Annals of Noninvasive Electrocardiology最新文献

{"title":"Commentary on the Predictive Value of P-Wave Dispersion and QTc Dispersion in Preeclampsia","authors":"Selda Murat, Ugur Keser, Bulent Gorenek","doi":"10.1111/anec.70185","DOIUrl":"10.1111/anec.70185","url":null,"abstract":"<p>We read with great interest the recent article by Zhi et al. investigating the predictive value of P-wave dispersion (PWD) and QTc dispersion (QTc-d) in pregnant women with preeclampsia (Zhi et al. <span>2026</span>). The authors report that both parameters were independently associated with preeclampsia and propose diagnostic cut-off values. Given that hypertensive disorders of pregnancy are increasingly recognized as markers of future cardiovascular risk, this study addresses a clinically relevant question. Nevertheless, several methodological aspects warrant further consideration.</p><p>First, the interpretation of “predictive value” should be approached cautiously given the cross-sectional design of the study. Electrocardiographic parameters and preeclampsia were assessed simultaneously, precluding any temporal relationship between ECG changes and disease development. It remains unclear whether these alterations precede preeclampsia or reflect secondary hemodynamic changes. Establishing true predictive value would require prospective studies with pre-diagnostic ECG assessment. This distinction between diagnostic association and true prediction is essential for clinical interpretation.</p><p>Second, the relatively small sample size (<i>n</i> = 185), with only 56 patients in the preeclampsia group, raises concerns about the robustness of the proposed diagnostic thresholds. Cut-off values derived from limited datasets are prone to overfitting and may lack reproducibility in external populations. The use of internal validation methods, such as bootstrapping or cross-validation, could have strengthened the reliability of the reported ROC-based thresholds (Collins et al. <span>2015</span>; Steyerberg et al. <span>2013</span>).</p><p>Third, the multivariable model included only ECG parameters without adjustment for key clinical confounders. Factors such as gestational age, parity, body mass index (BMI), and disease severity may influence ECG morphology and arrhythmogenic indices. Notably, BMI differed between groups, and obesity is known to affect ECG parameters, including P-wave characteristics (Dykiert et al. <span>2024</span>; Parikh et al. <span>2018</span>). Lack of adjustment may introduce residual confounding and affect the interpretation of the reported associations.</p><p>Fourth, the manual measurement of ECG parameters introduces the possibility of measurement bias. Although excellent interobserver agreement was reported, intraobserver variability was not described, and the method used to resolve discrepancies between observers was not specified. In addition, QT correction was performed using Bazett's formula, which is known to overcorrect QT intervals at higher heart rates. Considering the physiologically elevated heart rate during pregnancy, alternative correction methods such as Fridericia's formula may have provided more reliable QTc estimates in this population (Andršová et al. <span>2021</span>).</p><p>Finally, while PWD demonstra","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70185","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147589566","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":"Mixed Reality-Assisted Thoracic Endovascular Aortic Repair: A Retrospective Study on Efficacy and Safety","authors":"Jian-Jun Gu,&nbsp;Teng-Yue Zhao,&nbsp;Xiao-Chao Tian,&nbsp;Ying-Chao Ma","doi":"10.1111/anec.70184","DOIUrl":"10.1111/anec.70184","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the efficacy and safety of Mixed Reality (MR)-Assisted Thoracic Endovascular Aortic Repair (TEVAR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 46 patients with aortic dissection who underwent TEVAR. In the Control Group, Computed Tomography Angiography (CTA) was performed on the thoracic and abdominal aorta, after which surgery was performed based on traditional 2D imaging data. In the observation group, the Star Map HoloLens Image System was used for data processing and 3D modeling, and preoperative analysis and intraoperative path guidance were conducted with the MR Microsoft HoloLens Headset. The communication time, satisfaction, and anxiety after communication, as well as the operation duration, intraoperative blood loss, postoperative complications, and rehabilitation of these two groups were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study aimed to evaluate the perioperative outcomes of MR-guided stent placement. A total of 46 patients were equally divided into the MR group and control group (<i>n</i> = 23 each), with data analyzed via non-parametric tests. Compared with the control group, the MR group exhibited significantly shorter operation duration (70.91 ± 8.533 vs. 77.48 ± 8.474 min, <i>Z</i> = −2.785, <i>p</i> = 0.005), fewer fluoroscopy times (3.74 ± 1.214 vs. 5.61 ± 1.530, <i>Z</i> = −3.813, <i>p</i> &lt; 0.001), and less stent adjustments (1.65 ± 1.152 vs. 2.91 ± 1.411, <i>Z</i> = −2.765, <i>p</i> = 0.006), suggesting MR guidance may optimize perioperative efficiency.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Multimodal MR has an important auxiliary role in patient education, surgical planning, and accurate positioning of the surgical approach.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70184","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580159","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":"Alternative Lead ECG Placements","authors":"José Luis Morales-Arteaga,&nbsp;Amin Meghdadi,&nbsp;Derek Wu,&nbsp;Abdullah Bhuiyan,&nbsp;Nicole Langleben,&nbsp;Cengiz Burak,&nbsp;Emily Wilson,&nbsp;Ashley Pellerito,&nbsp;David Aristizábal,&nbsp;Keanu Razzaghi,&nbsp;Juan Maria Farina,&nbsp;Shyla Gupta,&nbsp;Adrian Baranchuk","doi":"10.1111/anec.70176","DOIUrl":"10.1111/anec.70176","url":null,"abstract":"<p>Electrocardiography (ECG) is a critical diagnostic tool for identifying cardiac conditions. While standard lead positions are widely used to ensure diagnostic accuracy, alternative lead placements have been developed to address specific clinical scenarios. These alternative configurations can overcome physical or technical challenges, enhance rhythm assessment, improve signal quality, and provide greater specificity for certain conditions, ultimately enabling more personalized diagnostic strategies. This paper examines the clinical significance of alternative ECG lead positions, highlighting their advantages, limitations, and potential applications in various clinical settings.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70176","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147525674","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 Predictors of Major Adverse Cardiovascular Events in Women With Suspected Ischemia and no Obstructive Coronary Artery Disease: Results of the Women's Ischemia Syndrome Evaluation","authors":"Jennifer R. Dungan,&nbsp;Yasmeen K. Taha,&nbsp;Qinglin Pei,&nbsp;Michael T. Weaver,&nbsp;Michael J. Tavormina,&nbsp;Steven E. Reis,&nbsp;Eileen M. Handberg,&nbsp;C. Noel Bairey Merz,&nbsp;Carl J. Pepine","doi":"10.1111/anec.70168","DOIUrl":"10.1111/anec.70168","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>An estimated four million individuals have suspected Ischemia and No Obstructive Coronary Arteries (INOCA), often due to coronary microvascular dysfunction, a subtype of ischemic heart disease that disproportionately affects women. Previously hypothesized as a benign condition, patients with INOCA demonstrate an elevated risk profile for major adverse cardiovascular events (MACE), yet biomarkers to inform this risk have not been identified.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To examine ECG indices as predictors of MACE among women with INOCA, we conducted a secondary analysis of the Women's Ischemia Syndrome Evaluation (WISE) original cohort in 481 women with suspected INOCA and complete data. Cox multivariable regression analysis was conducted in baseline ECG indices (intervals, rate, rhythm, and abnormalities) and their association with time-to-incident MACE (angina hospitalization, myocardial infarction, stroke, heart failure, revascularization with stent or angioplasty, or all-cause death). Cox proportional hazards modeling was performed as time from study enrollment to event censored on days to last contact, using stepwise backward selection and bootstrapping for model determination.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 165 (34.3%) experienced at least one MACE, including 26 (5.41%) all cause deaths, over an average follow-up time of 5.25 years. Significant predictors in the final model were resting heart rate (RHR), race, CHF, depression, and use of nitrates within 24 h of ECG measurement. Higher RHR was associated with increased hazards of incident composite MACE (adjusted hazard ratio 1.018, <i>p</i> = 0.0348).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Identifying unique biomarkers for MACE among women with INOCA is a clinical and research priority to inform screening and prevention strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70168","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147525741","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":"Heart Rate Variability in Newborns From Diabetic Mothers: Clinical Application and Significance","authors":"Virginia Beretta,&nbsp;Laura Cannavò,&nbsp;Sebastiano Ravenda,&nbsp;Chiara Petrolini,&nbsp;Vincenzo Raitano,&nbsp;Sabrina Moretti,&nbsp;Valentina Dell'Orto,&nbsp;Serafina Perrone","doi":"10.1111/anec.70173","DOIUrl":"10.1111/anec.70173","url":null,"abstract":"&lt;p&gt;Gestational diabetes mellitus (GDM) is defined as glucose intolerance first detected during pregnancy and is one of the most common conditions that can lead to pregnancy complications (American Diabetes Association &lt;span&gt;2003&lt;/span&gt;). GDM results from insufficient insulin production by pancreatic β-cells and increased insulin resistance in tissues. Normally, insulin resistance increases in pregnancy to provide nutrients to the fetus, and β-cells compensate by producing more insulin. However, when they fail to adapt, persistent high blood sugar levels lead to GDM (Lim et al. &lt;span&gt;2023&lt;/span&gt;).&lt;/p&gt;&lt;p&gt;Since 1995, Barker has hypothesized the influence of the intrauterine environment on fetal programming (Barker &lt;span&gt;1995&lt;/span&gt;). Today, the influence on the long-term programming of life processes is increasingly recognized. It has been shown that adverse maternal conditions, such as gestational diabetes (GDM) and early postnatal life, can influence offspring development, leading to long-term health problems in the newborn (Schlatterer and du Plessis &lt;span&gt;2021&lt;/span&gt;). Fetal programming, influenced by maternal hyperglycemia, stress, and inflammation, can lead to conditions like macrosomia and insulin resistance and predispose individuals to obesity, diabetes, and cardiovascular diseases later in life. Key factors include placental adaptations, altered nutrient transport, glucocorticoid regulation, and oxidative stress. Managing maternal health, including blood glucose control, is crucial to prevent adverse outcomes and reduce the risk of long-term diseases in the offspring (Mitanchez &lt;span&gt;2010&lt;/span&gt;).&lt;/p&gt;&lt;p&gt;GDM can alter fetal and neonatal physiology through a range of pathophysiological mechanisms that might impact both heart rate variability (HRV) (Sharma et al. &lt;span&gt;2022&lt;/span&gt;). HRV, influenced by autonomic modulation, represents a non-invasive tool to indirectly assess autonomic function at the cardiac level in newborns, although it does not provide a direct quantification of sympathetic or parasympathetic neural discharge (Statello et al. &lt;span&gt;2021&lt;/span&gt;). Consequently, HRV may be considered an indicator of early alterations in ANS development (Seifert et al. &lt;span&gt;2014&lt;/span&gt;; Chiera et al. &lt;span&gt;2020&lt;/span&gt;). In cases of pathology, evidence shows that HRV patterns are frequently altered and are often characterized by reduced HRV (Ali and Chen &lt;span&gt;2023&lt;/span&gt;; Agorastos et al. &lt;span&gt;2023&lt;/span&gt;). These variations in heart rate (HR) reflect potential early dysregulation in the balance between sympathetic and parasympathetic activity.&lt;/p&gt;&lt;p&gt;A reduced HRV has often been interpreted as reflecting altered autonomic balance, sometimes attributed to sympathetic predominance; however, the physiological interpretation of specific HRV components remains complex and context-dependent (Olivieri et al. &lt;span&gt;2024&lt;/span&gt;). Moreover, the decrease in neonatal HRV is associated with conditions such as intrauterine growth restriction (IUGR), prematu","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70173","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147525700","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":"Possible Deslanoside-Induced Left Posterior Fascicular Ventricular Tachycardia: A Case Report","authors":"Zhang Wenjun,&nbsp;Chen Yao","doi":"10.1111/anec.70166","DOIUrl":"10.1111/anec.70166","url":null,"abstract":"<p>Cardiac glycosides, including Deslanoside, are widely used for ventricular rate control in atrial fibrillation (AF). We report a 73-year-old man with paroxysmal AF and no structural heart disease who developed left posterior fascicular ventricular tachycardia (LPFVT) shortly after intravenous Deslanoside administration. A close temporal relationship was observed between drug administration and arrhythmia onset, with a shorter latency following a second intravenous dose. These findings suggest that Deslanoside may have facilitated LPFVT. This case highlights that cardiac glycosides, while effective for rate control, may occasionally precipitate Purkinje-related ventricular tachycardia.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70166","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147525726","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":"Conduction System Pacing Versus Biventricular Cardiac Resynchronization in HFmrEF: A Systematic Review and Meta-Analysis","authors":"Mounika Kotte,&nbsp;Imad Sibhai,&nbsp;Zaid Shaikh,&nbsp;Mohammed Amreliya,&nbsp;Jahanzeb Malik,&nbsp;Aadil Memon,&nbsp;Bhavna Singla,&nbsp;Shivam Singla,&nbsp;Muhammad Subhan,&nbsp;FNU Sandesh,&nbsp;Pooja Kumari,&nbsp;Abida Perveen","doi":"10.1111/anec.70174","DOIUrl":"10.1111/anec.70174","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare the efficacy and safety of conduction system pacing (CSP) versus biventricular pacing (BiVP) in patients with heart failure with mildly reduced ejection fraction (HFmrEF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and meta-analysis was conducted according to PRISMA guidelines. PubMed, Embase, and Cochrane databases were searched through August 2025. Studies enrolling patients with HFmrEF (left ventricular ejection fraction 41%–49%) who underwent CSP (His-bundle pacing [HBP] or left bundle branch pacing [LBBP]) or BiVP were included. Outcomes assessed included all-cause mortality, heart failure hospitalization (HFH), composite endpoints (death + HFH), echocardiographic and electrical remodeling, functional status, and procedural/device complications. Risk of bias was evaluated, and evidence was graded using the GRADE framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seven studies (<i>n</i> = 1867 patients) met inclusion criteria. Pooled analysis showed CSP reduced HFH (HR 0.63, 95% CI 0.49–0.82) and improved the composite outcome of death or HFH (HR 0.64, 95% CI 0.43–0.94) compared with BiVP. Mortality was similar between groups (HR 0.82, 95% CI 0.63–1.07). CSP resulted in greater QRS narrowing (MD −14 ms) and consistent trends toward functional improvement. Device-related complications were numerically lower with CSP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CSP, particularly LBBP, appears superior to BiVP in reducing HFH and enhancing electrical resynchronization in HFmrEF. Large randomized trials are warranted to confirm these findings and establish CSP as a standard resynchronization strategy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70174","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147525759","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":"Are Correlation Analyses Sufficient for Cardiac Output Method Comparison?","authors":"Halit Emre Yalvaç,&nbsp;Bülent Görenek","doi":"10.1111/anec.70182","DOIUrl":"10.1111/anec.70182","url":null,"abstract":"&lt;p&gt;We read with great interest the recent study by Wang et al. evaluating the accuracy of three transthoracic echocardiographic techniques—fractional shortening, Simpson's method, and LVOT velocity–time integral (VTI)—for the assessment of cardiac output and stroke volume in hemodynamically unstable patients (Wang et al. &lt;span&gt;2026&lt;/span&gt;). The authors should be commended for addressing an important clinical question regarding noninvasive hemodynamic monitoring in critically ill patients. As the use of invasive monitoring techniques has declined due to potential complications and costs, bedside echocardiography has emerged as an attractive alternative for cardiac output assessment (Monnet and Teboul &lt;span&gt;2017&lt;/span&gt;; Messina et al. &lt;span&gt;2023&lt;/span&gt;).&lt;/p&gt;&lt;p&gt;Nevertheless, several methodological aspects of the study merit further consideration when interpreting the reported findings. First, the study population is relatively small. Only 12 patients were included, and the total of 54 measurements represents repeated observations within the same individuals. Although repeated measurements increase the number of data points, the effective sample size remains limited, which may influence the statistical robustness and generalizability of the results. This issue becomes particularly relevant when interpreting the very high correlation coefficients reported for the LVOT-VTI method.&lt;/p&gt;&lt;p&gt;Second, the comparison between measurement techniques relied primarily on correlation analysis. While correlation coefficients describe the strength of association between two variables, they do not necessarily reflect agreement between measurement methods. In studies evaluating alternative hemodynamic monitoring techniques, agreement analyses—most commonly using Bland–Altman methodology—are generally considered more appropriate to determine whether two methods can be used interchangeably (Bland and Altman &lt;span&gt;1986&lt;/span&gt;). Incorporating such analyses could provide a clearer understanding of the actual agreement between transthoracic echocardiographic measurements and the reference technique.&lt;/p&gt;&lt;p&gt;Another point that warrants attention is the choice of reference method. In the present study, PiCCO monitoring was used as the comparator for echocardiographic measurements. Although PiCCO is widely used in critical care settings and has been validated in several clinical studies, it is not traditionally regarded as the definitive reference standard for cardiac output measurement, which has historically been pulmonary artery catheter thermodilution (Monnet and Teboul &lt;span&gt;2017&lt;/span&gt;). Consequently, the present comparison may be interpreted as an evaluation between two indirect measurement techniques rather than a strict validation against a gold-standard method.&lt;/p&gt;&lt;p&gt;Finally, the included patient population appears clinically heterogeneous, including patients with sepsis, acute coronary syndromes, gastrointestinal bleeding, and malignancy-related complications. These di","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70182","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147508985","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":"Comment on “Artificial Intelligence-Enhanced Electrocardiography for Predicting Paroxysmal Atrial Fibrillation From Sinus Rhythm”","authors":"Hadi Verdiyev,&nbsp;Bülent Görenek","doi":"10.1111/anec.70181","DOIUrl":"10.1111/anec.70181","url":null,"abstract":"&lt;p&gt;We read with great interest the recent article entitled “Artificial Intelligence-Enhanced Electrocardiography for Predicting Paroxysmal Atrial Fibrillation From Sinus Rhythm: Impact of Data Integration Across Institutions and Devices,” published in &lt;i&gt;Annals of Noninvasive Electrocardiology&lt;/i&gt;. The application of artificial intelligence (AI) to standard electrocardiograms (ECGs) recorded during sinus rhythm to identify individuals at risk of atrial fibrillation (AF) represents a rapidly evolving and highly promising field. Such approaches have the potential to improve early detection and screening strategies for AF. In this regard, the authors' effort to integrate datasets obtained from different institutions and devices is particularly valuable, as it may enhance the generalizability of AI-based models. Nevertheless, several methodological aspects of the study merit further clarification.&lt;/p&gt;&lt;p&gt;First, the time window used to define AF-positive cases deserves additional consideration. In the analysis, patients who developed AF within 31 days after an ECG recorded during sinus rhythm were classified as AF-positive. However, the rationale for selecting this specific interval is not clearly explained. In patients diagnosed with AF within such a short timeframe, it is conceivable that ECGs recorded during sinus rhythm may already reflect subtle electrical changes associated with subclinical AF that has not yet been clinically recognized. Consequently, the algorithm may be detecting imminent or previously unrecognized AF rather than predicting the development of future AF. This distinction has increasingly been highlighted as an important methodological issue in AI-based ECG research (Attia et al. &lt;span&gt;2019&lt;/span&gt;; Raghunath et al. &lt;span&gt;2021&lt;/span&gt;).&lt;/p&gt;&lt;p&gt;Second, the methods used to establish AF diagnosis are not described in sufficient detail. It remains unclear whether systematic rhythm monitoring strategies, such as prolonged Holter monitoring or implantable loop recorders, were employed during follow-up. If AF diagnoses were based primarily on routine clinical encounters, some episodes of paroxysmal AF may have gone undetected. As a result, patients with undiagnosed AF might have been included in the AF-negative group, potentially introducing bias into the labeling of the training dataset. Previous studies have demonstrated that a substantial proportion of paroxysmal AF episodes may be asymptomatic and therefore remain unrecognized during routine clinical evaluations (Xiong et al. &lt;span&gt;2015&lt;/span&gt;).&lt;/p&gt;&lt;p&gt;Another aspect worth considering is that the model was developed exclusively using ECG signal data. However, numerous clinical factors are known to influence AF risk, including age, hypertension, heart failure, and structural cardiac changes such as left atrial enlargement. Evaluating AI-ECG performance alongside clinical variables, or developing combined prediction models, may help clarify the incremental value of the algorithm beyond co","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70181","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147509025","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":"Letter to the Editor, “Association Between Renal Function and Left Atrial Low-Voltage Area Burden in Paroxysmal Atrial Fibrillation”","authors":"Ahmed Raza,&nbsp;Shahzadi Gulfishan","doi":"10.1111/anec.70178","DOIUrl":"10.1111/anec.70178","url":null,"abstract":"&lt;p&gt;We read with great interest the recently published study by Deng et al. (&lt;span&gt;2025&lt;/span&gt;) in &lt;i&gt;Annals of Noninvasive Electrocardiology&lt;/i&gt;, which investigated the relationship between estimated glomerular filtration rate (eGFR) and left atrial low-voltage area (LVA) burden in elderly patients with paroxysmal atrial fibrillation (AF). By demonstrating an inverse association between renal function and atrial substrate remodeling, the authors provide important insights into the interplay between chronic kidney disease (CKD) and atrial fibrosis, an area of growing relevance in contemporary electrophysiology. Their findings contribute meaningfully to pre-ablation risk stratification and highlight the potential value of renal function in anticipating substrate complexity. We commend the authors for addressing this important and underexplored topic; however, several limitations warrant consideration.&lt;/p&gt;&lt;p&gt;First, the retrospective single-center design increases susceptibility to selection and institutional procedural bias. Patients referred for ablation may not represent the broader CKD, AF population, and variations in mapping techniques, operator expertise, and voltage thresholds across centers may restrict external validity and generalizability. This may lead to over- or underestimation of the association between eGFR and LVA burden and limit applicability to other populations, ethnicities, and healthcare systems. Naruse et al. (&lt;span&gt;2011&lt;/span&gt;) demonstrated that CKD predicted AF recurrence after ablation in a multicenter cohort, while Yanagisawa et al. (&lt;span&gt;2017&lt;/span&gt;) emphasized the importance of multicenter validation in studies evaluating renal dysfunction and AF outcomes. Second, LVA burden was used as a surrogate for atrial fibrosis; however, voltage mapping is influenced by catheter contact, rhythm status, wall thickness, and mapping density, and does not always correspond directly to histologic fibrosis. Without late gadolinium enhancement cardiac MRI (LGE-MRI), substrate characterization remains incomplete, introducing measurement bias and limiting conclusions regarding true fibrosis burden. Marrouche et al. (&lt;span&gt;2014&lt;/span&gt;) showed that MRI-quantified atrial fibrosis independently predicts AF recurrence and offers a more direct structural assessment. Third, limited mapping resolution and voltage variability may affect accuracy. LVA was defined as &lt; 0.5 mV during sinus rhythm, yet bipolar voltage amplitude is influenced by electrode size, interelectrode spacing, catheter orientation, and contact force. Mapping density and rhythm variability further affect quantification. These methodological factors may result in misclassification of LVA burden, potentially attenuating or exaggerating its association with eGFR. Lin et al. (&lt;span&gt;2014&lt;/span&gt;) demonstrated that atrial substrate abnormalities vary depending on rhythm during mapping, and Masuda et al. (&lt;span&gt;2018&lt;/span&gt;) highlighted that voltage thresholds and mapping density cri","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70178","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147462650","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}