Annals of Noninvasive Electrocardiology最新文献

{"title":"Heart Rate Variability in Newborns From Diabetic Mothers: Clinical Application and Significance","authors":"Virginia Beretta, Laura Cannavò, Sebastiano Ravenda, Chiara Petrolini, Vincenzo Raitano, Sabrina Moretti, Valentina Dell'Orto, Serafina Perrone","doi":"10.1111/anec.70173","DOIUrl":"10.1111/anec.70173","url":null,"abstract":"<p>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 <span>2003</span>). 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. <span>2023</span>).</p><p>Since 1995, Barker has hypothesized the influence of the intrauterine environment on fetal programming (Barker <span>1995</span>). 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 <span>2021</span>). 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 <span>2010</span>).</p><p>GDM can alter fetal and neonatal physiology through a range of pathophysiological mechanisms that might impact both heart rate variability (HRV) (Sharma et al. <span>2022</span>). 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. <span>2021</span>). Consequently, HRV may be considered an indicator of early alterations in ANS development (Seifert et al. <span>2014</span>; Chiera et al. <span>2020</span>). In cases of pathology, evidence shows that HRV patterns are frequently altered and are often characterized by reduced HRV (Ali and Chen <span>2023</span>; Agorastos et al. <span>2023</span>). These variations in heart rate (HR) reflect potential early dysregulation in the balance between sympathetic and parasympathetic activity.</p><p>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. <span>2024</span>). 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}

{"title":"Fibrillatory Wave Amplitude: A Marker of Atrial Remodeling Rather Than a Chronological Clock?","authors":"Emre Şener,&nbsp;Bektaş Murat,&nbsp;Bülent Görenek","doi":"10.1111/anec.70175","DOIUrl":"10.1111/anec.70175","url":null,"abstract":"&lt;p&gt;We have meticulously reviewed the study by Li et al. (&lt;span&gt;2026&lt;/span&gt;), which proposes surface electrocardiogram (ECG) fibrillatory wave (f-wave) amplitude as a noninvasive surrogate for atrial fibrillation (AF) duration. While we commend the authors for their impressive sample size and the pragmatic pursuit of simple ECG markers, we believe that certain physiological and methodological paradoxes inherent in the study design warrant a more critical appraisal.&lt;/p&gt;&lt;p&gt;First, the core premise of the study using f-wave amplitude to “date” AF assumes a linear temporal decline in voltage that may not account for the biological heterogeneity of atrial cardiomyopathy. Current evidence suggests that f-wave amplitude is primarily a reflection of the degree of atrial fibrosis and low-voltage zones rather than a simple chronological “clock” (Yin et al. &lt;span&gt;2017&lt;/span&gt;). By defining AF duration based on retrospective clinical records, which are notoriously prone to underestimating the silent burden of AF (Hindricks et al. &lt;span&gt;2021&lt;/span&gt;), the study risks a “circular validation.” In essence, the authors may be correlating an imprecise ECG marker with an equally imprecise clinical variable, potentially leading to overoptimistic conclusions regarding its predictive power.&lt;/p&gt;&lt;p&gt;Second, the reliance on lead V1 for manual amplitude assessment introduces significant confounding variables. Surface ECG amplitudes are highly sensitive to extracardiac factors, including chest wall impedance and electrode positioning. Without normalizing the f-wave amplitude to the QRS complex or utilizing automated signal processing to minimize interobserver variability, the clinical generalizability of a few millivolts' difference remains questionable. Recent data in this Journal (Relander et al. &lt;span&gt;2024&lt;/span&gt;) emphasize the need for robust morphological analysis when linking f-waves to clinical outcomes, suggesting that amplitude alone may be too simplistic a metric.&lt;/p&gt;&lt;p&gt;Third, the lack of formal diagnostic performance metrics, such as a Receiver Operating Characteristic (ROC) analysis to identify specific cutoff values for AF duration (e.g., &gt; 10 years), limits the practical utility for the clinician. If the goal is to assist in the decision-making process for catheter ablation, the study must move beyond statistical correlation and provide clinically actionable thresholds with defined sensitivity and specificity.&lt;/p&gt;&lt;p&gt;In conclusion, while the findings of Li et al. (&lt;span&gt;2026&lt;/span&gt;) are hypothesis-generating, the translation of these markers into clinical practice requires validation against objective measures of atrial substrate, such as delayed-enhancement MRI or invasive electroanatomical mapping. We invite the authors to clarify how they accounted for the dominant influence of structural remodeling (Allessie et al. &lt;span&gt;2002&lt;/span&gt;) over purely temporal AF history.&lt;/p&gt;&lt;p&gt;Emre Şener and Bektaş Murat read the article and write the letter. Bülent Görenek contr","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70175","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147455298","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":"Critique on the Fibrillatory Wave Amplitude of ECG Decreases Over Time in Patients With Persistent AF","authors":"Ahmed Raza,&nbsp;Shahzadi Gulfishan","doi":"10.1111/anec.70177","DOIUrl":"10.1111/anec.70177","url":null,"abstract":"&lt;p&gt;We read with great interest the article by Li et al. (&lt;span&gt;2026&lt;/span&gt;) “The Fibrillatory Wave Amplitude of ECG Decreases Over Time in Patients With Persistent AF,” which provides valuable insight into noninvasive markers of atrial remodeling. In this retrospective cohort of 998 patients, the authors show a significant inverse, nonlinear association between AF duration and both fibrillatory wave amplitude and coarse F-waves in lead V1, with thresholds at 10.184 and 17.238 years. Their large sample, robust modeling, and focus on a simple ECG parameter offer practical utility for estimating AF chronicity, particularly in settings lacking advanced diagnostics. Nonetheless, several limitations warrant consideration.&lt;/p&gt;&lt;p&gt;The study by Li et al. offers valuable insight into the relationship between atrial fibrillation (AF) duration and fibrillatory wave amplitude, yet several limitations temper its conclusions. First, AF duration was derived from hospital records, which risks misclassification since AF onset is often silent. This underestimation may distort the nonlinear thresholds identified and weaken the observed inverse association, as highlighted by Steinberg et al. (&lt;span&gt;2014&lt;/span&gt;) who showed AF is frequently asymptomatic and undetected. Second, F-wave amplitude was measured manually without reporting interobserver reliability. Manual assessment introduces bias and variability, and given the small effect sizes, even minor measurement error could alter statistical significance. Bollmann et al. (&lt;span&gt;1998&lt;/span&gt;) demonstrated that automated spectral analysis improves reproducibility, underscoring the need for objective methods. Third, the study lacks structural validation. Declining F-wave amplitude was interpreted as progressive fibrosis, yet no voltage mapping, LGE-MRI, or histopathology was performed. Without such correlation, the link between amplitude and remodeling remains speculative. Evidence from Marrouche et al. (&lt;span&gt;2014&lt;/span&gt;) in the DECAAF study shows that imaging-based fibrosis quantification predicts AF recurrence, highlighting the importance of structural validation. Fourth, medication effects were insufficiently controlled. While amiodarone users were excluded, other agents such as beta-blockers, calcium channel blockers, digoxin, ACE inhibitors, and statins can influence atrial conduction and ECG morphology. Unmeasured pharmacologic confounding may therefore bias results, as shown by Nault et al. (&lt;span&gt;2009&lt;/span&gt;) and Saksena et al. (&lt;span&gt;2018&lt;/span&gt;) who reported drug effects on atrial activation and fibrillatory wave characteristics. Finally, survival bias is a concern in patients with AF duration exceeding 10 years. These individuals represent survivors who avoided death from stroke or heart failure and were not referred for early ablation, forming a distinct subgroup with potentially milder disease. This selection effect may distort the nonlinear associations observed, echoing Schnabel et al. (&lt;span&gt;2012&lt;/span&gt;)","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70177","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147442169","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":"Inferior-Lead Lambda (λ) Wave Revealing Critical Right Coronary Artery Stenosis: A Case Report","authors":"Jian Xiong,&nbsp;Djandan Tadum Arthur Vithran,&nbsp;Jingjing Chai,&nbsp;Zheng Cao,&nbsp;Zhixiao Wang,&nbsp;Xiaoyong Hu","doi":"10.1111/anec.70169","DOIUrl":"10.1111/anec.70169","url":null,"abstract":"<p>Lambda (λ) waves are uncommon ECG markers of malignant arrhythmias, usually associated with channelopathies or transient ischemia. We report a 34-year-old man with recurrent syncope preceded by subxiphoid chest pain and diaphoresis. Admission ECG showed λ-like morphology in the inferior leads with dynamic ST changes. Laboratory tests and echocardiography were normal, while Holter monitoring demonstrated persistent ST-segment depression. Coronary angiography revealed diffuse right coronary artery disease with a critical 95% stenosis, treated with drug-eluting stent placement. ECG abnormalities resolved after PCI, and syncope did not return. Serial angiography over 3.5 years confirmed sustained stent patency.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12966345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147368750","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":"Temporal Characteristics and Management of Prolonged Sinus Pause Following Atrial Fibrillation Termination After Catheter Ablation—A Preliminary Study","authors":"Yi Guo,&nbsp;Cheng Cai,&nbsp;Hongwu Chen,&nbsp;Kai Gu,&nbsp;Weizhu Ju,&nbsp;Gang Yang,&nbsp;Jiaojiao Shi,&nbsp;Zidun Wang,&nbsp;Hailei Liu,&nbsp;Xiaohong Jiang,&nbsp;Chang Cui,&nbsp;Mingfang Li,&nbsp;Minglong Chen","doi":"10.1111/anec.70172","DOIUrl":"10.1111/anec.70172","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Prolonged sinus pause (PSP) after atrial fibrillation (AF) termination shortly after catheter ablation seems to be a reversible phenomenon without further need for pacemaker implantation (PMI). However, no mature management strategy has been established.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective observational study, we included consecutive patients who developed PSP ≥ 3 s upon AF termination during hospitalization following AF ablation at our center between October 2020 and October 2022. Regular follow-up was conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twelve patients (mean age 66.3 ± 8.5 years; 7 females) were included. PSP ≥ 3 s upon AF termination initiated at a median of 2.0 days (IQR: 1.3–3.8) post-ablation and resolved by 5.0 days (IQR: 3.5–7.5). Three patients received temporary PMI, all of which were removed before discharge without further pacing. One patient underwent permanent PMI during hospitalization due to Adams-Stokes syndrome. After discharge, one patient received permanent pacing for symptomatic sinus arrest at 3 months, and another underwent atrioventricular node ablation followed by permanent pacing due to recurrent arrhythmia. The remaining patients had no related symptoms or need for pacing during follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PSP ≥ 3 s upon AF termination shortly after catheter ablation appears to be reversible. A watch-and-wait strategy was practical. Management may involve discontinuation of antiarrhythmic drugs or temporary pacing support. A small proportion of patients may ultimately require permanent PMI.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12963023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363687","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}