Journal of electrocardiology最新文献

{"title":"Prevalence and clinical relevance of left septal fascicular block following conduction system pacing","authors":"Ahmet Taha Sahin ,&nbsp;Oznur Keskin ,&nbsp;Serhat Kesriklioglu ,&nbsp;Nuraiym Moloshova ,&nbsp;Hasan Kan ,&nbsp;Muhammet Fatih Kaleli ,&nbsp;Busra Ozyesil ,&nbsp;Ahmet Salvarci ,&nbsp;Leyla Feyzullayeva ,&nbsp;Ahmet Lutfu Sertdemir ,&nbsp;Enes Elvin Gul","doi":"10.1016/j.jelectrocard.2025.154182","DOIUrl":"10.1016/j.jelectrocard.2025.154182","url":null,"abstract":"<div><h3>Background</h3><div>Left bundle branch area pacing (LBBAP) has emerged as a promising physiological pacing strategy. Due to capture of either posterior or anterior fascicles there might be electrocardiograhic (ECG) changes associated with it. However, the prevalence and clinical relevance of left septal fascicular block (LSFB) following LBBAP remain poorly understood, with available data limited to isolated case reports.</div></div><div><h3>Methods</h3><div>This prospective, single-center study included 137 consecutive patients who underwent LBBAP between February 2024 and March 2025. Standard 12‑lead ECGs were obtained at baseline, at 24 h and one month post-implantation, with LSFB defined by established electrocardiographic criteria. Clinical, echocardiographic, biomarker, and procedural data were collected.</div></div><div><h3>Results</h3><div>Mean age was 67.4 ± 12.4 years. LSFB was identified in 40 patients (29 %) and was mostly common in patients with ischemic cardiomyopathy (52.5 % vs. 34.0 %, <em>p</em> = 0.04). Although post-implantation troponin levels showed a significant increase compared to baseline, patients with LSFB had similar level of increase in troponin compared to patients without (∆Troponin 34.3 vs 34.0, <em>p</em> = 0.52). Procedural success rates and pacing parameters were comparable between groups.</div></div><div><h3>Conclusion</h3><div>LSFB is a relatively common and clinically relevant finding after LBBAP, strongly associated with ischemic cardiomyopathy. These findings suggest LSFB may represent a marker of underlying ischemic vulnerability and warrant further investigation in larger multicenter cohorts.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"94 ","pages":"Article 154182"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145862405","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 value of electrocardiographic phenotypes based on conduction intervals and waveform amplitudes in acute anterior myocardial infarction","authors":"Masamichi Yano MD, PhD ,&nbsp;Yasuyuki Egami MD ,&nbsp;Noriyuki Kobayashi MD ,&nbsp;Ayako Sugino MD ,&nbsp;Masaru Abe MD ,&nbsp;Mizuki Ohsuga MD ,&nbsp;Hiroaki Nohara MD ,&nbsp;Shodai Kawanami MD ,&nbsp;Kohei Ukita MD ,&nbsp;Akito Kawamura MD ,&nbsp;Koji Yasumoto MD ,&nbsp;Naotaka Okamoto MD ,&nbsp;Yasuharu Matsunaga-Lee MD ,&nbsp;Masami Nishino MD, PhD","doi":"10.1016/j.jelectrocard.2025.154175","DOIUrl":"10.1016/j.jelectrocard.2025.154175","url":null,"abstract":"<div><h3>Background</h3><div>In patients with acute anterior myocardial infarction (MI), abnormalities in conduction intervals and waveform amplitudes observed on admission electrocardiograms may reflect the extent of myocardial damage. However, their prognostic significance following percutaneous coronary intervention (PCI) remains incompletely understood.</div></div><div><h3>Methods</h3><div>We enrolled consecutive patients undergoing emergent PCI for acute anterior MI and performed hierarchical cluster analysis based on P-wave duration (Pd), P-wave amplitude (PWA), PQ interval, QRS duration, and corrected QT interval (QTc). The primary outcome was a composite of heart failure hospitalization and all-cause mortality after PCI, which was compared across the identified phenogroups.</div></div><div><h3>Results</h3><div>A total of 426 patients were included. Optimal cut-off values for Pd, PWA (leads II, V2, and V6), PQ interval, QRS duration, and QTc in predicting the composite outcome were determined via receiver operating characteristic (ROC) curve analysis. Hierarchical clustering identified four distinct electrocardiographic phenotypes: Phenotype 1 (“Normal morphology”), Phenotype 2 (“Low PWA and wide QRS”), Phenotype 3 (“Prolonged Pd/PQ, low PWA, wide QRS, and prolonged QTc”), and Phenotype 4 (“Prolonged Pd/PQ”). Kaplan–Meier analysis revealed that Phenotype 3 was significantly associated with the highest risk of the composite outcome. This phenotype also exhibited the highest prevalence of atrial fibrillation, along with more frequent renal dysfunction and multivessel coronary artery disease, suggesting the coexistence of pre-existing atrial dysfunction and ventricular electrical–structural abnormalities possibly related to ischemia.</div></div><div><h3>Conclusions</h3><div>In patients with acute anterior MI undergoing PCI, electrocardiographic markers indicative of atrial dysfunction, particularly abnormal P-wave morphology, were significantly associated with adverse clinical outcomes.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"94 ","pages":"Article 154175"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145819368","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":"Ventricular fibrillation, atrial fibrillation, early repolarization and dynamic QT shortening: An unusual presentation of a storm","authors":"Abhinav B. Anand DM,&nbsp;Mohsin S. Shaikh MD,&nbsp;Pratap J. Nathani DM,&nbsp;Yash Y. Lokhandwala DM","doi":"10.1016/j.jelectrocard.2025.154159","DOIUrl":"10.1016/j.jelectrocard.2025.154159","url":null,"abstract":"<div><div>The coexistence of atrial fibrillation (AF) and ventricular fibrillation (VF) in a structurally normal heart is a rare presentation. We describe a case of a previously healthy, 30-year-old man presenting with a family history of sudden cardiac death. The ECG during admission showed early repolarization pattern and he spontaneously developed AF, junctional rhythm and VF and dynamic QT shortening with prominent U waves during the arrhythmic storm. Genetic testing revealed novel heterozygous missense substitution p.Ile73Val in exon 2 of the CACNA1C gene.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"94 ","pages":"Article 154159"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145594699","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":"Comment on “Deep inspiration as a diagnostic maneuver to differentiate accessory-pathway–induced ST elevation from inferior myocardial infarction”","authors":"Zhong-Qun Zhan MD","doi":"10.1016/j.jelectrocard.2025.154133","DOIUrl":"10.1016/j.jelectrocard.2025.154133","url":null,"abstract":"","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"94 ","pages":"Article 154133"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086294","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":"Diagnostic accuracy of 18-lead versus 12-lead electrocardiography in acute coronary syndrome: A systematic review and meta-analysis","authors":"Almaz Rehman Koolikad,&nbsp;Syed Ahmad Khan,&nbsp;Muhammad Shahzaib,&nbsp;Bushra Arif,&nbsp;Shivam Singla,&nbsp;Bhavna Singla,&nbsp;Muhammad Subhan,&nbsp;Abida Perveen,&nbsp;Jahanzeb Malik","doi":"10.1016/j.jelectrocard.2025.154161","DOIUrl":"10.1016/j.jelectrocard.2025.154161","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the diagnostic accuracy and clinical impact of 18‑lead electrocardiography compared with conventional 12‑lead ECG in patients with suspected acute coronary syndromes (ACS).</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis were conducted by searching PubMed, Embase, Scopus, and the Cochrane Library from inception to August 2025. Eligible studies compared 18‑lead with 12‑lead ECG using angiography, biomarkers, or imaging as reference standards. Data were extracted to construct 2 × 2 tables where available, and pooled sensitivity, specificity, and risk ratios were calculated using random-effects models. Risk of bias was assessed with QUADAS-2, and certainty of evidence was graded with GRADE.</div></div><div><h3>Results</h3><div>Seven studies met the inclusion criteria, of which four provided extractable diagnostic accuracy data (n ≈ 535). Across studies, 18‑lead ECG significantly improved sensitivity for posterior myocardial infarction (≈80–85 % vs 55–65 % with 12‑lead) and right ventricular infarction (≈78 % vs 58 %) while preserving specificity (≈90 %). Pooled analysis demonstrated a 34 % relative improvement in diagnostic yield (RR 1.34, 95 % CI 1.18–1.55; <em>p</em> &lt; 0.01). Approximately 10–15 % of patients initially classified as NSTEMI were reclassified as STEMI-equivalents using 18‑lead recordings. Evidence of earlier catheterization laboratory activation was noted in emergency department cohorts.</div></div><div><h3>Conclusion</h3><div>Eighteen‑lead ECG enhances detection of posterior and right ventricular infarctions without loss of specificity and supports earlier intervention. Broader clinical adoption and outcome-focused trials are warranted.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"94 ","pages":"Article 154161"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145668673","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 criteria and algorithms to identify the culprit artery in inferior wall infarction. Back to the basics","authors":"Anton P.M. Gorgels MD, PhD","doi":"10.1016/j.jelectrocard.2025.154154","DOIUrl":"10.1016/j.jelectrocard.2025.154154","url":null,"abstract":"","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"94 ","pages":"Article 154154"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781155","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":"Association of P-wave duration with all-cause and cardiovascular mortality in MASHAD cohort study","authors":"Hedieh Alimi ,&nbsp;Ali Tajik ,&nbsp;Mohsen Moohebati ,&nbsp;Alireza Heidari-Bakavoli ,&nbsp;Naghmeh Layegh Khavidaki ,&nbsp;Alireza Ghajari ,&nbsp;Zahra Ghazizadeh ,&nbsp;Habibollah Esmaily ,&nbsp;Gordon A. Ferns ,&nbsp;Sara Saffar Soflaei ,&nbsp;Majid Ghayour-Mobarhan","doi":"10.1016/j.jelectrocard.2025.154177","DOIUrl":"10.1016/j.jelectrocard.2025.154177","url":null,"abstract":"<div><h3>Background and objective</h3><div>P wave indices obtained from the electrocardiogram (ECG) serve as indicators of atrial conduction. P-wave duration (PWD) has been associated with various pathological conditions. The relationship between this factor and cardiovascular mortality remains insufficiently explored. To ascertain the association of PWD and cardiovascular and all-cause mortality in the MASHAD cohort study population.</div></div><div><h3>Method</h3><div>Participants were recruited from the Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) cohort study. Participants' demographic information were recorded by checklist. Additionally, a comprehensive medical history was collected to identify cardiovascular risk factors, and history of pre-existing cardiovascular disease (CVD). A 12‑lead electrocardiogram (ECG) was obtained from the participants and they were subsequently categorized into two groups based on their PWD (≥ 120 msec and &lt; 120 msec). All participants were followed for a minimum of 10 years for mortality assessment. We employed Cox regression to evaluate the relationship between PWD and cardiovascular and all-cause mortality. In order to evaluate the incremental predictive value of P wave duration, we calculated the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) at 10-year follow-up timepoint. Subsequently, we developed Kaplan-Meier plots, time-dependent ROC curves, and restricted cubic splines (RCS) to thoroughly evaluate the association between PWD and cardiovascular mortality. Subgroup analysis was conducted to evaluate the impact of PWD across various distinct groups.</div></div><div><h3>Results</h3><div>A total of 8885 participants were enrolled in the study. Prolonged PWD was associated with higher all-cause, cardiovascular mortality in unadjusted model. After controlling for covariates, PWD remained significantly associated with all-cause and cardiovascular mortality in continuous form of it. However, PWD in categorical form did not show significant association with cardiovascular mortality. The addition of P wave duration to the conventional model did not provide statistically significant improvement in risk reclassification or discrimination for either all-cause or cardiovascular mortality. The RCS models indicated that the PWD displayed a positive linear correlation with the risk of all-cause mortality across all models. The time-dependent ROC curve demonstrated favorable predictive performance for the adjusted models at both the 5-year and 10-year timepoints. The subgroup analysis revealed no interaction among the subgroups in our statistically significant multivariable models (all p for interaction &gt;0.05).</div></div><div><h3>Conclusion</h3><div>Continuous P-wave duration predicted all-cause and cardiovascular mortality, whereas the conventional 120 ms cut-off showed limited prognostic utility.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"94 ","pages":"Article 154177"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145819564","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 interpretation for pre-participation screening in athletes","authors":"Francesca Graziano MD ,&nbsp;Alessandro Zorzi MD, PhD ,&nbsp;Domenico Corrado MD, PhD","doi":"10.1016/j.jelectrocard.2025.154157","DOIUrl":"10.1016/j.jelectrocard.2025.154157","url":null,"abstract":"<div><div>The role of electrocardiography (ECG) in pre-participation screening (PPS) has long been debated, but accumulating evidence supports its importance in detecting cardiovascular diseases associated with sudden cardiac death (SCD). Its systematic use has contributed to a reduction in SCD incidence among athletes. Over the past two decades, interpretation standards have evolved, culminating in the International Criteria, which classify ECG findings as normal, borderline, or abnormal. Training-related and vagal tone–related changes are recognized as physiological variants, borderline alterations represent intermediate findings that require careful contextual interpretation, and abnormal patterns constitute true red flags that always warrant further investigation. Additional challenges concern special populations, including children, women, and master athletes, where training-induced remodeling and ECG expression may differ from young male cohorts on which the current criteria are based. While the International Criteria remain the reference framework, future updates are needed to refine thresholds, incorporate emerging evidence, and adapt to diverse athletic populations, with the ultimate goal of improving diagnostic accuracy and preventing SCD.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"94 ","pages":"Article 154157"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145594698","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 predictive value of fragmented QRS for severe coronary stenosis in patients undergoing coronary CT angiography","authors":"Eyyup Tusun M.D ,&nbsp;Necmettin Korucuk M.D ,&nbsp;Mustafa Çetin M.D ,&nbsp;Ali Nizami Elmas M.D","doi":"10.1016/j.jelectrocard.2025.154181","DOIUrl":"10.1016/j.jelectrocard.2025.154181","url":null,"abstract":"<div><h3>Background</h3><div>Coronary artery disease (CAD) is the leading cause of death worldwide. Fragmented QRS (fQRS) has emerged as a new prognostic marker in cardiovascular disease. Coronary computed tomography angiography (CCTA) is an effective method to diagnose obstructive CAD. The degree of stenosis determines the severity of the disease.</div></div><div><h3>Methods</h3><div>A total of 120 patients admitted to the cardiology outpatient clinic with angina pectoris symptoms were included in the study. The fQRS is defined as the presence of an additional R wave, notching of the R wave, notching of the nadir of the S wave in 2 contiguous leads, or the presence of more than one R' wave without a typical bundle branch block. CCTA was performed on patients with low-moderate risk. The patients were divided into two groups based on the presence (Group 1, <em>n</em> = 58 patients) or the absence (Group 2, <em>n</em> = 62 patients) of ≥70 % coronary artery stenosis.</div></div><div><h3>Results</h3><div>The baseline characteristics of the patients were not significantly different. Group 1 had a higher prevalence of DM, hyperlipidemia, smoking, and fQRS compared to Group 2 (<em>p</em> &lt; 0.05, for all). When the subjects were divided into two groups, fQRS (+) and fQRS (−), a statistically significant difference was revealed between the two groups (<em>p</em> &lt; 0.001). A positive correlation was found between fQRS and ≥ 70 % stenosis in CCTA. In the multivariate regression analysis, smoking and fQRS were independent predictors of ≥70 % stenosis in CCTA.</div></div><div><h3>Conclusion</h3><div>According to our study, fQRS, an important ECG finding, is associated with ≥70 % stenosis in CCTA and may be evaluated for the prediction of significant coronary stenosis.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"94 ","pages":"Article 154181"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145862453","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":"Septal notch plus loss of the septal q wave: A potential early ECG sign suggestive of interstitial septal fibrosis in heart disease","authors":"Zhong-Qun Zhan MD ,&nbsp;Xin-Yi Yu BMed","doi":"10.1016/j.jelectrocard.2025.154155","DOIUrl":"10.1016/j.jelectrocard.2025.154155","url":null,"abstract":"<div><h3>Background</h3><div>Early detection of interstitial septal fibrosis remains challenging. We describe a novel ECG pattern that may represent an early marker of fibrotic conduction changes.</div></div><div><h3>Case findings</h3><div>We evaluated a case demonstrating a triphasic QRS sequence evolving from narrow QRS (88 ms) to complete LBBB-like pattern (160 ms) within three beats. Notable features included: (i) a subtle notch within the initial 20 ms of QRS in leads II, V5 and V6; (ii) disappearance of physiological septal q waves in V5–V6; (iii) multiple notches in leads II, V4-V6; and (iv) late-QRS notching in leads III, aVL, aVF. These findings differed significantly from true LBBB criteria.</div></div><div><h3>Interpretation</h3><div>This ECG pattern may represent functional conduction alternans within fibrotic myocardium rather than anatomical His-Purkinje block. The presence of preserved rapid early forces, absence of mandatory mid-QRS notching in lateral leads, and reduced lateral voltage suggests myocardial conduction slowing rather than true complete LBBB.</div></div><div><h3>Limitations</h3><div>This is a single-case observation without confirmatory cardiac MRI or histopathology. Computer modeling referenced was not performed by our group. The proposed mechanism remains hypothetical and requires validation in prospective cohorts.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"94 ","pages":"Article 154155"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145682160","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}