Journal of electrocardiology最新文献

{"title":"Reply to the Letter by doctor Mazen M. Kawji “Reversal of left arm and left leg rather alternating left fascicular block” [J Electrocardiol 2024;86:153774]","authors":"Paolo Alboni","doi":"10.1016/j.jelectrocard.2024.153809","DOIUrl":"10.1016/j.jelectrocard.2024.153809","url":null,"abstract":"","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"87 ","pages":"Article 153809"},"PeriodicalIF":1.3,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142323187","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":"Aslanger's pattern with acute lesion in the left coronary system: A case report","authors":"Marco Antônio Vinciprova Dall Agnese ,&nbsp;Alana Sangalli Copetti ,&nbsp;Sérgio Ferreira de Ferreira Filho ,&nbsp;Pedro Rotta de Ferreira ,&nbsp;Tiago Luiz Luz Leiria","doi":"10.1016/j.jelectrocard.2024.153807","DOIUrl":"10.1016/j.jelectrocard.2024.153807","url":null,"abstract":"<div><div>Acute Coronary Syndrome (ACS) is characterized by the suspicion or confirmation of acute ischemia or acute myocardial infarction (MI). The presence of ST segment elevation (STE) consists in the main criterion for indication of immediate reperfusion therapy due to acute coronary occlusion, although significant part of the acute coronary occlusion cases do not fit the ST-segment elevation myocardial infarction (STEMI) criteria.</div><div>A case report of a 50 year-old male presenting typical anginal pain, whose electrocardiogram (EKG) presented Aslanger's pattern. The patient had severe lesion of the left anterior descending artery (ADA) and chronic occlusion of the right coronary artery on cardiac catheterization, with important collateral flow from branches of the left coronary artery to the right coronary artery.</div><div>The dichotomy between STEMI and Non-ST segment elevation myocardial infarction (NSTEMI) must be contested, owing to the evidence that one third of the NSTEMI patients presents a total coronary occlusion. There are other electrocardiographic patterns which must be considered to diagnose ACS. Our case report outlines a different clinical presentation of Aslanger pattern, that shows a ADA acute occlusion, instead of the lesion being in the right coronary system.</div><div>There is evidence that, in addition to the STEMI vs NSTEMI criteria, the Aslanger pattern and other electrocardiographic patterns characterize occlusive ACS. Recognizing those patterns in clinical practice is essential to improve the diagnosis and early treatment of patients with ACS.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"87 ","pages":"Article 153807"},"PeriodicalIF":1.3,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288942","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":"Causal relationship between Brugada syndrome and electrocardiogram traits: A bidirectional Mendelian randomization study","authors":"Changxi Li ,&nbsp;Xinquan Wu ,&nbsp;Xudong Song ,&nbsp;Hanfang Liu ,&nbsp;Xuemin Xian ,&nbsp;Peihua Cao ,&nbsp;Yuhang Chen ,&nbsp;Fei Miao ,&nbsp;Xiuli Zhang","doi":"10.1016/j.jelectrocard.2024.153805","DOIUrl":"10.1016/j.jelectrocard.2024.153805","url":null,"abstract":"<div><h3>Introduction</h3><div>Observational studies have suggested associations between Brugada syndrome (BrS) and electrocardiograms traits. Nonetheless, the causal relationships remains uncertain in observational studies. This study aims to investigate the causal relationships between BrS phenotypic risk and electrocardiogram traits using Mendelian randomization (MR) analysis and colocalization analysis.</div></div><div><h3>Methods</h3><div>MR analysis was performed to investigate the causal relationships between BrS phenotype risk and electrocardiogram traits (P wave duration, PR interval, QRS wave duration, ST segment duration, T wave duration, QT interval, heart rate (HR) and heart rate variability). The genetic instruments for BrS (number of cases = 12,821) were obtained from the latest GWAS. GWAS summary data of electrocardiogram traits were obtained from the MRC-IEU and GWAS catalog databases. The causal relationships were obtained through MR methods, and sensitivity analyses (e.g. Cochran's Q test, MR-PRESSO). Furthermore, the causal relationships were evaluated whether they were driven by one linkage disequilibrium using colocalization analysis.</div></div><div><h3>Results</h3><div>We found that there are positive causal relationships between BrS phenotypic risk and P wave duration, PR interval, QRS wave duration and QT interval, respectively (IVW_P: β = 1.238, 95 % CI = 0.857–1.619, <em>P</em>&lt;0.001; IVW_PR: β = 2.199, 95 % CI = 1.358–3.039, <em>P</em>&lt;0.001; IVW_QRS: β = 0.157, 95 % CI = 0.115–0.198, <em>P</em>&lt;0.001; IVW_QT: β = 0.593, 95 % CI = 0.391–0.796, <em>P</em>&lt;0.001), and there is a negative causal relationship between BrS phenotypic risk and heart rate (IVW_HR: β = −0.023, 95 % CI = −0.03 ∼ −0.015, <em>P</em>&lt;0.001). Additionally, there are bidirectional causal relationships between BrS phenotypic risk and P wave duration and PR interval, respectively (IVW_P: OR = 1.217, 95 % CI = 1.118–1.325, <em>P</em>&lt;0.001; IVW_PR: OR = 1.02, 95 % CI = 1.008–1.032, <em>P</em> = 0.001). Furthermore, colocalization analysis identified that the causal relationships between BrS phenotype risk and P wave duration, PR interval and QRS wave duration were driven by rs6790396, rs6801957 and rs6801957, respectively.</div></div><div><h3>Conclusions</h3><div>Bidirectional causal relationships were identified between BrS phenotypic risk and P wave duration and PR interval, respectively. There were positive causal relationships between BrS phenotypic risk and QRS wave duration and QT interval, respectively, and there is a negative causal relationship between BrS phenotypic risk and heart rate.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"87 ","pages":"Article 153805"},"PeriodicalIF":1.3,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142314339","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":"Deep negative T-waves in a patient with three different QRS morphologies in a single electrocardiographic strip: What is going on?","authors":"Iosif Xenogiannis ,&nbsp;Georgios Fakas ,&nbsp;Loukianos S Rallidis","doi":"10.1016/j.jelectrocard.2024.153808","DOIUrl":"10.1016/j.jelectrocard.2024.153808","url":null,"abstract":"","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"87 ","pages":"Article 153808"},"PeriodicalIF":1.3,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142243689","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":"Refining ECG interpretation: From false assumptions to evidence-based precision","authors":"José Nunes de Alencar MD ,&nbsp;Claudio Cirenza MD, PhD ,&nbsp;Angelo Amato Vincenzo de Paola MD, PhD","doi":"10.1016/j.jelectrocard.2024.153803","DOIUrl":"10.1016/j.jelectrocard.2024.153803","url":null,"abstract":"<div><h3>Introduction</h3><p>Electrocardiography (ECG) remains a fundamental tool in cardiovascular diagnostics, frequently relying on System 1 thinking—rapid, intuitive pattern recognition (PR). However, this approach can be insufficient when dealing with complex cases where diagnostic precision is essential. This article emphasizes the importance of integrating System 2 thinking—a more deliberate, evidence-based approach—into ECG interpretation to enhance diagnostic accuracy and avoid clinical errors.</p></div><div><h3>Methods</h3><p>This review examines the distinction between findings that can be adequately managed through System 1 PR and those requiring System 2 reasoning supported by diagnostic accuracy studies.</p></div><div><h3>Results</h3><p>While System 1 PR is effective for recognizing routine ECG findings and self-evident truths, it falls short in conditions where the ECG serves as a mere surrogate marker for underlying pathology. Examples such as false-negative acute coronary occlusions illustrate the need for System 2 reasoning to account for the limitations of ECG's diagnostic precision. Relying solely on System 1 in these contexts risks treating the ECG as an infallible diagnostic tool and as a false gold standard for many diseases, which it is not.</p></div><div><h3>Conclusion</h3><p>To prevent diagnostic errors, ECG interpretation must distinguish between self-evident truths suited for PR and findings that require System 2 reasoning due to their association with actual pathology. Clinicians and educators should prioritize evidence-based methods, incorporating System 2 reasoning into practice to improve diagnostic precision and patient outcomes.</p></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"87 ","pages":"Article 153803"},"PeriodicalIF":1.3,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142243688","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":"Acute myocardial infarction in a patient with permanent left bundle branch pacing","authors":"Francesco Deluca,&nbsp;Lina Marcantoni,&nbsp;Gianni Pastore,&nbsp;Simone Valenza,&nbsp;Giorgio Porcelli,&nbsp;Francesco Zanon","doi":"10.1016/j.jelectrocard.2024.153804","DOIUrl":"10.1016/j.jelectrocard.2024.153804","url":null,"abstract":"<div><h3>Background</h3><p>Electrocardiographic diagnosis of acute myocardial infarction in the setting of cardiac pacing represents diagnostic challenge. There are no focusing data, neither reporting about diagnostic sensitivity of 12‑lead ECG with left bundle branch area pacing (LBBAP) during acute myocardial infarction (AMI).</p></div><div><h3>Case summary</h3><p>We present 12‑lead ECG morphology in a patient with permanent LBBAP during AMI.</p></div><div><h3>Discussion</h3><p>Abnormal repolarization changes induced by ventricular pacing can lead to delay in diagnosis in patients with AMI. LBBAP and overall conduction system pacing may facilitate a timely diagnosis providing additional, still underestimated, advantages of physiological pacing of the heart.</p></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"87 ","pages":"Article 153804"},"PeriodicalIF":1.3,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230588","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 “regularly irregular” tachycardia with wide and narrow QRS complexes","authors":"Daniela Mascaretti MD ,&nbsp;Gianluca Ricchetti MD ,&nbsp;Massimo Slavich MD ,&nbsp;Filippo Maria Cauti MD, PhD","doi":"10.1016/j.jelectrocard.2024.153806","DOIUrl":"10.1016/j.jelectrocard.2024.153806","url":null,"abstract":"","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"87 ","pages":"Article 153806"},"PeriodicalIF":1.3,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142232536","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":"Prognostic significance of ratio of P-wave duration to P-wave vector magnitude for mortality in acute anterior myocardial infarction","authors":"Masamichi Yano,&nbsp;Yasuyuki Egami,&nbsp;Masaru Abe,&nbsp;Mizuki Osuga,&nbsp;Hiroaki Nohara,&nbsp;Shodai Kawanami,&nbsp;Kohei Ukita,&nbsp;Akito Kawamura,&nbsp;Koji Yasumoto,&nbsp;Naotaka Okamoto,&nbsp;Yasuharu Matsunaga-Lee,&nbsp;Masami Nishino","doi":"10.1016/j.jelectrocard.2024.153791","DOIUrl":"10.1016/j.jelectrocard.2024.153791","url":null,"abstract":"<div><h3>Background</h3><p>The impact of P-wave abnormality in acute anterior MI, where the culprit vessel is the left anterior descending artery, remains undetermined. This study aimed to elucidate the impact of P-wave morphology on clinical outcomes in acute anterior MI.</p></div><div><h3>Methods</h3><p>Patients undergoing emergent percutaneous coronary intervention for acute anterior MI were enrolled between September 2014 and April 2019 (derivation cohort) and May 2019 through July 2023 (validation cohort). P-wave duration (Pd) and P-wave vector magnitude (Pvm) were measured. The Pvm was calculated as the square root of the sum of the squared P-wave magnitudes in leads II and V6 and one-half of the P-wave amplitude in V2. The patients were categorized into high and low Pd/Pvm groups using a statistically derived cut-off value. The endpoint comprised the composite of heart failure (HF) hospitalization and all-cause death.</p></div><div><h3>Results</h3><p>Consecutive 426 patients were enrolled in this study (derivation cohort, 213 patients; validation cohort, 216 patients). The calculated cut-off value of Pd/Pvm for predicting the clinical endpoint, determined through receiver operating curve analysis, was 793.5 ms/mV (area under the curve [AUC] = 0.85, sensitivity of 73.8 %, and specificity of 94.0 %) in the derivation cohort. Kaplan-Meier analyses revealed a significantly higher risk of the endpoint in patients with high Pd/Pvm than those with low Pd/Pvm in derivation and validation cohorts (Log-rank <em>p</em> &lt; 0.001 and p &lt; 0.001, respectively). Multivariate Cox proportional hazards analysis identified advanced age, elevated Pd/Pvm, and reduced left ventricular ejection fraction as independent and significant factors associated with the endpoint in the validation cohort (<em>p</em> = 0.008, <em>p</em> &lt; 0.001, and p &lt; 0.001, respectively).</p></div><div><h3>Conclusion</h3><p>High Pd/Pvm was significantly associated with the composite of HF hospitalization and all-cause death after acute anterior MI.</p></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"87 ","pages":"Article 153791"},"PeriodicalIF":1.3,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142164524","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":"Clinical usability of deep learning-based saliency maps for occlusion myocardial infarction identification from the prehospital 12-Lead electrocardiogram","authors":"Nathan T. Riek PhD(c) ,&nbsp;Tanmay A. Gokhale MD, PhD ,&nbsp;Christian Martin-Gill MD, MPH ,&nbsp;Karina Kraevsky-Philips PhD(c), RN ,&nbsp;Jessica K. Zègre-Hemsey RN, PhD ,&nbsp;Samir Saba MD ,&nbsp;Clifton W. Callaway MD, PhD ,&nbsp;Murat Akcakaya PhD ,&nbsp;Salah S. Al-Zaiti PhD","doi":"10.1016/j.jelectrocard.2024.153792","DOIUrl":"10.1016/j.jelectrocard.2024.153792","url":null,"abstract":"<div><h3>Introduction</h3><p>Deep learning (DL) models offer improved performance in electrocardiogram (ECG)-based classification over rule-based methods. However, for widespread adoption by clinicians, explainability methods, like saliency maps, are essential.</p></div><div><h3>Methods</h3><p>On a subset of 100 ECGs from patients with chest pain, we generated saliency maps using a previously validated convolutional neural network for occlusion myocardial infarction (OMI) classification. Three clinicians reviewed ECG-saliency map dyads, first assessing the likelihood of OMI from standard ECGs and then evaluating clinical relevance and helpfulness of the saliency maps, as well as their confidence in the model's predictions. Questions were answered on a Likert scale ranging from +3 (most useful/relevant) to −3 (least useful/relevant).</p></div><div><h3>Results</h3><p>The adjudicated accuracy of the three clinicians matched the DL model when considering area under the receiver operating characteristics curve (AUC) and F1 score (AUC 0.855 vs. 0.872, F1 score = 0.789 vs. 0.747). On average, clinicians found saliency maps slightly clinically relevant (0.96 ± 0.92) and slightly helpful (0.66 ± 0.98) in identifying or ruling out OMI but had higher confidence in the model's predictions (1.71 ± 0.56). Clinicians noted that leads I and aVL were often emphasized, even when obvious ST changes were present in other leads.</p></div><div><h3>Conclusion</h3><p>In this clinical usability study, clinicians deemed saliency maps somewhat helpful in enhancing explainability of DL-based ECG models. The spatial convolutional layers across the 12 leads in these models appear to contribute to the discrepancy between ECG segments considered most relevant by clinicians and segments that drove DL model predictions.</p></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"87 ","pages":"Article 153792"},"PeriodicalIF":1.3,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0022073624002620/pdfft?md5=35679429fcb9a91950afb59c5b50379d&pid=1-s2.0-S0022073624002620-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157850","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":"A novel way to prospectively evaluate of AI-enhanced ECG algorithms","authors":"","doi":"10.1016/j.jelectrocard.2024.06.046","DOIUrl":"10.1016/j.jelectrocard.2024.06.046","url":null,"abstract":"<div><p><span><span>Significant strides will be made in the field of computerized electrocardiology through the development of artificial intelligence (AI)-enhanced ECG (AI-ECG) algorithms. Yet, the scientific discourse has primarily relied upon on retrospective analyses for deriving and externally validating AI-ECG classification algorithms, an approach that fails to fully judge their real-world effectiveness or reveal potential unintended consequences. Prospective trials and analyses of AI-ECG algorithms will be crucial for assessing real-world diagnostic scenarios and understanding their practical utility and degree influence they confer onto clinicians. However, conducting such studies is challenging due to their resource-intensive nature and associated technical and logistical hurdles. To overcome these challenges, we propose an innovative approach to assess AI-ECG algorithms using a virtual testing environment. This strategy can yield critical insights into the practical utility and clinical implications of novel AI-ECG algorithms. Moreover, such an approach can enable an assessment of the influence of AI-ECG algorithms have their users. Herein, we outline a proposed </span>randomized control trial for evaluating the diagnostic efficacy of new AI-ECG algorithm(s) specifically designed to differentiate between </span>wide complex tachycardias<span> into ventricular tachycardia and supraventricular wide complex tachycardia.</span></p></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"86 ","pages":"Article 153756"},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141600177","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}