Pub Date : 2024-11-22DOI: 10.1016/j.jelectrocard.2024.153837
Vladimir Shusterman , Cees A. Swenne , Stacy Hoffman , Patrick J. Strollo , Barry London
We present a concise review of the background, pitfalls, and potential solutions for the noninvasive evaluation and continuous tracking of cardiac autonomic nervous system activity (ANSA), using surface-ECG-accessible parameters, including heart rate (HR), heart-rate variability (HRV), and cardiac repolarization. These parameters have provided insights into the dynamics of cardiac ANSA in controlled experiments and have proved useful in risk assessment with respect to sudden cardiac death and all-cause mortality in some patient populations, as well as in implantable device programming. Yet attempts to translate these parameters from the laboratory environment to ambulatory settings have been hampered by the presence of multiple uncontrolled factors, including changes in blood pressure, body position, physical activity, and respiration frequency. We show that a single-parameter-based, simplified cardiac ANSA evaluation in an uncontrolled ambulatory setting could be inaccurate, and we discuss several approaches to improve accuracy. Discerning cardiac ANSA effects in uncontrolled ambulatory environments requires tracking multiple physiological processes, preferably using multisensor, multiparametric monitoring and controlling some physiological variables (e.g., respiration frequency); data fusion and machine-learning-based analytics are instrumental for developing more accurate personalized ANSA evaluation.
{"title":"Tracking autonomic nervous system activity using surface ECG: Personalized, multiparametric evaluation","authors":"Vladimir Shusterman , Cees A. Swenne , Stacy Hoffman , Patrick J. Strollo , Barry London","doi":"10.1016/j.jelectrocard.2024.153837","DOIUrl":"10.1016/j.jelectrocard.2024.153837","url":null,"abstract":"<div><div>We present a concise review of the background, pitfalls, and potential solutions for the noninvasive evaluation and continuous tracking of cardiac autonomic nervous system activity (ANSA), using surface-ECG-accessible parameters, including heart rate (HR), heart-rate variability (HRV), and cardiac repolarization. These parameters have provided insights into the dynamics of cardiac ANSA in controlled experiments and have proved useful in risk assessment with respect to sudden cardiac death and all-cause mortality in some patient populations, as well as in implantable device programming. Yet attempts to translate these parameters from the laboratory environment to ambulatory settings have been hampered by the presence of multiple uncontrolled factors, including changes in blood pressure, body position, physical activity, and respiration frequency. We show that a single-parameter-based, simplified cardiac ANSA evaluation in an uncontrolled ambulatory setting could be inaccurate, and we discuss several approaches to improve accuracy. Discerning cardiac ANSA effects in uncontrolled ambulatory environments requires tracking multiple physiological processes, preferably using multisensor, multiparametric monitoring and controlling some physiological variables (e.g., respiration frequency); data fusion and machine-learning-based analytics are instrumental for developing more accurate personalized ANSA evaluation.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"88 ","pages":"Article 153837"},"PeriodicalIF":1.3,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142746453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-22DOI: 10.1016/j.jelectrocard.2024.153830
Tipparaju Hasitha MBBS Intern , Nikhil Singhania MBBS, MD , Suresh Kumar Sukumaran MBBS, MD, DM , Raja J. Selvaraj MBBS, MD, DNB, PDF in Cardiac Electrophysiology
Background
The Electrocardiogram (ECG) can be visualised either in a scalar form, as waves in the standard 12‑lead ECG, or vectorially, as vector loops in different planes in the Vectorcardiogram (VCG). An Electro-Vectorcardiogram (ECG-VCG) is a graphic visualization combining scalar and vector ECGs. We aimed to assess if integrating the scalar 12‑lead ECG and vector ECG makes ECG interpretation by medical students more accurate, faster, and easier than using 12‑lead ECG alone.
Methods
Undergraduate medical students were randomised into ECG group and ECG-VCG group. The students received a web-based tutorial followed by a test. The ECG group were taught with and had to interpret standard 12‑lead ECG images, while the ECG-VCG group were taught and had to interpret ECG-VCG images with two-dimensional VCG panels (frontal and horizontal) of the same diagnosis. On completion, participants reported their ease of interpretation as grades. Test scores, time taken and ease were compared between the groups.
Results
The study included 296 medical students. The primary outcome, interpretation accuracy (test score out of 10), was significantly greater in the ECG-VCG group (7.34 ± 2.13 vs 6.09 ± 2.34, p < 0.001). The time taken for interpretation was significantly lower and ease of interpretation was significantly greater in the ECG-VCG group.
Conclusion
The use of ECG-VCG to teach undergraduate medical students can outperform the 12‑lead ECG in terms of accuracy, speed and ease.
{"title":"Ease and accuracy of ECG interpretation using 12-lead ECG versus a combination of 12-lead and vector ECG (electro-vectorcardiogram) by medical students: A prospective, randomised controlled study","authors":"Tipparaju Hasitha MBBS Intern , Nikhil Singhania MBBS, MD , Suresh Kumar Sukumaran MBBS, MD, DM , Raja J. Selvaraj MBBS, MD, DNB, PDF in Cardiac Electrophysiology","doi":"10.1016/j.jelectrocard.2024.153830","DOIUrl":"10.1016/j.jelectrocard.2024.153830","url":null,"abstract":"<div><h3>Background</h3><div>The Electrocardiogram (ECG) can be visualised either in a scalar form, as waves in the standard 12‑lead ECG, or vectorially, as vector loops in different planes in the Vectorcardiogram (VCG)<strong>.</strong> An Electro-Vectorcardiogram (ECG-VCG) is a graphic visualization combining scalar and vector ECGs. We aimed to assess if integrating the scalar 12‑lead ECG and vector ECG makes ECG interpretation by medical students more accurate, faster, and easier than using 12‑lead ECG alone.</div></div><div><h3>Methods</h3><div>Undergraduate medical students were randomised into ECG group and ECG-VCG group. The students received a web-based tutorial followed by a test. The ECG group were taught with and had to interpret standard 12‑lead ECG images, while the ECG-VCG group were taught and had to interpret ECG-VCG images with two-dimensional VCG panels (frontal and horizontal) of the same diagnosis. On completion, participants reported their ease of interpretation as grades. Test scores, time taken and ease were compared between the groups.</div></div><div><h3>Results</h3><div>The study included 296 medical students. The primary outcome, interpretation accuracy (test score out of 10), was significantly greater in the ECG-VCG group (7.34 ± 2.13 vs 6.09 ± 2.34, <em>p</em> < 0.001). The time taken for interpretation was significantly lower and ease of interpretation was significantly greater in the ECG-VCG group.</div></div><div><h3>Conclusion</h3><div>The use of ECG-VCG to teach undergraduate medical students can outperform the 12‑lead ECG in terms of accuracy, speed and ease.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"88 ","pages":"Article 153830"},"PeriodicalIF":1.3,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-22DOI: 10.1016/j.jelectrocard.2024.153833
Akira Sato , Takuya Takahashi , Seiko Kuwata , Satoshi Nakano , Junichi Koizumi , Hirofumi Saiki , Manami Akasaka
Here we report the case of a 10-year-old boy with long QT syndrome type 3 (LQT3) who developed refractory torsade de pointes (TdP) associated with ventricular arrhythmia with a short coupling time (VASCT). After implantable cardioverter-defibrillator replacement, an electrical storm occurred, which was irresponsive to the ventricular pacing as high as 120 bpm. Close inspection of the intracardiac potential revealed TdP associated with VASCT. Dexmedetomidine and verapamil were effective in controlling TdP, which allowed management with slower ventricular pace. Our case highlights the importance of focusing on ventricular arrhythmias particularly those with short coupling interval, in LQT3 with refractory TdP. (99 words).
{"title":"Electrical storm induced by premature ventricular beat with extremely short coupling interval in a patient with long QT syndrome type 3","authors":"Akira Sato , Takuya Takahashi , Seiko Kuwata , Satoshi Nakano , Junichi Koizumi , Hirofumi Saiki , Manami Akasaka","doi":"10.1016/j.jelectrocard.2024.153833","DOIUrl":"10.1016/j.jelectrocard.2024.153833","url":null,"abstract":"<div><div>Here we report the case of a 10-year-old boy with long QT syndrome type 3 (LQT3) who developed refractory torsade de pointes (TdP) associated with ventricular arrhythmia with a short coupling time (VASCT). After implantable cardioverter-defibrillator replacement, an electrical storm occurred, which was irresponsive to the ventricular pacing as high as 120 bpm. Close inspection of the intracardiac potential revealed TdP associated with VASCT. Dexmedetomidine and verapamil were effective in controlling TdP, which allowed management with slower ventricular pace. Our case highlights the importance of focusing on ventricular arrhythmias particularly those with short coupling interval, in LQT3 with refractory TdP. (99 words).</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"88 ","pages":"Article 153833"},"PeriodicalIF":1.3,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142699142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-21DOI: 10.1016/j.jelectrocard.2024.153832
Deling Chen , Yuchen Yao , Ethan D. Moser , Wendy Wang , Elsayed Z. Soliman , Thomas Mosley , Wei Pan
Aim
Create an ECG-based model to predict dementia and compare its performance with the existing Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) model.
Methods and Results
Participants without prevalent dementia in the Atherosclerosis Risk in Communities study were studied. Visit 4 (V4) (1996–98, mean age, 62 years) and V5 (2011–13, mean age, 75 years) were used as baselines. Incident dementia cases were adjudicated through 2019. We created parsimonious ECG models by using Cox regression with a backward selection method. C-statistic (95 % CI) of the ECG-based model (two or three ECG variables and age) was higher than the CAIDE model (seven variables) at V4 (0.72 [0.71–0.74] vs. 0.67 [0.66–0.68]) and V5 (0.70 [0.68–0.72] vs. 0.64 [0.62–0.66]). The ECG-based model was well calibrated, but the CAIDE model was poorly calibrated at V4 (P < 0.001).
Conclusion
For middle-aged and older adults, a novel ECG-based model has good discrimination that is superior to the CAIDE model in predicting dementia. Since ECG variables are readily obtainable, the ECG-based model will be easy to adopt clinically.
{"title":"A novel electrocardiogram-based model for prediction of dementia—The Atherosclerosis Risk in Communities (ARIC) study","authors":"Deling Chen , Yuchen Yao , Ethan D. Moser , Wendy Wang , Elsayed Z. Soliman , Thomas Mosley , Wei Pan","doi":"10.1016/j.jelectrocard.2024.153832","DOIUrl":"10.1016/j.jelectrocard.2024.153832","url":null,"abstract":"<div><h3>Aim</h3><div>Create an ECG-based model to predict dementia and compare its performance with the existing Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) model.</div></div><div><h3>Methods and Results</h3><div>Participants without prevalent dementia in the Atherosclerosis Risk in Communities study were studied. Visit 4 (V4) (1996–98, mean age, 62 years) and V5 (2011–13, mean age, 75 years) were used as baselines. Incident dementia cases were adjudicated through 2019. We created parsimonious ECG models by using Cox regression with a backward selection method. C-statistic (95 % CI) of the ECG-based model (two or three ECG variables and age) was higher than the CAIDE model (seven variables) at V4 (0.72 [0.71–0.74] vs. 0.67 [0.66–0.68]) and V5 (0.70 [0.68–0.72] vs. 0.64 [0.62–0.66]). The ECG-based model was well calibrated, but the CAIDE model was poorly calibrated at V4 (<em>P</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>For middle-aged and older adults, a novel ECG-based model has good discrimination that is superior to the CAIDE model in predicting dementia. Since ECG variables are readily obtainable, the ECG-based model will be easy to adopt clinically.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"88 ","pages":"Article 153832"},"PeriodicalIF":1.3,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142746454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper describes a case of patient post-TAVI who developed Left Septal Fascicular Block (LSFB) and Right Bundle Branch Block (RBBB). This combination has not been previously reported and must be actively sought out, given the possible increased risk of complete atrioventricular block and sudden cardiac death. RBBB following transcatheter aortic valve replacement is rare and is associated with complete atrioventricular block and permanent pacemaker implantation. LFSB on ECG may be a surrogate maker of diffuse conduction systemic damage following TAVI. Therefore, there should be a low threshold for permanent pacing in patients who develop new RBBB and LSFB post-TAVI.
{"title":"A Case of Post-TAVI: Left Septal Fascicular Block & Right Bundle Branch Block","authors":"Gustavo Goldenberg , Shyla Gupta , Nili Schamroth Pravda , Andrés Ricardo Pérez-Riera , Adrian Baranchuk","doi":"10.1016/j.jelectrocard.2024.153827","DOIUrl":"10.1016/j.jelectrocard.2024.153827","url":null,"abstract":"<div><div>This paper describes a case of patient post-TAVI who developed Left Septal Fascicular Block (LSFB) and Right Bundle Branch Block (RBBB). This combination has not been previously reported and must be actively sought out, given the possible increased risk of complete atrioventricular block and sudden cardiac death. RBBB following transcatheter aortic valve replacement is rare and is associated with complete atrioventricular block and permanent pacemaker implantation. LFSB on ECG may be a surrogate maker of diffuse conduction systemic damage following TAVI. Therefore, there should be a low threshold for permanent pacing in patients who develop new RBBB and LSFB post-TAVI.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"88 ","pages":"Article 153827"},"PeriodicalIF":1.3,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142699141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-21DOI: 10.1016/j.jelectrocard.2024.153829
Associate Professor Dr. Erdoğan Sökmen, Dr. Muhammet Salih Ateş, Dr. Zafer Kök, Dr. Bilge Bingöl
Objectives and background
Our objective was to determine the diagnostic significance of a low T-wave amplitude (TWA) and T/R ratio, defined as the amplitude ratio between the T waves and the R waves, in patients with acute non-ST elevation myocardial infarction (ANSTEMI). Syntax score (SS) shows the extension of coronary artery disease. Previously, low TWA and T/R ratios were demonstrated to be inversely proportional to the risk of sudden cardiac arrest in different cardiac disease conditions.
Methods
266 patients were retrospectively included with ANSTEMI between July 2021 and December 2022. SS-1 and SS-2 scores were calculated using the angiographic and clinical data of the patients. The patients were stratified into tertiles based on their median SS-1 scores as lower, moderate, and higher SS-1 tertiles. ECG parameters, including TWAs and T/R ratios in leads II and V5, were measured digitally. TWA and T/R ratios were compared with SSs among the tertiles.
Results
TWA and T/R ratios in leads II and V5 were significantly lower across the increasing SS-1 tertiles (p < 0.001 for TWA in lead II) (p < 0.001 for T/R ratio in lead II) (p = 0.014 for TWA in lead V5) (p = 0.002 for T/R ratio in lead V5).ROC analysis identified T/R ratios in leads II and V5 of 0.254 (AUC: 0.758, p < 0.001) and 0.201 (AUC: 0.635, p < 0.015), respectively.
Conclusion
A low T/R ratio, particularly in lead II due to its greater AUC, better predicts moderate-to-high SS-1 in patients with ANSTEMI.
目的和背景我们的目的是确定急性非 ST 段抬高型心肌梗死（ANSTEMI）患者 T 波振幅（TWA）和 T/R 比值（定义为 T 波和 R 波之间的振幅比值）偏低的诊断意义。语法评分（SS）显示冠状动脉疾病的扩展情况。方法回顾性纳入了 2021 年 7 月至 2022 年 12 月期间的 266 例 ANSTEMI 患者。根据患者的血管造影和临床数据计算出 SS-1 和 SS-2 评分。根据中位 SS-1 评分将患者分为低、中、高 SS-1 三等分。以数字方式测量心电图参数，包括 II 和 V5 导联的 TWA 和 T/R 比值。结果TWA和T/R比值在导联II和V5中明显低于SS-1三等分（导联II中的TWA为0.001）（导联II中的T/R比值为0.001）（导联V5中的TWA为0.014）（导联V5中的T/R比值为0.002）。结论 T/R比值较低，尤其是在导联II中，因为其AUC较大，能更好地预测ANSTEMI患者的中度至高度SS-1。
{"title":"Relationship between ECG-derived T-wave amplitude and T/R ratio and Syntax score in patients with acute non-st segment elevation myocardial infarction","authors":"Associate Professor Dr. Erdoğan Sökmen, Dr. Muhammet Salih Ateş, Dr. Zafer Kök, Dr. Bilge Bingöl","doi":"10.1016/j.jelectrocard.2024.153829","DOIUrl":"10.1016/j.jelectrocard.2024.153829","url":null,"abstract":"<div><h3>Objectives and background</h3><div>Our objective was to determine the diagnostic significance of a low T-wave amplitude (TWA) and T/R ratio, defined as the amplitude ratio between the T waves and the R waves, in patients with acute non-ST elevation myocardial infarction (ANSTEMI). Syntax score (SS) shows the extension of coronary artery disease. Previously, low TWA and T/R ratios were demonstrated to be inversely proportional to the risk of sudden cardiac arrest in different cardiac disease conditions.</div></div><div><h3>Methods</h3><div>266 patients were retrospectively included with ANSTEMI between July 2021 and December 2022. SS-1 and SS-2 scores were calculated using the angiographic and clinical data of the patients. The patients were stratified into tertiles based on their median SS-1 scores as lower, moderate, and higher SS-1 tertiles. ECG parameters, including TWAs and T/R ratios in leads II and V5, were measured digitally. TWA and T/R ratios were compared with SSs among the tertiles.</div></div><div><h3>Results</h3><div>TWA and T/R ratios in leads II and V5 were significantly lower across the increasing SS-1 tertiles (<em>p</em> < 0.001 for TWA in lead II) (<em>p</em> < 0.001 for T/R ratio in lead II) (<em>p</em> = 0.014 for TWA in lead V5) (<em>p</em> = 0.002 for T/R ratio in lead V5).ROC analysis identified T/R ratios in leads II and V5 of 0.254 (AUC: 0.758, p < 0.001) and 0.201 (AUC: 0.635, <em>p</em> < 0.015), respectively.</div></div><div><h3>Conclusion</h3><div>A low T/R ratio, particularly in lead II due to its greater AUC, better predicts moderate-to-high SS-1 in patients with ANSTEMI.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"88 ","pages":"Article 153829"},"PeriodicalIF":1.3,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142699140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-21DOI: 10.1016/j.jelectrocard.2024.153831
Alper Kepez , Cagan Yildirim MD , Kamil Gulsen , Kartal Emre Aslanger , Abdulkadir Uslu , Ayhan Kup , Mehmet Celik , Serdar Demir , Ayhan Kol MD , Batur Gonenc Kanar , Kursat Tigen
Background
The aim of the present study was to investigate the value of ‘time to first nadir of the QRS complex in aVR/time to first nadir of the QRS complex in aVL’ for distinguishing left vs. right outflow tract premature ventricular complexes (PVCs) with precordial transition in lead V3.
Methods
Data from 88 eligible consecutive patients (39 males; 48.3 ± 13.4 years of age) who had undergone ablation due to outflow tract PVCs that had transition in V3 were retrospectively evaluated and used in the analysis.
Results
Fifty-one patients (57.9 %) had PVCs with a left ventricular outflow tract (LVOT) origin, and 37 (42.1 %) patients had PVCs with a right ventricular outflow tract (RVOT) origin. There were significant differences between the LVOT and RVOT PVC groups in terms of the V2S/V3R index (0.97 ± 0.70 vs. 1.96 ± 0.80, p < 0.001), V1–V3 transition index (−2.6 ± 4.4 vs. -0.4 ± 4.6, p = 0.026), and ‘aVR/aVL time to first nadir of the QRS complex’ (0.94 ± 0.15 vs. 1.1 ± 0.2, p = 0.001). ROC curve analysis revealed that a ‘aVR/aVL time to first nadir of the QRS complex ratio’ greater than 0.98 predicted the RVOT origin, with 67.6 % sensitivity and 62.7 % specificity. A V1-V3 transition index > − 1.21 predicted an RVOT origin with 75.7 % sensitivity and 72.5 % specificity. A V2S/V3R index <1.4 predicted the origin of the LVOT, with a sensitivity of 78.4 % and a specificity of 80.4 %.
Conclusion
Although less precise than other established ECG criteria, the novel parameter ‘time to first nadir of the QRS complex in aVR/aVL’ was able to aid in the differentiation of LVOT vs. RVOT PVCs with V3 precordial transition in our study. Based on this finding, it may be suggested that if an OT PVC has an earlier negative QRS peak on aVL compared with aVR, the probability of it being the RVOT origin is high. This simple observation might aid the preprocedural planning of OT PVC ablation in clinical practice.
{"title":"Time to first nadir of the QRS complex in aVR/time to first nadir of the QRS complex in aVL: A novel method for distinguishing left from right outflow tract premature ventricular complexes (PVCs) with precordial transition in V3","authors":"Alper Kepez , Cagan Yildirim MD , Kamil Gulsen , Kartal Emre Aslanger , Abdulkadir Uslu , Ayhan Kup , Mehmet Celik , Serdar Demir , Ayhan Kol MD , Batur Gonenc Kanar , Kursat Tigen","doi":"10.1016/j.jelectrocard.2024.153831","DOIUrl":"10.1016/j.jelectrocard.2024.153831","url":null,"abstract":"<div><h3>Background</h3><div>The aim of the present study was to investigate the value of ‘time to first nadir of the QRS complex in aVR/time to first nadir of the QRS complex in aVL’ for distinguishing left vs. right outflow tract premature ventricular complexes (PVCs) with precordial transition in lead V3.</div></div><div><h3>Methods</h3><div>Data from 88 eligible consecutive patients (39 males; 48.3 ± 13.4 years of age) who had undergone ablation due to outflow tract PVCs that had transition in V3 were retrospectively evaluated and used in the analysis.</div></div><div><h3>Results</h3><div>Fifty-one patients (57.9 %) had PVCs with a left ventricular outflow tract (LVOT) origin, and 37 (42.1 %) patients had PVCs with a right ventricular outflow tract (RVOT) origin. There were significant differences between the LVOT and RVOT PVC groups in terms of the V2S/V3R index (0.97 ± 0.70 vs. 1.96 ± 0.80, <em>p</em> < 0.001), V1–V3 transition index (−2.6 ± 4.4 vs. -0.4 ± 4.6, <em>p</em> = 0.026), and ‘aVR/aVL time to first nadir of the QRS complex’ (0.94 ± 0.15 vs. 1.1 ± 0.2, <em>p</em> = 0.001). ROC curve analysis revealed that a ‘aVR/aVL time to first nadir of the QRS complex ratio’ greater than 0.98 predicted the RVOT origin, with 67.6 % sensitivity and 62.7 % specificity. A V1-V3 transition index > − 1.21 predicted an RVOT origin with 75.7 % sensitivity and 72.5 % specificity. A V<sub>2</sub>S/V<sub>3</sub>R index <1.4 predicted the origin of the LVOT, with a sensitivity of 78.4 % and a specificity of 80.4 %.</div></div><div><h3>Conclusion</h3><div>Although less precise than other established ECG criteria, the novel parameter ‘time to first nadir of the QRS complex in aVR/aVL’ was able to aid in the differentiation of LVOT vs. RVOT PVCs with V3 precordial transition in our study. Based on this finding, it may be suggested that if an OT PVC has an earlier negative QRS peak on aVL compared with aVR, the probability of it being the RVOT origin is high. This simple observation might aid the preprocedural planning of OT PVC ablation in clinical practice.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"88 ","pages":"Article 153831"},"PeriodicalIF":1.3,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142699169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-21DOI: 10.1016/j.jelectrocard.2024.153834
Maiko Arichi PhD , Dale H. Mugler PhD , Stephen Fannin M.D.
A real-time automated identification technique is developed for the detection of ischemic episodes in long-term electrocardiographic (ECG) signals using mathematical expansions involving the Discrete Dilated Hermite Transform. The Discrete Hermite functions could be viewed as a set of orthogonal vectors that resemble a finite Fourier series. They are generated easily as eigenvectors of a symmetric tridiagonal matrix that commutes with the centered Fourier matrix. The Discrete Hermite Transform (DHmT) values are computed from a simple dot product between an individual ECG complex extracted from the European Society of Cardiology (ESC) ST-T database and the corresponding discrete Hermite function. These values are found to contain information about the ECG shape, highlighting changes between ST segment and T wave alterations which are the features of ischemic episodes. This information from the discrete Hermite transform, based on an orthonormal set of n-dimensional digital Hermite functions that serve as shape-identification functions, can be used to identify ischemic episodes from the ECG. The performance measures resulting from applying this method to detect ischemic episodes were Sensitivity 87 %, Specificity 86 %, and positive predictive accuracy 81 %. The computer time to analyze one heartbeat for ischemia with this method is 0.031 seconds on a standard PC.
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Pub Date : 2024-11-20DOI: 10.1016/j.jelectrocard.2024.153828
Mary G. Carey PhD, RN, FAHA, FAAN , Sudhir K. Mummidi MBBS, RN , Amanda Kammer BS, RN , Dillon J. Dzikowicz PhD, RN, PCCN
Background
Chest pain is the second most common reason to present to the emergency department in the United States, and the ECG is a first-line diagnostic tool for myocardial ischemia assessment. For patients with ongoing symptoms or unclear initial ECGs, guidelines recommend performing multiple standard ECGs at 15–30-min intervals during the first 1–2 h, which improves acute coronary syndrome (ACS) detection by 15 % and accelerates triage of high-risk ACS patients. However, obtaining serial ECG is not consistently practiced due to overcrowding and the limited technical abilities of current 12‑lead ECG machines. This study aimed to evaluate an FDA-approved wireless 12‑lead ECG patch for serial cardiac monitoring in the hospital setting.
Methods
Prospectively, ECG patch was applied in the Mason-Likar electrode configuration after obtaining consent. The patch remained in place for at least one hour. Clinical Utility of the ECGs was categorized from 1 to 3: 1 = uninterpretable, 2 = borderline, and 3 = interpretable.
Results
Among hospitalized cardiac patients, 28 consented to wear the ECG patch for at least one hour and patients were free to ambulate during the study. Most (70 %) patients were in sinus rhythm, and an episode of asymptomatic TMI was captured. The clinical utility of the ECGs (n = 364) was mostly interpretable, 64 % (n = 231), while 15 % (n = 55) were uninterpretable and 18 % (n = 65) were borderline. Most (69 %) preferred the patch, while 12 % preferred telemetry. The hospitalized cardiac patients reported significantly better ability to ambulate with the ECG patch (Z = −3.607, p < 0.001).
Conclusion
Thus, this experiment demonstrated that the ECG patch provides quality serial ECG monitoring and captures TMI of hospitalized cardiac patients without increasing burden.
{"title":"The feasibility of a serial 12‑lead ECG wireless patch in the hospital setting","authors":"Mary G. Carey PhD, RN, FAHA, FAAN , Sudhir K. Mummidi MBBS, RN , Amanda Kammer BS, RN , Dillon J. Dzikowicz PhD, RN, PCCN","doi":"10.1016/j.jelectrocard.2024.153828","DOIUrl":"10.1016/j.jelectrocard.2024.153828","url":null,"abstract":"<div><h3>Background</h3><div>Chest pain is the second most common reason to present to the emergency department in the United States, and the ECG is a first-line diagnostic tool for myocardial ischemia assessment. For patients with ongoing symptoms or unclear initial ECGs, guidelines recommend performing multiple standard ECGs at 15–30-min intervals during the first 1–2 h, which improves acute coronary syndrome (ACS) detection by 15 % and accelerates triage of high-risk ACS patients. However, obtaining serial ECG is not consistently practiced due to overcrowding and the limited technical abilities of current 12‑lead ECG machines. This study aimed to evaluate an FDA-approved wireless 12‑lead ECG patch for serial cardiac monitoring in the hospital setting.</div></div><div><h3>Methods</h3><div>Prospectively, ECG patch was applied in the Mason-Likar electrode configuration after obtaining consent. The patch remained in place for at least one hour. Clinical Utility of the ECGs was categorized from 1 to 3: 1 = uninterpretable, 2 = borderline, and 3 = interpretable.</div></div><div><h3>Results</h3><div>Among hospitalized cardiac patients, 28 consented to wear the ECG patch for at least one hour and patients were free to ambulate during the study. Most (70 %) patients were in sinus rhythm, and an episode of asymptomatic TMI was captured. The clinical utility of the ECGs (<em>n</em> = 364) was mostly interpretable, 64 % (<em>n</em> = 231), while 15 % (<em>n</em> = 55) were uninterpretable and 18 % (<em>n</em> = 65) were borderline. Most (69 %) preferred the patch, while 12 % preferred telemetry. The hospitalized cardiac patients reported significantly better ability to ambulate with the ECG patch (Z = −3.607, <em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>Thus, this experiment demonstrated that the ECG patch provides quality serial ECG monitoring and captures TMI of hospitalized cardiac patients without increasing burden.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"88 ","pages":"Article 153828"},"PeriodicalIF":1.3,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142699170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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