myocardial infarction with nonobstructive coronary arteries (MINOCA) occurs in 6–15 % of MI patients. Cardiac magnetic resonance (CMR) imaging identifies MINOCA etiologies, but access may be limited.</div></div><div><h3>Methods</h3><div>We assessed associations between the index electrocardiogram (ECG) and CMR in MINOCA. Women with MI and &lt; 50 % angiographic stenosis in all vessels were prospectively enrolled at 16 sites. CMR (median 6d from MI) was analyzed for late gadolinium enhancement (LGE), myocardial edema, and wall motion. We assessed ECGs for T-wave inversions (TWI), Q-waves (QW), ST-elevations (STE), ST-depressions (STD), and fragmented QRS complexes (fQRS). We calculated the DETERMINE score (# leads TWI + # fQRS +2*[# QW], excluding aVR, V1).</div></div><div><h3>Results</h3><div>Among 112 women with interpretable ECG, 81.3 % (91/112) had abnormal ECG; 50 % (56/112) had ≥1 TWI. CMR was abnormal in 74.1 % (83/112), with LGE in 49.1 % (55/112) and myocardial edema in 61.6 % (69/112). DETERMINE score ≥ 3 was associated with abnormal CMR (adjusted odds ratio [aOR] aOR 6.06 [1.89, 24.6], <em>p</em> = 0.002) and LGE (aOR 3.10 [1.26, 8.00], <em>p</em> = 0.013), but not edema (aOR 1.86 [0.80, 4.43], <em>p</em> = 0.152). TWI was also associated with abnormal CMR and LGE after adjustment (aOR 3.13 [1.08, 10.1], <em>p</em> = 0.036, aOR 3.23 [1.27, 8.63], p = 0.013, respectively), but not edema (aOR 1.26 [0.54, 2.96], <em>p</em> = 0.589). Specificity for abnormal CMR was 0.83 for DETERMINE score ≥ 3 and 0.75 for TWI. No other ECG findings were associated with CMR abnormality.</div></div><div><h3>Conclusion</h3><div>DETERMINE score ≥ 3 and the presence of any TWI were associated with abnormal CMR and with LGE in MINOCA. Our findings demonstrate that the index ECG can provide insight on CMR findings but without sensitivity or specificity required to forgo the CMR. We reaffirm the central role of CMR in elucidating MINOCA pathophysiology.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"87 ","pages":"Article 153813"},"PeriodicalIF":1.3,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501624","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":"Premature ventricular contraction patterns associated with nonsustained ventricular tachycardia","authors":"Juan F. Rodriguez-Riascos MD,&nbsp;Whilman G. Rodriguez MD,&nbsp;Carlos A. Porras-Meza MD","doi":"10.1016/j.jelectrocard.2024.153812","DOIUrl":"10.1016/j.jelectrocard.2024.153812","url":null,"abstract":"<div><h3>Background</h3><div>Occurrence of nonsustained ventricular tachycardia (NSVT) is associated with negative outcomes. It is not clear whether specific electrocardiographic characteristics of premature ventricular contractions (PVCs) are associated with the occurrence of NSVT. The aim of this study was to identify electrocardiographic patterns associated with the presence of NSVT during 24-h electrocardiographic monitoring in patients with &gt;10 PVCs per hour.</div></div><div><h3>Methods</h3><div>This was a retrospective, observational, cross-sectional study. We reviewed consecutive patients who received 24-h ECG monitoring performed at a single outpatient cardiology center. Patients who received 24-h electrocardiographic monitoring, with a PVC burden ≥10 PVCs/h were included. Occurrence of NSVT during 24-h electrocardiographic monitoring was the main outcome.</div></div><div><h3>Results</h3><div>A total of 343 patients were analyzed (mean [SD] age, 69.7 [12.5] years; 177 men [51.6 %]). NSVT occurred in 72 patients who were compared with 271 patients without NSVT. The novel term “premature beat ratio”, which aims to correlate the coupling interval and compensatory pause, was introduced; a value &gt;0.5 was independently associated with NSVT according to the multivariate model (OR = 3.73, 95 % CI = 1.57–8.82; <em>P</em> = 0.002). PVC burden (OR = 1.09, 95 % CI = 1.02–1.17; <em>P</em> = 0.006), and triplets (OR = 18.19, 95 % CI = 7.32–45.18 P = 0.0) were also associated with NSVT in the multivariate model.</div></div><div><h3>Conclusion</h3><div>These findings suggest that patients with a high PVC burden, triplets, and a premature beat ratio greater than 0.5 have an increased probability of presenting with NSVT and may benefit from more rigorous follow-up.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"87 ","pages":"Article 153812"},"PeriodicalIF":1.3,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400456","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 change in QT interval and ST-segment after radiofrequency catheter ablation in pediatric patients with Wolff–Parkinson–White syndrome","authors":"Shuhei Fujita M.D., Ph.D ,&nbsp;Eriko Kabata M.D ,&nbsp;Shinichiro Mizutomi M.D ,&nbsp;Kazuo Usuda M.D., Ph.D ,&nbsp;Akio Chikata M.D., Ph.D ,&nbsp;Takeshi Futatani M.D., Ph.D ,&nbsp;Kiyoshi Hatasaki M.D., Ph.D","doi":"10.1016/j.jelectrocard.2024.153814","DOIUrl":"10.1016/j.jelectrocard.2024.153814","url":null,"abstract":"<div><h3>Background</h3><div>Few studies have examined QT, JT interval, and ST-segment changes due to radiofrequency catheter ablation (RFA) in manifest Wolff–Parkinson–White (WPW) syndrome in pediatric patients.</div></div><div><h3>Methods</h3><div>The study involved 27 patients (male-to-female, 13:14; age, 12 (5–16) years) who were diagnosed with WPW syndrome and underwent RFA in our hospital between 2009 and 2022. Electrocardiographic (ECG) changes were compared between the group with ventricular preexcitation due to an accessory pathway (manifest group, <em>n</em> = 16) and those without it (concealed group, <em>n</em> = 11).</div></div><div><h3>Results</h3><div>The QT interval before RFA was significantly longer in the manifest group than in the concealed group (402 [362–482] vs. 344 [323–427]; <em>p</em> = 0.001). The QT interval was significantly shortened in the manifest group before and after RFA (402 [362–482] vs. 360 [298–422] msec; <em>p</em> = 0.01). At 1 month, the QT interval difference between the manifest and concealed groups disappeared (366 [305–437] vs. 335 [301–436] msec; <em>p</em> = 0.001). ST-segment changes were found after RFA in 56 % (9/16) of the patients in the manifest group but not in the concealed group. ECG changes presenting the Brugada-pattern was found in one patient. One month later, ECG abnormalities persisted in only one patient.</div></div><div><h3>Conclusions</h3><div>In pediatric patients, the QT interval was prolonged in manifest WPW syndrome but shortened after RFA. In the manifest group, transient ST-segment change and T-wave abnormalities were often observed after RFA; however, the ECG normalized in approximately 1 month.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"87 ","pages":"Article 153814"},"PeriodicalIF":1.3,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400455","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 Chapman's sign?","authors":"S. Serge Barold","doi":"10.1016/j.jelectrocard.2024.153811","DOIUrl":"10.1016/j.jelectrocard.2024.153811","url":null,"abstract":"<div><div>Chapman's (electrographic) sign is of a notch on the ascending limb of the R wave in leads I, aVL and V6. It has been used in the diagnosis of myocardial infarction (MI) during left bundle branch block (LBBB) and cardiac pacing. A number of studies have yielded divergent results about its diagnostic usefulness. However, the sign can be helpful in the diagnosis of MI during LBBB or pacing in the absence of other manifestations of MI.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"87 ","pages":"Article 153811"},"PeriodicalIF":1.3,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521970","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":"Modified torso vs distal limb electrode placement for performing ECGs in children: A method comparison study","authors":"Ivor B. Asztalos MD, MSCE, MBMI ,&nbsp;Amanda S. Artis MS, MPH ,&nbsp;Alexis E. Zavez PhD ,&nbsp;Victoria L. Vetter MD, MSHP, MPH","doi":"10.1016/j.jelectrocard.2024.153810","DOIUrl":"10.1016/j.jelectrocard.2024.153810","url":null,"abstract":"<div><h3>Background</h3><div>The electrocardiogram (ECG) is routinely performed in children with the limb electrodes positioned on the torso, but few studies have investigated the effects of this modification on the pediatric ECG. Our objective was to assess the agreement between the standard limb lead configuration and a modified torso electrode configuration in normal, healthy children, and to assess the effect of height on that agreement.</div></div><div><h3>Methods</h3><div>185 children aged 5–18 years underwent two consecutive 12‑lead ECGs, one with standard distal limb lead placement and one with the limb leads placed on the torso. Agreement was assessed for 17 ECG parameters (intervals, axes, and amplitudes) using Bland-Altman plots, height-dependent mean error, and false positive rates.</div></div><div><h3>Results</h3><div>The torso configuration systematically biased the QRS and P wave axes rightwards (towards aVF). Adequate agreement was observed for PR interval and QRS duration, but QTc limits of agreement (±40 ms) were wide. The torso configuration overestimated left-precordial Q, R, and S wave amplitudes and underestimated right-precordial R and S wave amplitudes compared to the distal limb placement. Mean measurement errors increased with the magnitude of the ECG parameter. Mean and variance of measurement errors were more pronounced in shorter children. False positive rates did not differ between the torso and distal limb configurations.</div></div><div><h3>Conclusion</h3><div>Modified placement of the limb electrodes onto the torso resulted in multiple differences in the pediatric ECG signals. This may lead to misclassification of electrocardiographic abnormalities, particularly in children with measurement values at the upper limits of normal.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"87 ","pages":"Article 153810"},"PeriodicalIF":1.3,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501625","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}