Annals of Noninvasive Electrocardiology最新文献

{"title":"Modifiable Risk Factors in Atrial Fibrillation: Clinical Implications and Pathophysiological Insights","authors":"Chamath Jagoda","doi":"10.1111/anec.70171","DOIUrl":"10.1111/anec.70171","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide, and its growing prevalence is increasingly driven by modifiable lifestyle and clinical factors. Understanding how obesity, hypertension, diabetes, obstructive sleep apnoea (OSA), alcohol intake, and cardiorespiratory fitness each contribute to AF onset, progression, and recurrence is essential for developing comprehensive prevention and treatment strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a narrative review of the available literature assessing six key modifiable risk factors for AF. Evidence was synthesized regarding each factor's pathophysiological effects on atrial structure and electrophysiology, as well as the impact of targeted interventions on arrhythmia burden and procedural outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Every 1 kg/m² increase in body mass index (BMI) raises AF risk by 50%, with sustained weight loss reversing atrial remodeling and improving arrhythmia-free survival. Hypertension increases atrial pressure, electrical heterogeneity, and fibrosis; resistant cases may benefit from adjunctive renal denervation. Diabetes promotes oxidative stress, profibrotic signaling, and autonomic neuropathy, reducing cardioversion success and antiarrhythmic efficacy. OSA induces intermittent hypoxia and sympathetic surges, destabilizing atrial substrates; CPAP therapy reduces remodeling and halves recurrence after cardioversion or ablation. Alcohol exerts dose-dependent ion-channel alterations, structural changes, and autonomic disruption. Cardiorespiratory fitness shows a U-shaped relationship: moderate exercise is protective, whereas endurance extremes and inactivity foster atrial stretch, fibrosis, and ectopic triggers. Across all factors, shared mechanisms of fibrosis, inflammation, and autonomic imbalance emerge as key therapeutic targets.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Integrating risk-factor modification into AF rhythm-control protocols addresses fundamental disease mechanisms and enhances procedural efficacy, offering clinicians a framework for prevention and therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12953207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147343550","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":"Worsening Heart Failure due to AV Dissociation From Safety Mode in CRT-P: A Case Requiring Urgent Generator Replacement","authors":"Yuki Osada,&nbsp;Nobuhiko Ueda,&nbsp;Toshihiro Nakamura,&nbsp;Kohei Ishibashi,&nbsp;Kengo Kusano","doi":"10.1111/anec.70167","DOIUrl":"10.1111/anec.70167","url":null,"abstract":"<p>Boston Scientific reported that dual chamber INGENIO family pacemakers or cardiac resynchronization therapy pacemakers (CRT-P) may initiate safety mode. Once Safety Mode is activated, telemetry with the programmer becomes unavailable. This case highlights worsening heart failure due to loss of atrioventricular synchronization associated with transition to Safety Mode and VVI pacing. Urgent admission for generator replacement was necessary because mode adjustment was not possible.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12953173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147343520","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":"The Predictive Value of P-Wave Dispersion and QTc Dispersion in Preeclampsia","authors":"Liting Zhi,&nbsp;Fei Shen,&nbsp;Lili Mei,&nbsp;Jianling Jin,&nbsp;Shili Jiang,&nbsp;Xingmei Huang,&nbsp;Wei Zhu","doi":"10.1111/anec.70170","DOIUrl":"10.1111/anec.70170","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>There is growing evidence that pregnant women with gestational hypertension are more likely to develop cardiovascular disease in the future, including arrhythmias. The objective of this study was to analyze changes in electrocardiogram (ECG) parameters in pregnant women with gestational hypertension and identify independent risk factors for preeclampsia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We collected the ECG data of 185 pregnant women and classified them into three groups: the first group was 68 healthy pregnant women in the third trimester, the second group was 61 pregnant women with gestational hypertension (without preeclampsia), and the third group was 56 pregnant women with preeclampsia. P-wave amplitude, P-wave dispersion (PWD), P-wave area (PWA), ventricular activation time (VAT), T-wave peak-to-end interval (Tp-e interval), maximum QTc interval (QTc max), and QTc dispersion (QTc-d) were measured.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ordered logistic regression revealed significant differences in PWD, QTc max, Tp-e interval, and QTc-d values among the three groups. However, only PWD and QTc-d values were significantly higher in the preeclampsia group than in the non-preeclampsia group by binary logistic regression. Using a cut-off of ≥ 35.5 ms for the PWD achieved an accuracy of 74.8% in diagnosing preeclampsia (sensitivity 92.86%, specificity 56.59%). Using a cut-off of ≥ 43.5 ms for the QTc-d achieved an accuracy of 91.8% (sensitivity 85.71%, specificity 84.50%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PWD and QTc-d were identified as independent ECG risk factors for preeclampsia. Monitoring these parameters may help screen high-risk pregnant women and improve the management of those with a history of gestational hypertension or preeclampsia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12949089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147316139","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":"Comparative Evaluation of Three Transthoracic Echocardiographic Techniques for Cardiac Output and Stroke Volume Assessment Across Hemodynamic States","authors":"Lei Wang,&nbsp;Da-Wei Wang,&nbsp;Rui-Ming Xu,&nbsp;Jian-Zhong Li,&nbsp;Jing Zhang","doi":"10.1111/anec.70162","DOIUrl":"10.1111/anec.70162","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study compared the accuracy of three transthoracic echocardiographic (TTE) techniques—fractional shortening (FS), left ventricular outflow tract velocity-time integral (LVOT/VTI), and Simpson's method—for measuring cardiac output (CO) and stroke volume (SV) in hemodynamically unstable patients (systolic pressure &lt; 90 mmHg), using pulse index continuous cardiac output (PiCCO) as the reference.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted involving 12 patients admitted to an Emergency Intensive Care Unit between October 2023 and October 2024, who underwent a total of 54 echocardiographic examinations. The median length of hospital stay is 14 days. CO and SV values obtained using the three TTE methods as part of routine assessment were compared with simultaneous PiCCO measurements. The median number of examinations for patients is 4. Statistical analysis was performed using correlation methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All three TTE methods demonstrated the capability to estimate CO and SV. The VTI method showed the highest overall accuracy (CO-VTI vs. CO-PiCCO: <i>r</i> = 0.950, <i>p</i>&lt; 0.001). Under reduced CO conditions, correlations between echocardiographic and PiCCO-derived measurements decreased for all methods; however, the VTI method maintained superior reliability (<i>r</i> = 0.606, <i>p</i> = 0.006). In contrast, the Simpson's method did not accurately reflect CO in this setting (SV-Simpson vs. SV-PiCCO: <i>r</i> = 0.408, <i>p</i> = 0.083). Notably, the performance of the VTI method remained consistent regardless of SV or heart rate variations (SV-VTI vs. SV-PiCCO: overall <i>r</i> = 0.970; with heart rate &gt; 100 bpm, <i>r</i> = 0.946; with heart rate ≤ 100 bpm, <i>r</i> = 0.988).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The LVOT/VTI method exhibits the highest accuracy and consistency for measuring SV and CO, making it the preferred non-invasive technique for hemodynamic evaluation in critically ill patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12932115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147281978","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":"The Effects of Supraphysiological Estrogen Levels Observed During In Vitro Fertilization Treatment on Cardiac Electrophysiology","authors":"Burhan Savaş,&nbsp;Dilay Gök Korucu,&nbsp;Gülay Gök","doi":"10.1111/anec.70160","DOIUrl":"10.1111/anec.70160","url":null,"abstract":"<p>Supraphysiological estradiol (E2) levels during in vitro fertilization (IVF) may influence cardiac electrophysiology, but this effect is not well defined. We prospectively evaluated the impact of high E2 concentrations induced by controlled ovarian hyperstimulation (COH) on electrocardiographic (ECG) parameters of atrial conduction and ventricular repolarization. To our knowledge, this is the first study to examine these detailed electrophysiological indices in the context of supraphysiological E2. This prospective observational study included 62 healthy women undergoing an IVF protocol. Standard 12-lead ECGs and serum hormone levels were obtained before stimulation (baseline E2 &lt; 50 pg/mL) and at peak E2 concentration. Changes in PR interval, corrected QT (QTc) interval, J-Tpeak (J-Tp) distance, and Tpeak-Tend (Tp-e) interval were analyzed with paired tests. COH produced a marked rise in E2 and significant prolongations in all cardiac intervals. From baseline to peak E2, PR increased from 138.50 ± 20.59 to 144.53 ± 19.31 ms (<i>p</i> = 0.007), QTc from 410.0 to 422.0 ms (<i>p</i> = 0.003), J-Tp from 208.74 ± 30.52 to 216.56 ± 30.98 ms (<i>p</i> = 0.005), and Tp-e from 80.00 to 83.50 ms (<i>p</i> &lt; 0.001). Supraphysiological E2 levels during IVF are associated with alterations in cardiac electrophysiology, including prolongation of atrial conduction and ventricular repolarization intervals. Although values remained within normal limits in healthy women, the observed QTc and Tp-e prolongation suggest a potential pro-arrhythmic substrate and highlight the importance of cardiac monitoring in IVF patients, particularly those with cardiovascular risk.</p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT07007416</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12922783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146257240","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":"The Fibrillatory Wave Amplitude of ECG Decreases Over Time in Patients With Persistent AF: A Retrospective Cohort Study","authors":"Jing Li,&nbsp;LingLi Wang,&nbsp;LeiLei Guo,&nbsp;ChunChang Qin","doi":"10.1111/anec.70161","DOIUrl":"10.1111/anec.70161","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>A prolonged history of atrial fibrillation (AF) is associated with increased recurrence rates, and ablation is not recommended for AF lasting over 10 years. In some developing countries, patients may be unaware of when their AF began. Electrocardiogram (ECG) changes may correlate with AF duration, so this study aims to use ECG to estimate AF duration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study analyzed 998 patients with persistent AF. AF duration was the exposure variable, F-wave amplitude and number of coarse F waves were outcomes. Correlations were evaluated using multiple linear regression, subgroup analysis, and smooth curve fitting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 998 participants, 50.2% were male, with a mean age of 73.0 years. The average F-wave amplitude was 0.1 mV, and the average number of coarse F waves was 6.0. Longer AF duration was significantly associated with lower F-wave amplitude and fewer coarse F waves. The highest quartile had significantly fewer coarse F waves (<i>β</i> = −4.94, 95% CI = −6.24 to −3.65, <i>p</i> &lt; 0.001) and lower amplitude (<i>β</i> = −0.02, 95% CI = −0.03 to −0.02, <i>p</i> &lt; 0.001) compared to the lowest quartile. A nonlinear inverse correlation was observed with cutoffs at 10.184 and 17.238 years. Additionally, left atrial dimension increased with longer AF duration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In patients with persistent AF, lower F-wave amplitudes and fewer coarse F waves are associated with a longer history of AF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12902899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146177366","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":"Commentary on: Outcomes of Intravenous Normal Saline Infusion Pre-Cardiac Implantable Electronic Devices Versus no Infusion in Fasting","authors":"Selda Murat,&nbsp;Ali Yıldız,&nbsp;Bektas Murat","doi":"10.1111/anec.70165","DOIUrl":"10.1111/anec.70165","url":null,"abstract":"<p>We read with great interest the article by Umair et al. entitled “<i>Outcomes of Intravenous Normal Saline Infusion Pre-Cardiac Implantable Electronic Devices</i> Versus <i>No Infusion in Fasting</i> (Umair et al. <span>2026</span>).” The authors are to be congratulated for addressing a practical and clinically relevant issue in daily electrophysiology practice. The study provides valuable real-world data on pre-procedural hydration strategies in patients undergoing cardiac implantable electronic device implantation.</p><p>The topic is particularly important, as venous access remains one of the key procedural challenges in fasting patients, and evidence guiding routine pre-procedural fluid administration is limited. In this regard, the authors' effort to explore the impact of intravenous saline infusion on procedural outcomes represents a meaningful contribution to the field.</p><p>We note that the Introduction refers to prior work by Ho et al. to support the concept of optimizing venous filling before vascular Access (Ho et al. <span>2022</span>). As this reference primarily focuses on puncture techniques, this highlights the limited and indirect nature of the existing evidence base regarding pre-procedural volume loading, further underscoring the novelty and clinical relevance of the present study.</p><p>In the Methods section, a pre-procedural saline infusion of 500–1000 mL is described. However, the reported mean infused volume appears to be lower in the Results and Discussion sections, and the authors also acknowledge limitations in the precise documentation of infusion volumes due to the retrospective design. This reflects a real-world practice pattern but also represents an important methodological limitation that should be considered when interpreting the findings.</p><p>Furthermore, although the study focuses on venous filling and vascular access, objective assessment tools such as ultrasonography, which has been shown to significantly increase first-attempt and overall success rates in venous cannulation compared with landmark techniques, were not addressed (Anderssen et al. <span>2025</span>; Liccardo et al. <span>2018</span>). This highlights an area for future investigation and potential refinement of pre-procedural strategies.</p><p>Despite these limitations, the study provides important preliminary insights into a commonly encountered clinical scenario and opens the door for further prospective and mechanistic research in this area. We believe this work will stimulate discussion and contribute to the optimization of peri-procedural management in patients undergoing device implantation.</p><p>S.M., B.M., and A.Y. drafted the letter. S.M. and B.M. critically revised the content. All authors approved the final version.</p><p>The authors declare no conflicts of interest.</p><p>Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12895356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146164115","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":"Artificial Intelligence-Enhanced Electrocardiography for Predicting Paroxysmal Atrial Fibrillation From Sinus Rhythm: Impact of Data Integration Across Institutions and Devices","authors":"Shinya Suzuki,&nbsp;Mari Amino,&nbsp;Nobumoto Moriai,&nbsp;Yoshifumi Sumioka,&nbsp;Akira Hyodo,&nbsp;Keiichi Satoh,&nbsp;Tsuneo Takayanagi,&nbsp;Takuya Umemoto,&nbsp;Yota Sekiguchi,&nbsp;Naomi Hirota,&nbsp;Atsuhiko Yagishita,&nbsp;Yuji Ikari,&nbsp;Taira Nakayama,&nbsp;Yoichi Ohnuki,&nbsp;Eiichiro Nagata,&nbsp;Jun Motogi,&nbsp;Takeshi Yamashita,&nbsp;Koichiro Yoshioka","doi":"10.1111/anec.70159","DOIUrl":"10.1111/anec.70159","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Artificial intelligence (AI)-enhanced electrocardiography (ECG) has been developed to detect paroxysmal atrial fibrillation (AF) from sinus rhythm ECGs (SR-ECGs). For broader applicability, model development across institutions and ECG systems is essential.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We developed an AI-enhanced ECG model using SR-ECGs from Tokai University (<i>n</i> = 172,613; Nihon Kohden [NK] system) and The Cardiovascular Institute (<i>n</i> = 19,170; GE MUSE system). AF-labeled SR-ECGs were defined as recordings within 31 days of an AF episode, while SR-labeled SR-ECGs were those with ≥ 1095 days of AF-free follow-up. Three datasets were constructed: Dataset 1 (Tokai University, all departments, NK), Dataset 2 (Tokai University, Cardiology Department, NK), and Dataset 3 (The Cardiovascular Institute, Cardiology Department, MUSE). We developed five models: scratch models (S1–S3) trained on Datasets 1–3, and fine-tuned models (F1, F2) trained on Datasets 1 and 2 after pretraining on Dataset 3. Models were evaluated using A1–A3 (same as Datasets 1–3) and B1–B3, which differed in ECG resolution and compression (B1: original MUSE, B2: MUSE-NK intermediate, B3: NK-converted).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Model F2, fine-tuned on homogeneous datasets from cardiology departments, showed consistently high performance (AUC: A1 = 0.885, A2 = 0.829, A3 = 0.845). Model F1, fine-tuned on heterogeneous datasets, demonstrated lower performance (AUC: A1 = 0.837, A2 = 0.726, A3 = 0.660). Model performance was consistent across different ECG format variants (B1–B3).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Fine-tuning on homogeneous data improved performance and generalizability, whereas heterogeneous data led to reduced performance. ECG system format differences had minimal impact on model accuracy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146140775","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":"Reconsidering ECG-Defined Atrial Cardiomyopathy in Population Studies of Stroke Mortality","authors":"Mucahit Yetim,&nbsp;Macit Kalçık","doi":"10.1111/anec.70164","DOIUrl":"10.1111/anec.70164","url":null,"abstract":"&lt;p&gt;We read with interest the article by Xia et al. examining the joint association of metabolic syndrome (MetS) and electrocardiographically defined atrial cardiomyopathy (AtCM) with stroke mortality in the general population (Xia et al. &lt;span&gt;2026&lt;/span&gt;). Using NHANES III data and deep terminal negativity of the P wave in V1 (DTNPV1) as a surrogate of AtCM, the authors report the highest stroke mortality risk among individuals with concomitant MetS and AtCM. The topic is clinically relevant and addresses an important gap regarding non-atrial fibrillation substrates of thromboembolism. However, several methodological and interpretative issues merit further consideration.&lt;/p&gt;&lt;p&gt;A major concern relates to the operational definition of AtCM based solely on DTNPV1. Contemporary consensus statements emphasize that atrial cardiomyopathy is a multidimensional construct incorporating electrical, structural, and functional abnormalities, ideally assessed through a multimodal approach including imaging and biomarkers (Goette et al. &lt;span&gt;2017&lt;/span&gt;). Reliance on a single ECG parameter may lead to misclassification and attenuate effect estimates, particularly in population-based cohorts where atrial remodeling is heterogeneous. Although sensitivity analyses with composite ECG markers were performed, the absence of imaging or biomarker validation limits the specificity of the AtCM phenotype.&lt;/p&gt;&lt;p&gt;The analytic sample selection may also affect external validity. Exclusion of participants without fasting samples or ECGs resulted in the removal of a substantial proportion of the original NHANES III cohort, yielding an older and more metabolically burdened population. While appropriate weighting preserves representativeness of the fasting subsample, the findings may not be generalizable to healthier or younger individuals. Prior population studies have shown that the prevalence and prognostic impact of metabolic risk factors vary considerably across age strata and cardiometabolic profiles (Mottillo et al. &lt;span&gt;2010&lt;/span&gt;), which should temper extrapolation of the reported hazard ratios to the broader population.&lt;/p&gt;&lt;p&gt;Another important limitation is the absence of longitudinal atrial fibrillation (AF) ascertainment. AtCM is increasingly recognized as a substrate predisposing to AF and thromboembolism, yet AF itself remains a strong mediator of stroke risk. Without baseline or incident AF data, residual confounding or mediation cannot be excluded. Although adjustment for P-wave indices partly addresses atrial electrical remodeling, these markers cannot fully substitute for rhythm surveillance. Prior work suggests that subclinical AF and atrial disease frequently coexist and jointly influence stroke outcomes (Kamel et al. &lt;span&gt;2015&lt;/span&gt;).&lt;/p&gt;&lt;p&gt;Finally, the clinical implications regarding anticoagulation warrant caution. While the authors suggest that individuals with both MetS and AtCM may benefit from preventive strategies, current evidence does not suppo","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12886742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146148952","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":"Hormonal Modulation of Ventricular Repolarization Dynamics During the Menstrual Cycle","authors":"Mucahit Yetim,&nbsp;Macit Kalçık","doi":"10.1111/anec.70163","DOIUrl":"10.1111/anec.70163","url":null,"abstract":"&lt;p&gt;We read with interest the article by San et al. examining the association between sex hormone fluctuations and ventricular repolarization dynamics across the menstrual cycle in women treated with QT-prolonging drugs (San et al. &lt;span&gt;2026&lt;/span&gt;). The authors should be acknowledged for conducting a prospective study with repeated ECG recordings and parallel hormone assessments, an approach that is technically demanding and rarely implemented. The focus on QT-Apex as an alternative marker of repolarization is also noteworthy. Nevertheless, several aspects of study design and interpretation warrant closer scrutiny.&lt;/p&gt;&lt;p&gt;A primary limitation is the small sample size and marked heterogeneity between the treatment and control groups. Women receiving dofetilide or sotalol were significantly older and had a substantially higher burden of cardiovascular comorbidities than controls, factors independently known to influence repolarization parameters (Lehmann et al. &lt;span&gt;1996&lt;/span&gt;). Although mixed-effects models were used, residual confounding related to age, structural heart disease, and atrial arrhythmia history cannot be excluded. This imbalance complicates attribution of observed QT-Apex changes solely to hormonal variation.&lt;/p&gt;&lt;p&gt;Second, the clinical significance of QT-Apex modulation remains uncertain. While prior work suggests that QT-Apex may capture early repolarization abnormalities, its relationship with hard arrhythmic outcomes is far less established than that of QTc (Haapalahti et al. &lt;span&gt;2011&lt;/span&gt;). The study reports statistically significant correlations measured in milliseconds, yet it remains unclear whether these modest changes translate into a meaningful difference in torsade de pointes risk. Without outcome data or established thresholds, interpretation should remain cautious.&lt;/p&gt;&lt;p&gt;Third, hormone assessment relied on single-day salivary measurements for each menstrual phase, which may not accurately reflect integrated hormonal exposure over the seven-day ECG recording periods. Sex hormone levels are known to exhibit substantial intra-phase variability, and single time-point sampling risks misclassification (Sedlak et al. &lt;span&gt;2012&lt;/span&gt;). More frequent or averaged measurements could have strengthened the biological plausibility of the reported associations.&lt;/p&gt;&lt;p&gt;Finally, extrapolation of these findings to broader clinical practice appears premature. The study population was limited to women treated with two class III antiarrhythmic agents, and results may not apply to other QT-prolonging drugs commonly prescribed in clinical practice. Prior literature demonstrates that drug-specific ion channel interactions and sex-related differences vary considerably across agents (Zareba &lt;span&gt;2007&lt;/span&gt;). Larger, outcome-oriented studies across multiple drug classes are required before hormonal status can be incorporated into arrhythmic risk stratification.&lt;/p&gt;&lt;p&gt;Sincerely,&lt;/p&gt;&lt;p&gt;All of the authors contributed planning, writing, and ","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12886746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146148963","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}