Annals of Noninvasive Electrocardiology最新文献

{"title":"Long-Term Effect of Percutaneous Transvenous Mitral Commissurotomy on Atrial Electromechanical Delay and P-Wave Dispersion in Patients With Severe Mitral Stenosis","authors":"Jahangir Rashid Beig,&nbsp;Wasim Rashid,&nbsp;Devinder Kumar,&nbsp;Inaamul Haq,&nbsp;Khawar Khan Achakzai,&nbsp;Khalid Mohiuddin Mir,&nbsp;Bashir A. Naiku,&nbsp;Nisar A. Tramboo","doi":"10.1111/anec.70140","DOIUrl":"10.1111/anec.70140","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Rheumatic heart disease (RHD) remains a significant health burden, particularly in low- and middle-income countries, with rheumatic mitral stenosis (MS) contributing substantially to cardiovascular morbidity and mortality. Percutaneous transvenous mitral commissurotomy (PTMC) is an effective treatment for symptomatic MS, yet its long-term impact on atrial electromechanical properties remains underexplored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a prospective observational study involving 53 patients (mean age 33.3 ± 6.44 years) who underwent successful PTMC for severe MS. Patients were followed up for a mean duration of 5.34 ± 0.55 years post-procedure. Atrial electromechanical parameters, including P-wave dispersion (PWD) and atrial electromechanical delay (AEMD), were assessed using electrocardiography and tissue Doppler echocardiography at baseline, 1 year, 3 years, and 5 years post-PTMC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>PTMC resulted in significant improvements in mitral valve area and gradients immediately post-procedure, which were sustained over the long term. AEMD showed statistically significant improvement at mean 3 years and 5.3 years post-PTMC, indicating enhanced electromechanical function. Conversely, PWD demonstrated gradual and significant improvement at intermediate follow-up, with stabilization after 3 years. Patients who developed atrial fibrillation (AF) or restenosis during follow-up exhibited higher baseline values, suggesting a potential predictive role for these parameters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study demonstrates that PTMC leads to sustained improvements in atrial electromechanical function indices over long-term follow-up. AEMD and PWD serve as valuable markers for assessing atrial remodeling post-PTMC, with implications for predicting AF and restenosis risk in patients with rheumatic MS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146140772","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":"Outcomes of Left Bundle Branch Area Pacing in Heart Failure Patients: A Systematic Review","authors":"Hina Ahmed Siddiqui,&nbsp;Mounika Kotte,&nbsp;Hilana Soliman Omar,&nbsp;Saad Manzoor,&nbsp;Zohaib Qasim,&nbsp;Fnu Abdullah,&nbsp;Sadia Siddique,&nbsp;Muhammad Bari Hassan,&nbsp;Ali Karim,&nbsp;Hansa Devi,&nbsp;Ekta Rani,&nbsp;Aniket Tara,&nbsp;Payal Bai,&nbsp;Sajid Ali,&nbsp;Hina Kumari,&nbsp;Sitara Jabeen,&nbsp;Vikram Kumar,&nbsp;Abida Perveen","doi":"10.1111/anec.70158","DOIUrl":"10.1111/anec.70158","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Left bundle branch area pacing (LBBAP) is an emerging physiological pacing technique that restores ventricular electrical synchrony by directly engaging the left conduction system. It has been proposed as an alternative to conventional pacing strategies, particularly in heart failure patients with reduced left ventricular ejection fraction (LVEF ≤ 50%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic literature search of PubMed, MEDLINE, and Scopus was conducted up to December 2024 in accordance with PRISMA guidelines. Sixteen studies involving 5680 patients were included. Reported outcomes included changes in LVEF, QRS duration (QRSd), hospitalization rates, complications, and mortality. Due to heterogeneity among studies, a qualitative narrative synthesis was performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>LBBAP was associated with significant improvements in cardiac function, with most studies reporting increased LVEF and marked reductions in QRSd, indicating improved electrical synchrony. Complication rates were low, with rare events such as pneumothorax and lead dislodgement. Heart failure–related hospitalizations were lower with LBBAP compared with biventricular pacing (19.05% vs. 30.00%), while mortality rates remained low across pacing strategies. Overall, LBBAP demonstrated superior electrical resynchronization and favorable clinical outcomes compared with conventional pacing modalities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>LBBAP is a promising pacing strategy that improves electrical synchrony and cardiac function with a favorable short- to mid-term safety profile. Further large-scale randomized studies are needed to establish its long-term efficacy and safety.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12865226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146103299","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":"Physician Perspectives on the Initial Diagnostic Strategy of Syncope in Older Patients Without Diagnostic Clues","authors":"Stephanie Happ,&nbsp;Satish R. Raj,&nbsp;Derek Chew,&nbsp;Robert Sheldon","doi":"10.1111/anec.70155","DOIUrl":"10.1111/anec.70155","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Syncope in adults at least 50 years old without structural or electrical heart disease has numerous potential causes, and uncertainty persists in up to 41% of patients. Guideline-directed investigations include implantable cardiac monitoring (ICM) and tilt table testing (TTT). Physician preferences about which to perform first are unknown. We aimed to understand physician opinions on whether to first utilize ICM or TTT to investigate syncope in older patients without electrical or structural heart disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Physicians assessing syncope patients completed an online survey about diagnostic strategy, test availability, and values about test accuracy and clinical consequences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventy-one physicians completed the survey; 77% were cardiac electrophysiologists. Most respondents (62%) felt the optimum first test depended on the clinical scenario, 30% preferred an ICM, and 8% preferred a TTT. Tests were widely available: both tests were present in 76% of sites, TTT alone in 3%, ICM alone in 18%, and neither in 3%. TTT was preferred in Europe (75%) while ICM was preferred in North America (85%; <i>p</i> = 0.024). Concerns about missed diagnoses were expressed about TTT by 61% of physicians and only 19% for ICM. Following a negative first test, physicians were more likely to recommend an ICM (39%) than a TTT (11%), and more likely to watchfully wait after a negative ICM (45%) than a negative TTT (11%; <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>International equipoise exists about whether to pursue strategies of first conducting a TTT or implanting an ICM, although opinions differ between physicians practicing in Europe and North America.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov identifier: NCT05776810</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146083818","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":"Sex Hormones and Repolarization Dynamics During the Menstrual Cycle in Women Treated With QT-Prolonging Drugs","authors":"Aneliya San,&nbsp;Ilan Goldenberg,&nbsp;Arwa Younis,&nbsp;Kris Cutter,&nbsp;Scott McNitt,&nbsp;Nona Sotoodehnia,&nbsp;Peter J. Kudenchuk,&nbsp;Thomas D. Rea,&nbsp;Dan E. Arking,&nbsp;Bronislava Polonsky,&nbsp;Wojciech Zareba,&nbsp;Mehmet Kemal Aktaş","doi":"10.1111/anec.70151","DOIUrl":"10.1111/anec.70151","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Women with congenital and acquired long QT syndrome (LQTS) have increased risk of adverse cardiac events after adolescence, mainly due to sex hormones modulating the KCNH2 cardiac potassium channel. We hypothesized that sex hormones may influence ventricular tachyarrhythmia risk during the menstrual cycle in women treated with QT-prolonging drugs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the association between repolarization dynamics and sex hormone levels during the menstrual cycle in women treated with QT-prolonging drugs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We prospectively enrolled 41 women treated with dofetilide or sotalol (<i>N</i> = 20) and healthy controls (<i>N</i> = 21). Participants underwent three 7-day ECG recordings during their menstrual cycles, with concurrent saliva hormone measurements. Primary ECG outcomes were QT-Apex (early repolarization) and QT interval (total repolarization time), adjusted for heart rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age was 51 ± 11 years in the treatment group and 42 ± 12 years in controls. In women treated with QT-prolonging drugs, linear mixed-effects models (adjusted for RR interval) showed inverse correlations of QT-Apex with progesterone-to-estradiol ratio (<i>p</i> = 0.018) and testosterone (<i>p</i> = 0.026), and a direct correlation with estradiol (<i>p</i> = 0.004). QT interval inversely correlated with progesterone-to-estradiol ratio (<i>p</i> = 0.012). No significant correlations were observed in controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Sex hormones are significantly associated with ventricular repolarization dynamics during the menstrual cycle in women treated with QT-prolonging drugs, suggesting a mechanism for sex-specific arrhythmia susceptibility.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12823772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146016990","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":"De Novo ACTN2 Variant in a Chinese Neonate With Left Ventricular Non-Compaction and Metabolic Disturbances: A Rare Case Report","authors":"Jinqiu Huang,&nbsp;Ziyue Zhang,&nbsp;Juxian Yang","doi":"10.1111/anec.70117","DOIUrl":"10.1111/anec.70117","url":null,"abstract":"<p>Left ventricular non-compaction (LVNC) is a rare cardiomyopathy characterized by prominent trabeculations and deep recesses. Neonatal cases, particularly with severe metabolic disturbances, are uncommon. We report a 2-day-old neonate with LVNC and dilated cardiomyopathy, presenting recurrent heart failure associated with hyperkalemia, metabolic acidosis, hyperlactatemia, and hypoglycemia. Management included mechanical ventilation, metabolic correction, and heart failure therapy, leading to improved cardiac function. Genetic analysis revealed a de novo heterozygous pathogenic <i>ACTN2</i> deletion spanning exons 2–6. This case broadens the phenotypic spectrum of <i>ACTN2</i>-related LVNC and suggests a potential link between metabolic disturbances and cardiac deterioration.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146008540","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":"Is Left Bundle Branch Pacing Feasible in Patients With Ventricular Septal Defect?","authors":"Binbin Luo,&nbsp;Longfu Jiang,&nbsp;Lu Zhang,&nbsp;Jiabo Shen","doi":"10.1111/anec.70150","DOIUrl":"10.1111/anec.70150","url":null,"abstract":"<p>His bundle typically passes through the central fibrous body of the atrioventricular node and then enters the membranous portion of the interventricular septum, where it branches into the left and right bundle branches. The feasibility and safety of left bundle branch area pacing (LBBAP) in patients with perimembranous ventricular septal defect (pmVSD) have not been reported.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12820410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146008563","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":"Impact of Esophageal Temperature Monitoring on Esophageal Injury in PVI: A Systematic Review and Meta-Analysis","authors":"Saad Manzoor,&nbsp;Mounika Kotte,&nbsp;Jahanzeb Malik,&nbsp;Bhavna Singla,&nbsp;Shivam Singla,&nbsp;Muhammad Subhan,&nbsp;Fnu Sandesh,&nbsp;Pooja Kumari,&nbsp;Abdullah Ashraf,&nbsp;Abida Perveen","doi":"10.1111/anec.70156","DOIUrl":"10.1111/anec.70156","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This meta-analysis aimed to evaluate the impact of esophageal temperature monitoring (ETM) on the incidence of esophageal injury during cryoballoon ablation (CBA) for atrial fibrillation (AF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search identified randomized controlled and observational studies comparing CBA procedures performed with versus without ETM. Data on study design, patient characteristics, procedural details, and esophageal outcomes were extracted. The primary endpoint was the incidence of endoscopically detected esophageal lesions (EDEL). Secondary outcomes included severe ulceration, symptomatic esophageal thermal injury (ETI), and atrioesophageal fistula (AEF). Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Risk of bias was assessed according to Cochrane guidelines, and publication bias was evaluated with funnel plots.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four studies comprising 269 patients were included. ETM significantly reduced the risk of EDEL compared with no ETM (pooled OR 0.57, 95% CI 0.39–0.85), with low to moderate heterogeneity. Subgroup analyses confirmed consistent benefits across randomized and observational designs. Severe esophageal ulceration and symptomatic ETI were infrequent, and no AEF cases were reported. Funnel plot analysis indicated no major publication bias.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ETM significantly lowers the incidence of esophageal injury during CBA and should be considered a routine safety measure to improve procedural outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12816882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003004","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":"Incessant Narrow QRS Complex Tachycardia in a Patient With a Prior Ablation History","authors":"Yi Liu,&nbsp;Yuwei Chen,&nbsp;Xiangbin Xiao,&nbsp;Xiaobo Pu","doi":"10.1111/anec.70154","DOIUrl":"10.1111/anec.70154","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>A 30-year-old woman with a history of prior ablation for a concealed left posteroseptal accessory pathway (AP) presented with incessant narrow QRS tachycardia, highlighting a rare complication of incomplete AP ablation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>Adenosine transiently terminated the tachycardia, which recurred immediately. Electrophysiology study confirmed orthodromic atrioventricular reentry tachycardia (AVRT) due to a slow-conducting AP at the previously ablated site. Three-dimensional mapping localized the AP to the left posteroseptal region, and radiofrequency ablation at the shortest VA interval successfully eliminated the arrhythmia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case illustrates incessant AVRT caused by an iatrogenic slow-conducting posteroseptal accessory pathway following incomplete ablation. Recognition of this mechanism is important to guide appropriate repeat ablation and prevent tachycardia-induced cardiomyopathy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12811688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145987827","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":"Electrocardiographic Markers of Atrial Cardiomyopathy: Strengths and Limits of P-Wave–Based Assessment","authors":"Mehmet Mustafa Yılmaz,&nbsp;Mücahit Aker,&nbsp;Macit Kalçık","doi":"10.1111/anec.70152","DOIUrl":"10.1111/anec.70152","url":null,"abstract":"&lt;p&gt;We read with interest the article by Kazantzi et al. examining the association between established P-wave parameters and left atrial hemodynamics in the context of atrial cardiomyopathy (ACM) (Kazantzi et al. &lt;span&gt;2026&lt;/span&gt;). The authors should be acknowledged for addressing a clinically relevant question using a prospective design and comprehensive echocardiographic assessment. Their conclusion that advanced interatrial block (IAB) is the most reliable electrocardiographic marker of impaired left atrial function is clearly presented and supported by internal consistency within the dataset.&lt;/p&gt;&lt;p&gt;Nevertheless, several methodological aspects warrant closer scrutiny. The study population is heterogeneous, comprising patients with prior atrial fibrillation, embolic stroke of undetermined source, and individuals without manifest cardiovascular disease. While this broad inclusion enhances external validity, it may dilute pathophysiologically specific associations between P-wave indices and atrial remodeling. Current consensus documents emphasize that ACM represents a spectrum with variable electrical, structural, and mechanical manifestations, and pooling such diverse phenotypes may obscure parameter-specific diagnostic performance (Goette et al. &lt;span&gt;2024&lt;/span&gt;).&lt;/p&gt;&lt;p&gt;A further concern relates to the operational definition of pathological P-wave parameters. Thresholds derived from consensus recommendations are largely based on epidemiological associations rather than mechanistic validation against atrial tissue pathology or gold-standard imaging. In particular, the dismissal of P-wave terminal force in lead V1 as a hemodynamic marker may reflect cohort characteristics rather than a true lack of biological relevance, given its previously demonstrated association with atrial fibrosis and stroke risk in population-based studies (Kamel et al. &lt;span&gt;2014&lt;/span&gt;).&lt;/p&gt;&lt;p&gt;Additionally, the reliance on cross-sectional echocardiographic markers limits causal inference. Left atrial strain and PA-TDI are sensitive indicators of atrial function, yet they remain load-dependent and subject to inter-vendor variability. Longitudinal assessment or correlation with advanced imaging modalities such as late gadolinium-enhanced cardiac magnetic resonance imaging could have strengthened the argument that advanced IAB truly captures the substrate of atrial cardiomyopathy rather than representing an epiphenomenon of aging and comorbidity burden (Bisbal et al. &lt;span&gt;2020&lt;/span&gt;).&lt;/p&gt;&lt;p&gt;Finally, the clinical implications of prioritizing advanced IAB over other P-wave parameters deserve cautious interpretation. While advanced IAB appears strongly associated with impaired atrial hemodynamics, its relatively low prevalence may limit utility as a screening tool. A multiparametric approach integrating electrocardiographic, echocardiographic, and biomarker data may better reflect the complex biology of ACM and align with contemporary views of atrial disease as a continuum r","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12784103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145931508","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":"Why Temporary Pacing in Acute Inferior Myocardial Infarction or No-Reflow Becomes a Trigger—Not a Remedy—For Ventricular Fibrillation: Undersensing, “R-On-T”, Catheter Trauma and the Ischaemic Substrate","authors":"Zhong-Qun Zhan,&nbsp;Hai-Jun Xu","doi":"10.1111/anec.70149","DOIUrl":"10.1111/anec.70149","url":null,"abstract":"<p>Temporary pacing during acute inferior MI or no-reflow can trigger ventricular fibrillation rather than prevent it. Four mechanisms are highlighted: (1) acute ischemia lowers VF threshold and creates repolarization heterogeneity; (2) fragmented electrograms cause undersensing and asynchronous spikes; (3) bradycardia-related long RR cycles position spikes on the T-wave (“R-on-T”); and (4) catheter micro-displacement induces mechanical extrasystoles. We propose a bedside decision framework—three questions before pacing—and a prevention bundle focused on urgent ischemia reversal, continuous electrogram surveillance, and early electrode removal. Bradycardia in this setting is often transient, but the electrophysiological vulnerability is not. Treating ischemia first and avoiding unnecessary pacing are paramount to prevent iatrogenic arrhythmia.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12784284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145931641","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}