Pub Date : 2024-11-01DOI: 10.1016/j.jelectrocard.2024.153780
Nonparoxysmal junctional tachycardia with Wenckebach exit block is known to be associated with digitalis toxicity. This report documents the occurrence of this arrhythmia in the absence of digitalis therapy in a patient with structural heart disease.
{"title":"Nonparoxysmal junctional tachycardia associated with 3:2 Wenckebach exit block in the absence of digitalis therapy","authors":"","doi":"10.1016/j.jelectrocard.2024.153780","DOIUrl":"10.1016/j.jelectrocard.2024.153780","url":null,"abstract":"<div><div>Nonparoxysmal junctional tachycardia with Wenckebach exit block is known to be associated with digitalis toxicity. This report documents the occurrence of this arrhythmia in the absence of digitalis therapy in a patient with structural heart disease.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554642","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 : 2024-11-01DOI: 10.1016/j.jelectrocard.2024.153819
A 12-channel ECG and the ECG patterb from Holter monitoring of a 6-year-girl are presented.
本文介绍了一名 6 岁女孩的 12 道心电图和 Holter 监测的心电图模式。
{"title":"The ECG of a 6-year-old girl","authors":"","doi":"10.1016/j.jelectrocard.2024.153819","DOIUrl":"10.1016/j.jelectrocard.2024.153819","url":null,"abstract":"<div><div>A 12-channel ECG and the ECG patterb from Holter monitoring of a 6-year-girl are presented.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568469","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 : 2024-11-01DOI: 10.1016/j.jelectrocard.2024.153820
Background
Exercise electrocardiography (ECG) is a common diagnostic and prognostic method for the detection of coronary artery disease (CAD). However, its accuracy in asymptomatic women has not been comprehensively investigated and the diagnostic criteria may require refinements. This study evaluated the performance of ECG-derived ST/HR-index, ST/HR hysteresis and ST-segment depression parameters among asymptomatic middle-aged women.
Methods
108 women (mean age 56 ± 4 years) performed exercise ECG test on treadmill until exhaustion three times within a nine-month period. False-positive rates of maximum ST/HR-index, ST/HR hysteresis, and ST-segment depression values measured from 12 leads at peak exercise and after one-minute recovery were evaluated with recommended diagnostic partition values. Repeatability was assessed with intraclass correlation (ICC) and Bland-Altman plot analysis.
Results
False-positive rate was lower for all variables when a two‑lead configuration was used instead of a single‑lead configuration. Using a two‑lead configuration, ST/HR hysteresis (0–1.9 %) and ST-segment depression after one-minute recovery (0–2.8 %) had lower false-positive rates compared to ST/HR index (3.7–20.4 %) and ST-segment depression at peak exercise (9.3–27.8 %). ICC values indicated moderate repeatability for ST/HR hysteresis while ST/HR index, ST-segment at peak exercise, and ST-segment after one-minute recovery had moderate-to-good repeatability. Bland-Altman analysis indicated poor repeatability for all evaluated ECG variables.
Conclusion
In asymptomatic middle-aged women, practitioners should prefer the use of ST/HR hysteresis and ST-segment after one-minute recovery over the conventional ST-segment depression at peak exercise or ST/HR index, and evaluate the ECG data from a two‑lead configuration instead of single‑lead.
背景:运动心电图(ECG)是检测冠状动脉疾病(CAD)的常用诊断和预后方法。然而,该方法在无症状女性中的准确性尚未得到全面研究,诊断标准可能需要改进。本研究评估了无症状中年女性心电图ST/HR指数、ST/HR滞后和ST段压低参数的性能。方法:108名女性(平均年龄56±4岁)在9个月内三次在跑步机上进行运动心电图测试,直至力竭。用推荐的诊断分区值评估了运动高峰时和一分钟恢复后从 12 个导联测量的最大 ST/HR 指数、ST/HR 滞后和 ST 段压低值的假阳性率。通过类内相关性(ICC)和Bland-Altman图分析评估了重复性:结果:使用双导联配置而非单导联配置时,所有变量的假阳性率均较低。使用双导联配置时,ST/HR 滞后(0-1.9%)和一分钟恢复后的 ST 段压低(0-2.8%)的假阳性率低于 ST/HR 指数(3.7-20.4%)和运动高峰时的 ST 段压低(9.3-27.8%)。ICC值表明ST/HR滞后的重复性为中等,而ST/HR指数、运动高峰时的ST段和一分钟恢复后的ST段的重复性为中等至良好。Bland-Altman分析表明,所有评估的心电图变量的重复性都较差:结论:对于无症状的中年女性,医生应优先使用 ST/HR 滞后和一分钟恢复后的 ST 段,而不是传统的运动高峰期 ST 段压低或 ST/HR 指数,并从双导联配置而不是单导联评估心电图数据。
{"title":"Use of ST/HR hysteresis decreases false positive rate in exercise electrocardiography test of middle-aged asymptomatic women","authors":"","doi":"10.1016/j.jelectrocard.2024.153820","DOIUrl":"10.1016/j.jelectrocard.2024.153820","url":null,"abstract":"<div><h3>Background</h3><div>Exercise electrocardiography (ECG) is a common diagnostic and prognostic method for the detection of coronary artery disease (CAD). However, its accuracy in asymptomatic women has not been comprehensively investigated and the diagnostic criteria may require refinements. This study evaluated the performance of ECG-derived ST/HR-index, ST/HR hysteresis and ST-segment depression parameters among asymptomatic middle-aged women.</div></div><div><h3>Methods</h3><div>108 women (mean age 56 ± 4 years) performed exercise ECG test on treadmill until exhaustion three times within a nine-month period. False-positive rates of maximum ST/HR-index, ST/HR hysteresis, and ST-segment depression values measured from 12 leads at peak exercise and after one-minute recovery were evaluated with recommended diagnostic partition values. Repeatability was assessed with intraclass correlation (ICC) and Bland-Altman plot analysis.</div></div><div><h3>Results</h3><div>False-positive rate was lower for all variables when a two‑lead configuration was used instead of a single‑lead configuration. Using a two‑lead configuration, ST/HR hysteresis (0–1.9 %) and ST-segment depression after one-minute recovery (0–2.8 %) had lower false-positive rates compared to ST/HR index (3.7–20.4 %) and ST-segment depression at peak exercise (9.3–27.8 %). ICC values indicated moderate repeatability for ST/HR hysteresis while ST/HR index, ST-segment at peak exercise, and ST-segment after one-minute recovery had moderate-to-good repeatability. Bland-Altman analysis indicated poor repeatability for all evaluated ECG variables.</div></div><div><h3>Conclusion</h3><div>In asymptomatic middle-aged women, practitioners should prefer the use of ST/HR hysteresis and ST-segment after one-minute recovery over the conventional ST-segment depression at peak exercise or ST/HR index, and evaluate the ECG data from a two‑lead configuration instead of single‑lead.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590628","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 : 2024-11-01DOI: 10.1016/j.jelectrocard.2024.153817
<div><h3>Background</h3><div>The differentiation and diagnosis of ventricular tachycardia (VT) and pre-excited tachycardia (PXT) remains a challenging task, especially when typical AV dissociation is not present. The purpose of this article is to study the feasibility of a new theoretical algorithm for identifying ventricular arrhythmias (VA) and pre-excited arrhythmias (PA) rhythms (which can be used to distinguish VT from PXT, etc.).</div></div><div><h3>Method</h3><div>This study involved the deduction of a new algorithm by combining knowledge of cardiac anatomy, vectorcardiography, and cardiac electrophysiology. The new algorithm evaluated the diagnostic value through intracardiac electrophysiology in 205 cases of VA and PA. The new algorithm diagnoses VA based on the following 4-step process:<ul><li><span>1.</span><span><div>The QRS complex in leads II, III, and aVF shows a unidirectional R wave, and lead aVR shows a QS pattern.</div></span></li><li><span>2.</span><span><div>S waves are predominant in two or more of leads I, aVF, and V6.</div></span></li><li><span>3.</span><span><div>Lead V2 shows ≥3 phase waves or returning branch notching (note: returning branch refers to the band of QRS complexes returning to the baseline).</div></span></li><li><span>4.</span><span><div>Lead V5 shows a negative wave in the initial portion or returning branch notching.</div></span></li></ul></div><div>If none of these criteria are met, the diagnosis is PA. The diagnostic value of the new algorithm is compared with the Steurer algorithm and the Vereckei algorithm (diagnosed based on the QRS waveform characteristics of the two algorithms during electrophysiological verification, excluding the diagnosis of atrioventricular dissociation).</div></div><div><h3>Results</h3><div>The new algorithm showed significant advantages in terms of AUC value (0.83 vs. 0.61 vs. 0.57), sensitivity (83.6 % vs. 23.3 % vs. 24.8 %), and accuracy (82.9 % vs. 48.3 % vs. 46.3 %) compared to the Steurer algorithm and Vereckei algorithm based on QRS waveform characteristics for diagnosing VA (137 cases) and PA (68 cases). This indicates that the new algorithm is more accurate in identifying idiopathic VA. While there was a significant difference in specificity between the New algorithm and Steurer algorithm (82.3 % vs. 98.5 %, <em>p</em> < 0.05), the difference with Vereckei algorithm (82.3 % vs. 89.7 %) was not significant.</div><div>In the New algorithm, the sensitivity and specificity for each step are as follows:<ul><li><span>-</span><span><div>Step 1: Sensitivity 34.3 %, Specificity 94.1 %.</div></span></li><li><span>-</span><span><div>Step 2: Sensitivity 24.1 %, Specificity 98.5 %.</div></span></li><li><span>-</span><span><div>Step 3: Sensitivity 18.3 %, Specificity 100 %.</div></span></li><li><span>-</span><span><div>Step 4: Sensitivity 6.6 %, Specificity 89.7 %.</div></span></li></ul></div><div>Step 1 had the highest AUC value, indicating the best overall diagnostic performan
背景室性心动过速(VT)和预激性心动过速(PXT)的鉴别和诊断仍然是一项具有挑战性的任务,尤其是在不存在典型房室解离的情况下。本文旨在研究一种识别室性心律失常(VA)和预激性心律失常(PA)节律(可用于区分 VT 和 PXT 等)的新理论算法的可行性。新算法通过心内电生理学评估了 205 例 VA 和 PA 的诊断价值。新算法根据以下 4 个步骤诊断 VA:1.Ⅱ、Ⅲ 和 aVF 导联的 QRS 波群显示单向 R 波,aVR 导联显示 QS 模式。2.在 I、aVF 和 V6 导联中的两个或两个以上导联显示 S 波为主。3.V2 导联显示≥3 相波或回流支切迹(注:回流支指 QRS 波群返回基线的波段)。将新算法的诊断价值与 Steurer 算法和 Vereckei 算法(根据电生理验证时两种算法的 QRS 波形特征进行诊断,不包括房室解离的诊断)进行比较。结果在诊断 VA(137 例)和 PA(68 例)时,与基于 QRS 波形特征的 Steurer 算法和 Vereckei 算法相比,新算法在 AUC 值(0.83 vs. 0.61 vs. 0.57)、灵敏度(83.6 % vs. 23.3 % vs. 24.8 %)和准确度(82.9 % vs. 48.3 % vs. 46.3 %)方面均有显著优势。这表明新算法在识别特发性 VA 方面更为准确。在新算法中,每一步的灵敏度和特异度如下:第 1 步:灵敏度 34.第 2 步:灵敏度 24.1%,特异度 98.5%;第 3 步:灵敏度 18.3%,特异度 100%;第 4 步:灵敏度 6.6%,特异度 89.7%。结论:新算法适用于识别 VA 和 PA 节律的起源。
{"title":"Study on the feasibility of distinguishing ventricular and pre-excited arrhythmia rhythms by a new algorithm","authors":"","doi":"10.1016/j.jelectrocard.2024.153817","DOIUrl":"10.1016/j.jelectrocard.2024.153817","url":null,"abstract":"<div><h3>Background</h3><div>The differentiation and diagnosis of ventricular tachycardia (VT) and pre-excited tachycardia (PXT) remains a challenging task, especially when typical AV dissociation is not present. The purpose of this article is to study the feasibility of a new theoretical algorithm for identifying ventricular arrhythmias (VA) and pre-excited arrhythmias (PA) rhythms (which can be used to distinguish VT from PXT, etc.).</div></div><div><h3>Method</h3><div>This study involved the deduction of a new algorithm by combining knowledge of cardiac anatomy, vectorcardiography, and cardiac electrophysiology. The new algorithm evaluated the diagnostic value through intracardiac electrophysiology in 205 cases of VA and PA. The new algorithm diagnoses VA based on the following 4-step process:<ul><li><span>1.</span><span><div>The QRS complex in leads II, III, and aVF shows a unidirectional R wave, and lead aVR shows a QS pattern.</div></span></li><li><span>2.</span><span><div>S waves are predominant in two or more of leads I, aVF, and V6.</div></span></li><li><span>3.</span><span><div>Lead V2 shows ≥3 phase waves or returning branch notching (note: returning branch refers to the band of QRS complexes returning to the baseline).</div></span></li><li><span>4.</span><span><div>Lead V5 shows a negative wave in the initial portion or returning branch notching.</div></span></li></ul></div><div>If none of these criteria are met, the diagnosis is PA. The diagnostic value of the new algorithm is compared with the Steurer algorithm and the Vereckei algorithm (diagnosed based on the QRS waveform characteristics of the two algorithms during electrophysiological verification, excluding the diagnosis of atrioventricular dissociation).</div></div><div><h3>Results</h3><div>The new algorithm showed significant advantages in terms of AUC value (0.83 vs. 0.61 vs. 0.57), sensitivity (83.6 % vs. 23.3 % vs. 24.8 %), and accuracy (82.9 % vs. 48.3 % vs. 46.3 %) compared to the Steurer algorithm and Vereckei algorithm based on QRS waveform characteristics for diagnosing VA (137 cases) and PA (68 cases). This indicates that the new algorithm is more accurate in identifying idiopathic VA. While there was a significant difference in specificity between the New algorithm and Steurer algorithm (82.3 % vs. 98.5 %, <em>p</em> < 0.05), the difference with Vereckei algorithm (82.3 % vs. 89.7 %) was not significant.</div><div>In the New algorithm, the sensitivity and specificity for each step are as follows:<ul><li><span>-</span><span><div>Step 1: Sensitivity 34.3 %, Specificity 94.1 %.</div></span></li><li><span>-</span><span><div>Step 2: Sensitivity 24.1 %, Specificity 98.5 %.</div></span></li><li><span>-</span><span><div>Step 3: Sensitivity 18.3 %, Specificity 100 %.</div></span></li><li><span>-</span><span><div>Step 4: Sensitivity 6.6 %, Specificity 89.7 %.</div></span></li></ul></div><div>Step 1 had the highest AUC value, indicating the best overall diagnostic performan","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142561047","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 : 2024-10-16DOI: 10.1016/j.jelectrocard.2024.153816
Naoya Kataoka, Teruhiko Imamura
{"title":"Detailed association between adolescent obesity and ventricular repolarization.","authors":"Naoya Kataoka, Teruhiko Imamura","doi":"10.1016/j.jelectrocard.2024.153816","DOIUrl":"https://doi.org/10.1016/j.jelectrocard.2024.153816","url":null,"abstract":"","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467183","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 : 2024-10-11DOI: 10.1016/j.jelectrocard.2024.153815
The duration of the PR intervals in atypical Wenckebach atrioventricular block before and after a non-conducted P wave can exhibit a wide range of values and patterns. Understanding the different or at times puzzling manifestations of Wenckebach atrioventricular block in terms of its PR intervals can avoid diagnostic errors, especially the erroneous more serious diagnosis of Mobitz type II atrioventricular block.
在非典型文克巴赫房室传导阻滞中,PR 间期在非传导 P 波前后的持续时间可以表现出多种不同的值和模式。从 PR 间期的角度来理解温克巴赫房室传导阻滞的不同表现或有时令人费解的表现,可以避免诊断错误,尤其是对莫比茨 II 型房室传导阻滞更严重的错误诊断。
{"title":"Variability of the PR intervals in Wenckebach atrioventricular block","authors":"","doi":"10.1016/j.jelectrocard.2024.153815","DOIUrl":"10.1016/j.jelectrocard.2024.153815","url":null,"abstract":"<div><div>The duration of the PR intervals in atypical Wenckebach atrioventricular block before and after a non-conducted P wave can exhibit a wide range of values and patterns. Understanding the different or at times puzzling manifestations of Wenckebach atrioventricular block in terms of its PR intervals can avoid diagnostic errors, especially the erroneous more serious diagnosis of Mobitz type II atrioventricular block.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501626","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 : 2024-10-09DOI: 10.1016/j.jelectrocard.2024.153813
Background
Myocardial infarction with nonobstructive coronary arteries (MINOCA) occurs in 6–15 % of MI patients. Cardiac magnetic resonance (CMR) imaging identifies MINOCA etiologies, but access may be limited.
Methods
We assessed associations between the index electrocardiogram (ECG) and CMR in MINOCA. Women with MI and < 50 % angiographic stenosis in all vessels were prospectively enrolled at 16 sites. CMR (median 6d from MI) was analyzed for late gadolinium enhancement (LGE), myocardial edema, and wall motion. We assessed ECGs for T-wave inversions (TWI), Q-waves (QW), ST-elevations (STE), ST-depressions (STD), and fragmented QRS complexes (fQRS). We calculated the DETERMINE score (# leads TWI + # fQRS +2*[# QW], excluding aVR, V1).
Results
Among 112 women with interpretable ECG, 81.3 % (91/112) had abnormal ECG; 50 % (56/112) had ≥1 TWI. CMR was abnormal in 74.1 % (83/112), with LGE in 49.1 % (55/112) and myocardial edema in 61.6 % (69/112). DETERMINE score ≥ 3 was associated with abnormal CMR (adjusted odds ratio [aOR] aOR 6.06 [1.89, 24.6], p = 0.002) and LGE (aOR 3.10 [1.26, 8.00], p = 0.013), but not edema (aOR 1.86 [0.80, 4.43], p = 0.152). TWI was also associated with abnormal CMR and LGE after adjustment (aOR 3.13 [1.08, 10.1], p = 0.036, aOR 3.23 [1.27, 8.63], p = 0.013, respectively), but not edema (aOR 1.26 [0.54, 2.96], p = 0.589). Specificity for abnormal CMR was 0.83 for DETERMINE score ≥ 3 and 0.75 for TWI. No other ECG findings were associated with CMR abnormality.
Conclusion
DETERMINE score ≥ 3 and the presence of any TWI were associated with abnormal CMR and with LGE in MINOCA. Our findings demonstrate that the index ECG can provide insight on CMR findings but without sensitivity or specificity required to forgo the CMR. We reaffirm the central role of CMR in elucidating MINOCA pathophysiology.
{"title":"Electrocardiographic correlates of cardiac magnetic resonance findings in women with myocardial infarction with non-obstructive coronary arteries","authors":"","doi":"10.1016/j.jelectrocard.2024.153813","DOIUrl":"10.1016/j.jelectrocard.2024.153813","url":null,"abstract":"<div><h3>Background</h3><div>Myocardial infarction with nonobstructive coronary arteries (MINOCA) occurs in 6–15 % of MI patients. Cardiac magnetic resonance (CMR) imaging identifies MINOCA etiologies, but access may be limited.</div></div><div><h3>Methods</h3><div>We assessed associations between the index electrocardiogram (ECG) and CMR in MINOCA. Women with MI and < 50 % angiographic stenosis in all vessels were prospectively enrolled at 16 sites. CMR (median 6d from MI) was analyzed for late gadolinium enhancement (LGE), myocardial edema, and wall motion. We assessed ECGs for T-wave inversions (TWI), Q-waves (QW), ST-elevations (STE), ST-depressions (STD), and fragmented QRS complexes (fQRS). We calculated the DETERMINE score (# leads TWI + # fQRS +2*[# QW], excluding aVR, V1).</div></div><div><h3>Results</h3><div>Among 112 women with interpretable ECG, 81.3 % (91/112) had abnormal ECG; 50 % (56/112) had ≥1 TWI. CMR was abnormal in 74.1 % (83/112), with LGE in 49.1 % (55/112) and myocardial edema in 61.6 % (69/112). DETERMINE score ≥ 3 was associated with abnormal CMR (adjusted odds ratio [aOR] aOR 6.06 [1.89, 24.6], <em>p</em> = 0.002) and LGE (aOR 3.10 [1.26, 8.00], <em>p</em> = 0.013), but not edema (aOR 1.86 [0.80, 4.43], <em>p</em> = 0.152). TWI was also associated with abnormal CMR and LGE after adjustment (aOR 3.13 [1.08, 10.1], <em>p</em> = 0.036, aOR 3.23 [1.27, 8.63], p = 0.013, respectively), but not edema (aOR 1.26 [0.54, 2.96], <em>p</em> = 0.589). Specificity for abnormal CMR was 0.83 for DETERMINE score ≥ 3 and 0.75 for TWI. No other ECG findings were associated with CMR abnormality.</div></div><div><h3>Conclusion</h3><div>DETERMINE score ≥ 3 and the presence of any TWI were associated with abnormal CMR and with LGE in MINOCA. Our findings demonstrate that the index ECG can provide insight on CMR findings but without sensitivity or specificity required to forgo the CMR. We reaffirm the central role of CMR in elucidating MINOCA pathophysiology.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501624","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 : 2024-10-09DOI: 10.1016/j.jelectrocard.2024.153812
Background
Occurrence of nonsustained ventricular tachycardia (NSVT) is associated with negative outcomes. It is not clear whether specific electrocardiographic characteristics of premature ventricular contractions (PVCs) are associated with the occurrence of NSVT. The aim of this study was to identify electrocardiographic patterns associated with the presence of NSVT during 24-h electrocardiographic monitoring in patients with >10 PVCs per hour.
Methods
This was a retrospective, observational, cross-sectional study. We reviewed consecutive patients who received 24-h ECG monitoring performed at a single outpatient cardiology center. Patients who received 24-h electrocardiographic monitoring, with a PVC burden ≥10 PVCs/h were included. Occurrence of NSVT during 24-h electrocardiographic monitoring was the main outcome.
Results
A total of 343 patients were analyzed (mean [SD] age, 69.7 [12.5] years; 177 men [51.6 %]). NSVT occurred in 72 patients who were compared with 271 patients without NSVT. The novel term “premature beat ratio”, which aims to correlate the coupling interval and compensatory pause, was introduced; a value >0.5 was independently associated with NSVT according to the multivariate model (OR = 3.73, 95 % CI = 1.57–8.82; P = 0.002). PVC burden (OR = 1.09, 95 % CI = 1.02–1.17; P = 0.006), and triplets (OR = 18.19, 95 % CI = 7.32–45.18 P = 0.0) were also associated with NSVT in the multivariate model.
Conclusion
These findings suggest that patients with a high PVC burden, triplets, and a premature beat ratio greater than 0.5 have an increased probability of presenting with NSVT and may benefit from more rigorous follow-up.
{"title":"Premature ventricular contraction patterns associated with nonsustained ventricular tachycardia","authors":"","doi":"10.1016/j.jelectrocard.2024.153812","DOIUrl":"10.1016/j.jelectrocard.2024.153812","url":null,"abstract":"<div><h3>Background</h3><div>Occurrence of nonsustained ventricular tachycardia (NSVT) is associated with negative outcomes. It is not clear whether specific electrocardiographic characteristics of premature ventricular contractions (PVCs) are associated with the occurrence of NSVT. The aim of this study was to identify electrocardiographic patterns associated with the presence of NSVT during 24-h electrocardiographic monitoring in patients with >10 PVCs per hour.</div></div><div><h3>Methods</h3><div>This was a retrospective, observational, cross-sectional study. We reviewed consecutive patients who received 24-h ECG monitoring performed at a single outpatient cardiology center. Patients who received 24-h electrocardiographic monitoring, with a PVC burden ≥10 PVCs/h were included. Occurrence of NSVT during 24-h electrocardiographic monitoring was the main outcome.</div></div><div><h3>Results</h3><div>A total of 343 patients were analyzed (mean [SD] age, 69.7 [12.5] years; 177 men [51.6 %]). NSVT occurred in 72 patients who were compared with 271 patients without NSVT. The novel term “premature beat ratio”, which aims to correlate the coupling interval and compensatory pause, was introduced; a value >0.5 was independently associated with NSVT according to the multivariate model (OR = 3.73, 95 % CI = 1.57–8.82; <em>P</em> = 0.002). PVC burden (OR = 1.09, 95 % CI = 1.02–1.17; <em>P</em> = 0.006), and triplets (OR = 18.19, 95 % CI = 7.32–45.18 P = 0.0) were also associated with NSVT in the multivariate model.</div></div><div><h3>Conclusion</h3><div>These findings suggest that patients with a high PVC burden, triplets, and a premature beat ratio greater than 0.5 have an increased probability of presenting with NSVT and may benefit from more rigorous follow-up.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400456","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 : 2024-10-06DOI: 10.1016/j.jelectrocard.2024.153814
Background
Few studies have examined QT, JT interval, and ST-segment changes due to radiofrequency catheter ablation (RFA) in manifest Wolff–Parkinson–White (WPW) syndrome in pediatric patients.
Methods
The study involved 27 patients (male-to-female, 13:14; age, 12 (5–16) years) who were diagnosed with WPW syndrome and underwent RFA in our hospital between 2009 and 2022. Electrocardiographic (ECG) changes were compared between the group with ventricular preexcitation due to an accessory pathway (manifest group, n = 16) and those without it (concealed group, n = 11).
Results
The QT interval before RFA was significantly longer in the manifest group than in the concealed group (402 [362–482] vs. 344 [323–427]; p = 0.001). The QT interval was significantly shortened in the manifest group before and after RFA (402 [362–482] vs. 360 [298–422] msec; p = 0.01). At 1 month, the QT interval difference between the manifest and concealed groups disappeared (366 [305–437] vs. 335 [301–436] msec; p = 0.001). ST-segment changes were found after RFA in 56 % (9/16) of the patients in the manifest group but not in the concealed group. ECG changes presenting the Brugada-pattern was found in one patient. One month later, ECG abnormalities persisted in only one patient.
Conclusions
In pediatric patients, the QT interval was prolonged in manifest WPW syndrome but shortened after RFA. In the manifest group, transient ST-segment change and T-wave abnormalities were often observed after RFA; however, the ECG normalized in approximately 1 month.
{"title":"A change in QT interval and ST-segment after radiofrequency catheter ablation in pediatric patients with Wolff–Parkinson–White syndrome","authors":"","doi":"10.1016/j.jelectrocard.2024.153814","DOIUrl":"10.1016/j.jelectrocard.2024.153814","url":null,"abstract":"<div><h3>Background</h3><div>Few studies have examined QT, JT interval, and ST-segment changes due to radiofrequency catheter ablation (RFA) in manifest Wolff–Parkinson–White (WPW) syndrome in pediatric patients.</div></div><div><h3>Methods</h3><div>The study involved 27 patients (male-to-female, 13:14; age, 12 (5–16) years) who were diagnosed with WPW syndrome and underwent RFA in our hospital between 2009 and 2022. Electrocardiographic (ECG) changes were compared between the group with ventricular preexcitation due to an accessory pathway (manifest group, <em>n</em> = 16) and those without it (concealed group, <em>n</em> = 11).</div></div><div><h3>Results</h3><div>The QT interval before RFA was significantly longer in the manifest group than in the concealed group (402 [362–482] vs. 344 [323–427]; <em>p</em> = 0.001). The QT interval was significantly shortened in the manifest group before and after RFA (402 [362–482] vs. 360 [298–422] msec; <em>p</em> = 0.01). At 1 month, the QT interval difference between the manifest and concealed groups disappeared (366 [305–437] vs. 335 [301–436] msec; <em>p</em> = 0.001). ST-segment changes were found after RFA in 56 % (9/16) of the patients in the manifest group but not in the concealed group. ECG changes presenting the Brugada-pattern was found in one patient. One month later, ECG abnormalities persisted in only one patient.</div></div><div><h3>Conclusions</h3><div>In pediatric patients, the QT interval was prolonged in manifest WPW syndrome but shortened after RFA. In the manifest group, transient ST-segment change and T-wave abnormalities were often observed after RFA; however, the ECG normalized in approximately 1 month.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400455","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 : 2024-10-03DOI: 10.1016/j.jelectrocard.2024.153811
Chapman's (electrographic) sign is of a notch on the ascending limb of the R wave in leads I, aVL and V6. It has been used in the diagnosis of myocardial infarction (MI) during left bundle branch block (LBBB) and cardiac pacing. A number of studies have yielded divergent results about its diagnostic usefulness. However, the sign can be helpful in the diagnosis of MI during LBBB or pacing in the absence of other manifestations of MI.
查普曼(电图)征是指在 I、aVL 和 V6 导联的 R 波上升沿上出现一个切迹。它被用于诊断左束支传导阻滞(LBBB)和心脏起搏时的心肌梗死(MI)。许多研究对该征象的诊断作用得出了不同的结果。不过,在没有其他心肌梗死表现的情况下,该征象有助于诊断左束支传导阻滞或心脏起搏时的心肌梗死。
{"title":"What is Chapman's sign?","authors":"","doi":"10.1016/j.jelectrocard.2024.153811","DOIUrl":"10.1016/j.jelectrocard.2024.153811","url":null,"abstract":"<div><div>Chapman's (electrographic) sign is of a notch on the ascending limb of the R wave in leads I, aVL and V6. It has been used in the diagnosis of myocardial infarction (MI) during left bundle branch block (LBBB) and cardiac pacing. A number of studies have yielded divergent results about its diagnostic usefulness. However, the sign can be helpful in the diagnosis of MI during LBBB or pacing in the absence of other manifestations of MI.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521970","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}