Pub Date : 2026-03-01Epub Date: 2026-02-11DOI: 10.1016/j.jelectrocard.2026.154207
Luka Lovrenčić, Matija Bakoš
Junctional ectopic tachycardia (JET) is a rare but clinically important arrhythmia most often encountered in infants and children, either congenitally or within 72 h after congenital heart surgery. We report a neonate who developed postoperative JET with variable QRS morphologies after an arterial switch operation, in whom QP interval and QRS duration correlated with the preceding RR interval. The arrhythmia caused hemodynamic instability requiring antiarrhythmic therapy and supportive measures. This case illustrates the diverse electrocardiographic manifestations of postoperative JET and highlights the importance of early rhythm characterization to guide timely, mechanism-based management in critically ill neonates.
{"title":"Postoperative junctional ectopic tachycardia with variable QRS morphology: A case report","authors":"Luka Lovrenčić, Matija Bakoš","doi":"10.1016/j.jelectrocard.2026.154207","DOIUrl":"10.1016/j.jelectrocard.2026.154207","url":null,"abstract":"<div><div>Junctional ectopic tachycardia (JET) is a rare but clinically important arrhythmia most often encountered in infants and children, either congenitally or within 72 h after congenital heart surgery. We report a neonate who developed postoperative JET with variable QRS morphologies after an arterial switch operation, in whom QP interval and QRS duration correlated with the preceding RR interval. The arrhythmia caused hemodynamic instability requiring antiarrhythmic therapy and supportive measures. This case illustrates the diverse electrocardiographic manifestations of postoperative JET and highlights the importance of early rhythm characterization to guide timely, mechanism-based management in critically ill neonates.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"95 ","pages":"Article 154207"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146213340","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 : 2026-03-01Epub Date: 2026-01-13DOI: 10.1016/j.jelectrocard.2026.154194
Gergely Tuboly , Orsolya Kiss , Máté Babity , Márk Zámodics , Béla Merkely , György Kozmann , Mohamed F. Issa
This paper presents an algorithm capable of estimating malignant arrhythmia risk based on a short lead-I ECG record. We chose the mean and relative standard deviation of beat-to-beat QRST integrals as feature parameters. The algorithm was trained on a learning set consisting of three subgroups: 55 healthy subjects, 48 patients without malignant arrhythmia history, and 48 malignant arrhythmia patients. These subgroups represented the normal, moderate, and high risk, respectively. The 3 nearest neighbors (3−NN), and the 1-D and 2-D Bayesian classifiers were used as supervised machine-learning techniques. The test set contained ECG signals of 63 healthy subjects and 52 patients with confirmed malignant arrhythmia records. We obtained the best classification results with the 2-D Bayesian classifier, which produced a decision efficiency of 87.30% and 94.23% for the normal and malignant arrhythmia cases, respectively. Slightly lower results were achieved by the 3-NN method (80.95%, 94.23%) and the 1-D Bayesian classifier (77.78%, 94.23%). Considering the QTc parameter instead of the QRST integral produced a relatively low decision efficiency in the malignant arrhythmia case (84.62%). The proposed method performs best with the 2-D Bayesian method, while it is still efficient with the 3-NN classifier. According to our current knowledge, our algorithm is the first one which only requires a single-channel ECG as input and efficiently estimates malignant arrhythmia risk at the same time. As the proposed method relies only on lead-I ECG, it can be very useful in mobile ECG systems (e.g., in WIWE), making out-of-hospital risk assessment possible.
{"title":"Malignant arrhythmia risk assessment based on lead-I mobile ECG measurements using machine learning","authors":"Gergely Tuboly , Orsolya Kiss , Máté Babity , Márk Zámodics , Béla Merkely , György Kozmann , Mohamed F. Issa","doi":"10.1016/j.jelectrocard.2026.154194","DOIUrl":"10.1016/j.jelectrocard.2026.154194","url":null,"abstract":"<div><div>This paper presents an algorithm capable of estimating malignant arrhythmia risk based on a short lead-I ECG record. We chose the mean and relative standard deviation of beat-to-beat QRST integrals as feature parameters. The algorithm was trained on a learning set consisting of three subgroups: 55 healthy subjects, 48 patients without malignant arrhythmia history, and 48 malignant arrhythmia patients. These subgroups represented the normal, moderate, and high risk, respectively. The 3 nearest neighbors (3−NN), and the 1-D and 2-D Bayesian classifiers were used as supervised machine-learning techniques. The test set contained ECG signals of 63 healthy subjects and 52 patients with confirmed malignant arrhythmia records. We obtained the best classification results with the 2-D Bayesian classifier, which produced a decision efficiency of 87.30% and 94.23% for the normal and malignant arrhythmia cases, respectively. Slightly lower results were achieved by the 3-NN method (80.95%, 94.23%) and the 1-D Bayesian classifier (77.78%, 94.23%). Considering the QTc parameter instead of the QRST integral produced a relatively low decision efficiency in the malignant arrhythmia case (84.62%). The proposed method performs best with the 2-D Bayesian method, while it is still efficient with the 3-NN classifier. According to our current knowledge, our algorithm is the first one which only requires a single-channel ECG as input and efficiently estimates malignant arrhythmia risk at the same time. As the proposed method relies only on lead-I ECG, it can be very useful in mobile ECG systems (e.g., in WIWE), making out-of-hospital risk assessment possible.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"95 ","pages":"Article 154194"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029642","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 : 2026-03-01Epub Date: 2026-01-07DOI: 10.1016/j.jelectrocard.2026.154193
Jakub Zabłocki , Magdalena Warych , Julia Krawczyk , Jan Herc , Piotr Wieniawski , Bożena Werner
The use of the six‑lead AliveCor KardiaMobile (6LACKM) has not been thoroughly evaluated in children under three years of age. This report presents our initial experience with modified 6LACKM ECG acquisition techniques tailored to this population, including hand-assisted chest placement and adhesive electrodes adaptation, in various patient states and positions. In a prospective study, we aim to assess the feasibility of 6LACKM in this population and compare its diagnostic quality to standard 12‑lead ECG. Our preliminary experience demonstrate that high-quality tracings can be obtained with the proposed approaches, supporting the potential utility of 6LACKM in early pediatric electrocardiographic monitoring.
{"title":"Innovative application of six-lead KardiaMobile device in children under three years of age","authors":"Jakub Zabłocki , Magdalena Warych , Julia Krawczyk , Jan Herc , Piotr Wieniawski , Bożena Werner","doi":"10.1016/j.jelectrocard.2026.154193","DOIUrl":"10.1016/j.jelectrocard.2026.154193","url":null,"abstract":"<div><div>The use of the six‑lead AliveCor KardiaMobile (6LACKM) has not been thoroughly evaluated in children under three years of age. This report presents our initial experience with modified 6LACKM ECG acquisition techniques tailored to this population, including hand-assisted chest placement and adhesive electrodes adaptation, in various patient states and positions. In a prospective study, we aim to assess the feasibility of 6LACKM in this population and compare its diagnostic quality to standard 12‑lead ECG. Our preliminary experience demonstrate that high-quality tracings can be obtained with the proposed approaches, supporting the potential utility of 6LACKM in early pediatric electrocardiographic monitoring.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"95 ","pages":"Article 154193"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145940570","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 : 2026-03-01Epub Date: 2026-02-11DOI: 10.1016/j.jelectrocard.2026.154206
John E. Madias MD, FACC, FAHA
This short communication aims at raising an insight about an observation made 26 years ago, describing a transient false positive electrocardiogram (ECG)-based diagnosis of left ventricular hypertrophy (LVH) in patients with various tachycardias (e.g, sinus, supraventricular, atrial fibrillation) with or without evidence of LVH as assessed by cardiac imaging. The mechanism is purported to be due to a tachycardia-mediated shortening of the diastolic left ventricular (LV) dimensions due to tachycardias, with the diastolic LV volume centroid displaced closer to the anterior chest wall (e.g. “Wilson's proximity effect”). This insight prevents an inappropriate diagnosis of LVH; also, it is possible that the absence of such a phenomenon during tachycardias may imply in some cases advanced acute or chronic heart failure, resulting in LV diastolic dilatation, counteracting this ECG phenomenon. The author advocates that automated ECG interpretation algorithms providing interpretation upon recording of an ECG should be modified to reflect on this insight, since many physicians rely inappropriately on the automated ECG interpretation.
{"title":"Electrocardiogram-based false positive diagnosis of left ventricular hypertrophy during tachycardia: What more needs to be done","authors":"John E. Madias MD, FACC, FAHA","doi":"10.1016/j.jelectrocard.2026.154206","DOIUrl":"10.1016/j.jelectrocard.2026.154206","url":null,"abstract":"<div><div>This short communication aims at raising an insight about an observation made 26 years ago, describing a transient false positive electrocardiogram (ECG)-based diagnosis of left ventricular hypertrophy (LVH) in patients with various tachycardias (e.g, sinus, supraventricular, atrial fibrillation) with or without evidence of LVH as assessed by cardiac imaging. The mechanism is purported to be due to a tachycardia-mediated shortening of the diastolic left ventricular (LV) dimensions due to tachycardias, with the diastolic LV volume centroid displaced closer to the anterior chest wall (e.g. “Wilson's proximity effect”). This insight prevents an inappropriate diagnosis of LVH; also, it is possible that the absence of such a phenomenon during tachycardias may imply in some cases advanced acute or chronic heart failure, resulting in LV diastolic dilatation, counteracting this ECG phenomenon. The author advocates that automated ECG interpretation algorithms providing interpretation upon recording of an ECG should be modified to reflect on this insight, since many physicians rely inappropriately on the automated ECG interpretation.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"95 ","pages":"Article 154206"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146189089","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 : 2026-03-01Epub Date: 2026-02-21DOI: 10.1016/j.jelectrocard.2026.154216
Min-Hsin Ou Yang , Chia-Tung Wu M.D.
Background
The diagnostic accuracy of electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH) in Taiwanese adults remains uncertain, particularly in the presence of complete right bundle branch block (CRBBB).
Methods
We retrospectively enrolled 431 Taiwanese adults, including 205 with normal conduction and 226 with CRBBB. Echocardiographic left ventricular mass index (LVMI) served as the reference standard. We evaluated the sensitivity, specificity and area under the receiver operating characteristic curve (AUC) of six traditional ECG criteria: Sokolow-Lyon index, RaVL, modified Sokolow-Lyon, Cornell voltage, Gubner-Ungerleider and Peguero-Lo Presti. Linear regression examined associations between individual ECG parameters and LVMI, with a focus on the impact of CRBBB. Exploratory analyses were conducted to derive novel ECG indices.
Results
Traditional ECG criteria showed low sensitivity but high specificity overall. In patients with normal conduction, Cornell voltage performed best in females and Gubner-Ungerleider in males. However, diagnostic performance decreased substantially in the presence of CRBBB, particularly for criteria relying on anteroseptal leads. In CRBBB patients, QRS duration demonstrated stronger correlation with LVMI than voltage-based criteria. In our cohort, ECG criteria with superior performance is SD× QRS (AUC 0.754) in males with CRBBB, QRS duration (AUC 0.868) in CRBBB females and BMI<24, and SV4 amplitude (AUC 0.702) in CRBBB females with BMI≥ 24.
Conclusion
Traditional ECG criteria for LVH originally developed in Western cohorts demonstrated limited diagnostic performance in Taiwanese adults, particularly in the setting of CRBBB. QRS duration and derived indices may provide more accurate alternatives for detecting LVH in this population.
{"title":"Novel electrocardiographic diagnosis of left ventricular hypertrophy with right bundle branch block in a Taiwanese clinical cohort","authors":"Min-Hsin Ou Yang , Chia-Tung Wu M.D.","doi":"10.1016/j.jelectrocard.2026.154216","DOIUrl":"10.1016/j.jelectrocard.2026.154216","url":null,"abstract":"<div><h3>Background</h3><div>The diagnostic accuracy of electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH) in Taiwanese adults remains uncertain, particularly in the presence of complete right bundle branch block (CRBBB).</div></div><div><h3>Methods</h3><div>We retrospectively enrolled 431 Taiwanese adults, including 205 with normal conduction and 226 with CRBBB. Echocardiographic left ventricular mass index (LVMI) served as the reference standard. We evaluated the sensitivity, specificity and area under the receiver operating characteristic curve (AUC) of six traditional ECG criteria: Sokolow-Lyon index, RaVL, modified Sokolow-Lyon, Cornell voltage, Gubner-Ungerleider and Peguero-Lo Presti. Linear regression examined associations between individual ECG parameters and LVMI, with a focus on the impact of CRBBB. Exploratory analyses were conducted to derive novel ECG indices.</div></div><div><h3>Results</h3><div>Traditional ECG criteria showed low sensitivity but high specificity overall. In patients with normal conduction, Cornell voltage performed best in females and Gubner-Ungerleider in males. However, diagnostic performance decreased substantially in the presence of CRBBB, particularly for criteria relying on anteroseptal leads. In CRBBB patients, QRS duration demonstrated stronger correlation with LVMI than voltage-based criteria. In our cohort, ECG criteria with superior performance is SD× QRS (AUC 0.754) in males with CRBBB, QRS duration (AUC 0.868) in CRBBB females and BMI<24, and SV4 amplitude (AUC 0.702) in CRBBB females with BMI≥ 24.</div></div><div><h3>Conclusion</h3><div>Traditional ECG criteria for LVH originally developed in Western cohorts demonstrated limited diagnostic performance in Taiwanese adults, particularly in the setting of CRBBB. QRS duration and derived indices may provide more accurate alternatives for detecting LVH in this population.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"95 ","pages":"Article 154216"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147306484","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 : 2026-03-01Epub Date: 2026-01-24DOI: 10.1016/j.jelectrocard.2026.154198
Elif Didinmez Taşkırdı , Aycan Ünalp , Ünsal Yılmaz , Timur Meşe , Murat Muhtar Yılmazer
Background
Duchenne muscular dystrophy (DMD) is an inherited neuromuscular disorder causing progressive degeneration of skeletal and cardiac muscles due to dystrophin deficiency. Cardiac involvement ranges from mild to severe, including heart failure, arrhythmias, conduction defects, and sudden cardiac death.
Objective
This study aimed to evaluate early markers of cardiac repolarization abnormalities in DMD patients by analyzing standard 12‑lead ECG parameters—QT interval, corrected QT (QTc), T peak to T end (Tp-e), Tp-e/QT, and Tp-e/QTc ratios—and microvolt T-wave alternans (MTWA) from 24-h Holter monitoring.
Methods
Seventy-four individuals participated: 39 DMD patients and 35 age- and sex-matched healthy controls. Data on demographics, ambulation status, ECG, and Holter recordings were collected and compared. All participants underwent standard 12‑lead electrocardiography and 24-h Holter electrocardiogram monitoring. ECG measurements were performed manually by a blinded operator using standardized techniques. Holter recordings were collected and compared (analyzable data obtained from 33 patients and 34 controls). The QTc interval was calculated using Bazett's formula. Correlation analyses and statistical comparisons between groups were performed using appropriate parametric and non-parametric tests.
Results
DMD patients exhibited significantly higher resting heart rates. The Tp-e interval was similar between groups, while the QT interval was significantly shorter in the patient group, the QTc interval showed no significant difference between groups. Tp-e/QT ratio was higher in the patient group; Tp-e/QTc ratios showed no difference. The QTc interval was significantly prolonged in the non-ambulatory DMD group. MTWA values did not differ significantly between groups. Due to the limited sample size and absence of established pediatric reference values, MTWA findings must be considered inconclusive.
Conclusion
In conclusion, our study reveals subtle repolarization alterations in DMD patients, including elevated resting heart rate and a trend toward increased Tp-e/QT ratio. While these findings do not yet establish a definitive arrhythmic phenotype, they suggest the presence of early electrophysiological changes that may warrant longitudinal cardiac evaluation. Prospective follow-up studies are essential to determine the prognostic significance of these parameters and their relationship to clinical arrhythmic outcomes in the pediatric DMD population.
{"title":"Evaluation of repolarization abnormalities with 12-lead ECG and 24-hour Holter ECG monitoring in patients with Duchenne muscular dystrophy","authors":"Elif Didinmez Taşkırdı , Aycan Ünalp , Ünsal Yılmaz , Timur Meşe , Murat Muhtar Yılmazer","doi":"10.1016/j.jelectrocard.2026.154198","DOIUrl":"10.1016/j.jelectrocard.2026.154198","url":null,"abstract":"<div><h3>Background</h3><div>Duchenne muscular dystrophy (DMD) is an inherited neuromuscular disorder causing progressive degeneration of skeletal and cardiac muscles due to dystrophin deficiency. Cardiac involvement ranges from mild to severe, including heart failure, arrhythmias, conduction defects, and sudden cardiac death.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate early markers of cardiac repolarization abnormalities in DMD patients by analyzing standard 12‑lead ECG parameters—QT interval, corrected QT (QTc), T peak to T end (Tp-e), Tp-e/QT, and Tp-e/QTc ratios—and microvolt T-wave alternans (MTWA) from 24-h Holter monitoring.</div></div><div><h3>Methods</h3><div>Seventy-four individuals participated: 39 DMD patients and 35 age- and sex-matched healthy controls. Data on demographics, ambulation status, ECG, and Holter recordings were collected and compared. All participants underwent standard 12‑lead electrocardiography and 24-h Holter electrocardiogram monitoring. ECG measurements were performed manually by a blinded operator using standardized techniques. Holter recordings were collected and compared (analyzable data obtained from 33 patients and 34 controls). The QTc interval was calculated using Bazett's formula. Correlation analyses and statistical comparisons between groups were performed using appropriate parametric and non-parametric tests.</div></div><div><h3>Results</h3><div>DMD patients exhibited significantly higher resting heart rates. The Tp-e interval was similar between groups, while the QT interval was significantly shorter in the patient group, the QTc interval showed no significant difference between groups. Tp-e/QT ratio was higher in the patient group; Tp-e/QTc ratios showed no difference. The QTc interval was significantly prolonged in the non-ambulatory DMD group. MTWA values did not differ significantly between groups. Due to the limited sample size and absence of established pediatric reference values, MTWA findings must be considered inconclusive.</div></div><div><h3>Conclusion</h3><div>In conclusion, our study reveals subtle repolarization alterations in DMD patients, including elevated resting heart rate and a trend toward increased Tp-e/QT ratio. While these findings do not yet establish a definitive arrhythmic phenotype, they suggest the presence of early electrophysiological changes that may warrant longitudinal cardiac evaluation. Prospective follow-up studies are essential to determine the prognostic significance of these parameters and their relationship to clinical arrhythmic outcomes in the pediatric DMD population.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"95 ","pages":"Article 154198"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074047","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}
Atrial remodeling contributes to atrial fibrillation through structural and electrical alterations. Prolonged P-wave duration indicates conduction delay, while 3D mapping quantifies left atrial (LA) volume and conduction time.
Methods
This study enrolled 27 patients with atrial fibrillation (mean age 63 ± 10 years, 18 men) who underwent catheter ablation. Post-ablation 3D mapping was performed to assess atrial conduction time and LA volume. LA volume was also measured by transthoracic echocardiography. Electrocardiograms for analysis were obtained the following day while all patients were in sinus rhythm. Standard 12‑lead ECGs were recorded, and P-wave duration was digitally measured in each lead; the maximum value (Pmax) was used for analysis. Atrial conduction time and LA volume were compared between patients with Pmax ≥140 ms and those with Pmax <140 ms.
Results
Pmax was significantly correlated with LA conduction time (R = 0.51, p = 0.016), total atrial conduction time (R = 0.62, p < 0.001), and the LA volume index (R = 0.48, p = 0.034). Patients with Pmax ≥140 ms showed delayed conduction and a larger LA volume index compared with those with Pmax <140 ms (LA conduction time 137.3 ± 41.0 vs. 104.5 ± 19.9, p = 0.010; total atrial conduction time 178.8 ± 40.0 vs. 140.8 ± 24.2, p = 0.007; LA volume index 73.7 ± 8.4 vs. 53.6 ± 16.0 mL/m2, p = 0.014). Moreover, Pmax was significantly correlated with the LA volume index measured by echocardiography (R = 0.52, p = 0.013).
Conclusions
Prolongation of Pmax on electrocardiography was significantly associated with delayed atrial conduction and increased LA volume as measured by electro-anatomic mapping.
背景：心房重构通过结构和电的改变导致心房颤动。p波持续时间延长表明传导延迟，而3D测绘量化左房（LA）体积和传导时间。方法27例房颤患者（平均年龄63±10岁，男性18例）行导管消融治疗。消融后进行三维绘图以评估心房传导时间和左心室容积。经胸超声心动图测量LA容积。第二天，所有患者均处于窦性心律时，进行心电图分析。记录标准12导联心电图，并以数字方式测量每个导联的纵波持续时间；取最大值（Pmax）进行分析。结果spmax与左房传导时间（R = 0.51, p = 0.016）、总心房传导时间（R = 0.62, p < 0.001）、左房容积指数（R = 0.48, p = 0.034）显著相关。与Pmax≥140 ms的患者相比，Pmax≥140 ms的患者传导延迟，LA容积指数更大（LA传导时间137.3±41.0∶104.5±19.9,p = 0.010；心房总传导时间178.8±40.0∶140.8±24.2,p = 0.007； LA容积指数73.7±8.4∶53.6±16.0 mL/m2, p = 0.014）。此外，Pmax与超声心动图测量的LA容积指数显著相关（R = 0.52, p = 0.013）。结论心电图Pmax延长与电解剖测得的心房传导延迟和LA容积增大有显著相关性。
{"title":"Prolonged P-wave duration is associated with increased left atrial volume and delayed atrial conduction assessed by electro-anatomic mapping in patients with atrial fibrillation","authors":"Tomoyuki Kabutoya, Hisaki Makimoto, Kazunori Anno, Yuko Torigoe- Kurosu, Yoshifumi Kimura, Takafumi Okuyama, Hiroaki Watanabe, Ayako Yokota, Masashi Kamioka, Tomonori Watanabe, Takahiro Komori, Yasushi Imai, Kazuomi Kario","doi":"10.1016/j.jelectrocard.2026.154201","DOIUrl":"10.1016/j.jelectrocard.2026.154201","url":null,"abstract":"<div><h3>Background</h3><div>Atrial remodeling contributes to atrial fibrillation through structural and electrical alterations. Prolonged P-wave duration indicates conduction delay, while 3D mapping quantifies left atrial (LA) volume and conduction time.</div></div><div><h3>Methods</h3><div>This study enrolled 27 patients with atrial fibrillation (mean age 63 ± 10 years, 18 men) who underwent catheter ablation. Post-ablation 3D mapping was performed to assess atrial conduction time and LA volume. LA volume was also measured by transthoracic echocardiography. Electrocardiograms for analysis were obtained the following day while all patients were in sinus rhythm. Standard 12‑lead ECGs were recorded, and P-wave duration was digitally measured in each lead; the maximum value (Pmax) was used for analysis. Atrial conduction time and LA volume were compared between patients with Pmax ≥140 ms and those with Pmax <140 ms.</div></div><div><h3>Results</h3><div>Pmax was significantly correlated with LA conduction time (<em>R</em> = 0.51, <em>p</em> = 0.016), total atrial conduction time (<em>R</em> = 0.62, <em>p</em> < 0.001), and the LA volume index (<em>R</em> = 0.48, <em>p</em> = 0.034). Patients with Pmax ≥140 ms showed delayed conduction and a larger LA volume index compared with those with Pmax <140 ms (LA conduction time 137.3 ± 41.0 vs. 104.5 ± 19.9, <em>p</em> = 0.010; total atrial conduction time 178.8 ± 40.0 vs. 140.8 ± 24.2, <em>p</em> = 0.007; LA volume index 73.7 ± 8.4 vs. 53.6 ± 16.0 mL/m<sup>2</sup>, <em>p</em> = 0.014). Moreover, Pmax was significantly correlated with the LA volume index measured by echocardiography (<em>R</em> = 0.52, <em>p</em> = 0.013).</div></div><div><h3>Conclusions</h3><div>Prolongation of Pmax on electrocardiography was significantly associated with delayed atrial conduction and increased LA volume as measured by electro-anatomic mapping.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"95 ","pages":"Article 154201"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074048","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 : 2026-03-01Epub Date: 2026-01-24DOI: 10.1016/j.jelectrocard.2026.154199
Georgios Petmezas , Vasileios E. Papageorgiou , Rod S. Passman , John A. Rogers , Leandros Stefanopoulos , Aggelos K. Katsaggelos , Nicos Maglaveras
Introduction
Atrial fibrillation (AFib) is the most prevalent abnormal heart rhythm, significantly increasing the risk of stroke and heart failure. Accurate and timely detection remains challenging, particularly due to the complexity of 12‑lead electrocardiogram (ECG) interpretation. While machine learning (ML) and deep learning (DL) models have demonstrated high accuracy in AFib detection, selecting the optimal input features is often non-trivial. This study aims to develop a hybrid feature selection methodology that objectively identifies the most discriminative ECG-based features for distinguishing AFib from normal sinus rhythm (NSR).
Material & methods
We propose a hybrid framework that combines Extremely Randomized Trees (Extra-Trees) with statistical association measures to identify physiologically meaningful ECG features. Our analysis evaluates morphological, entropy-based and spectral hand-crafted features extracted from 12‑lead ECG recordings of patients who underwent catheter ablation for AFib. Two novel metrics, the feature importance score (FIS) and overall feature importance score (OFIS), are introduced to quantify feature relevance.
Results
The proposed approach ranked 97 extracted features and identified the 10 most important per ECG lead and 20 most relevant overall, with high consistency across leads. The interquartile range of RR-intervals achieved the highest normalized OFIS value (0.064), followed by other rhythm-related and entropy-based measures, confirming their strong discriminative power. The dimensionality of the feature space was thus reduced by nearly 80% while preserving interpretability and physiological meaning.
Conclusions
This methodology provides a reproducible, interpretable and statistically grounded framework for ECG-based feature discovery, offering a preprocessing step for ML/DL models and aiding clinicians in real-time AFib detection.
{"title":"Optimizing atrial fibrillation detection through ECG feature selection using Extra-Trees and statistical association measures","authors":"Georgios Petmezas , Vasileios E. Papageorgiou , Rod S. Passman , John A. Rogers , Leandros Stefanopoulos , Aggelos K. Katsaggelos , Nicos Maglaveras","doi":"10.1016/j.jelectrocard.2026.154199","DOIUrl":"10.1016/j.jelectrocard.2026.154199","url":null,"abstract":"<div><h3>Introduction</h3><div>Atrial fibrillation (AFib) is the most prevalent abnormal heart rhythm, significantly increasing the risk of stroke and heart failure. Accurate and timely detection remains challenging, particularly due to the complexity of 12‑lead electrocardiogram (ECG) interpretation. While machine learning (ML) and deep learning (DL) models have demonstrated high accuracy in AFib detection, selecting the optimal input features is often non-trivial. This study aims to develop a hybrid feature selection methodology that objectively identifies the most discriminative ECG-based features for distinguishing AFib from normal sinus rhythm (NSR).</div></div><div><h3>Material & methods</h3><div>We propose a hybrid framework that combines Extremely Randomized Trees (Extra-Trees) with statistical association measures to identify physiologically meaningful ECG features. Our analysis evaluates morphological, entropy-based and spectral hand-crafted features extracted from 12‑lead ECG recordings of patients who underwent catheter ablation for AFib. Two novel metrics, the feature importance score (FIS) and overall feature importance score (OFIS), are introduced to quantify feature relevance.</div></div><div><h3>Results</h3><div>The proposed approach ranked 97 extracted features and identified the 10 most important per ECG lead and 20 most relevant overall, with high consistency across leads. The interquartile range of RR-intervals achieved the highest normalized OFIS value (0.064), followed by other rhythm-related and entropy-based measures, confirming their strong discriminative power. The dimensionality of the feature space was thus reduced by nearly 80% while preserving interpretability and physiological meaning.</div></div><div><h3>Conclusions</h3><div>This methodology provides a reproducible, interpretable and statistically grounded framework for ECG-based feature discovery, offering a preprocessing step for ML/DL models and aiding clinicians in real-time AFib detection.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"95 ","pages":"Article 154199"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074049","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 : 2026-03-01Epub Date: 2026-01-07DOI: 10.1016/j.jelectrocard.2026.154190
Zhewen Wang , Siteng Wang , Ming Liu , Dan Li , Jinsheng Hua , Xiangyong Kong , Hongwu Chen , Hao Hu , Chao Gao , Jianyuan Pan
Background and objects
Exercise stress high-frequency QRS (ES-HFQRS) is a new non-invasive diagnostic technique mainly for myocardial ischemia, which has been demonstrated with favorable diagnostic efficacy in patients with early ischemic symptoms. Multiple studies confirmed ES-HFQRS's superior diagnostic performance over traditional exercise stress electrocardiography (EST) analysis. However, until now, there is still no meta-analysis that compares the diagnostic efficacy of ES-HFQRS and EST.Therefore, this meta aims to compare the diagnostic value of ES-HFQRS with EST.
Methods
Databases were searched up to August 4, 2025, using keywords including “exercise stress HFQRS” and “exercise stress electrocardiography”. Sensitivity and specificity were pooled using a bivariate random-effects model. Summary receiver operating characteristic (SROC) curves were plotted, and the area under the curve (AUC) was calculated. Subgroup analyses and Meta-regression explored sources of heterogeneity.
Results
Ten studies involving 3352 patients were included. The pooled sensitivity of ES-HFQRS was significantly higher than that of EST (65% [95% CI: 55%–73%] vs. 37% [95% CI: 29%–45%]; P < 0.001), with no significant difference in specificity (78% [95% CI: 72%–83%] for HFQRS vs. 85% [95% CI: 78%–90%] for EST; P = 0.12). The AUCs of ES-HFQRS and EST were 0.77 and 0.64, respectively. Parallel test combining both methods achieved significantly higher sensitivity than EST alone (76% [95% CI: 69%–82%] vs. 37% [95% CI: 29%–45%]; P < 0.001) while maintaining stable specificity at 64% (95% CI: 58%–70%). The serial test increased specificity to 96% (95% CI: 94%–97%),with a significantly lower sensitivity of 22% (95% CI: 17%–29%).
Conclusion
ES-HFQRS had superior sensitivity to EST for the non-invasive diagnosis of myocardial ischemia. Combining both analytical methods flexibly could enhance the diagnostic value in the detection of myocardial ischemia.
{"title":"Exercise high-frequency QRS versus exercise stress electrocardiography in diagnosing myocardial ischemia: A meta-analysis","authors":"Zhewen Wang , Siteng Wang , Ming Liu , Dan Li , Jinsheng Hua , Xiangyong Kong , Hongwu Chen , Hao Hu , Chao Gao , Jianyuan Pan","doi":"10.1016/j.jelectrocard.2026.154190","DOIUrl":"10.1016/j.jelectrocard.2026.154190","url":null,"abstract":"<div><h3>Background and objects</h3><div>Exercise stress high-frequency QRS (ES-HFQRS) is a new non-invasive diagnostic technique mainly for myocardial ischemia, which has been demonstrated with favorable diagnostic efficacy in patients with early ischemic symptoms. Multiple studies confirmed ES-HFQRS's superior diagnostic performance over traditional exercise stress electrocardiography (EST) analysis. However, until now, there is still no meta-analysis that compares the diagnostic efficacy of ES-HFQRS and EST.Therefore, this meta aims to compare the diagnostic value of ES-HFQRS with EST.</div></div><div><h3>Methods</h3><div>Databases were searched up to August 4, 2025, using keywords including “exercise stress HFQRS” and “exercise stress electrocardiography”. Sensitivity and specificity were pooled using a bivariate random-effects model. Summary receiver operating characteristic (SROC) curves were plotted, and the area under the curve (AUC) was calculated. Subgroup analyses and Meta-regression explored sources of heterogeneity.</div></div><div><h3>Results</h3><div>Ten studies involving 3352 patients were included. The pooled sensitivity of ES-HFQRS was significantly higher than that of EST (65% [95% CI: 55%–73%] vs. 37% [95% CI: 29%–45%]; <em>P</em> < 0.001), with no significant difference in specificity (78% [95% CI: 72%–83%] for HFQRS vs. 85% [95% CI: 78%–90%] for EST; <em>P</em> = 0.12). The AUCs of ES-HFQRS and EST were 0.77 and 0.64, respectively. Parallel test combining both methods achieved significantly higher sensitivity than EST alone (76% [95% CI: 69%–82%] vs. 37% [95% CI: 29%–45%]; <em>P</em> < 0.001) while maintaining stable specificity at 64% (95% CI: 58%–70%). The serial test increased specificity to 96% (95% CI: 94%–97%),with a significantly lower sensitivity of 22% (95% CI: 17%–29%).</div></div><div><h3>Conclusion</h3><div>ES-HFQRS had superior sensitivity to EST for the non-invasive diagnosis of myocardial ischemia. Combining both analytical methods flexibly could enhance the diagnostic value in the detection of myocardial ischemia.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"95 ","pages":"Article 154190"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018745","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 : 2026-03-01Epub Date: 2026-02-02DOI: 10.1016/j.jelectrocard.2026.154203
Hugo Villarroel-Ábrego , Raúl Norberto Garillo , Daniela Benzano Bumaguin , Bernardo Neuhaus Lignati , Andrés Di Leoni Ferrari
Background
Left ventricular (LV) mechanical dyssynchrony results from nonuniform myocardial activation, leading to inefficient LV contraction and worse clinical outcomes. Synchromax® is a noninvasive system that performs real-time spatial variance analysis of QRS complexes from a standard electrocardiogram, generating an electrical synchrony index (ESI) that may be a potential marker of LV mechanical dyssynchrony. This study evaluated the efficacy of the ESI in predicting LV mechanical dyssynchrony compared to the gold standard: LV mechanical dispersion (LVMD) > 60 ms as measured by speckle-tracking strain echocardiography.
Methods
A cross-sectional study was conducted with consecutive adult patients undergoing echocardiography in San Salvador, El Salvador. Clinical, electrocardiographic (rhythm, QRS duration, ESI), and echocardiographic (LVMD, LV ejection fraction, global longitudinal strain) data were collected.
Results
Eighty-four studies from 83 patients were analyzed. Mean ESI was 0.36 ± 0.31 and mean LVMD was 58.4 ± 27.1 ms. The ESI showed a sensitivity of 70.0% and a specificity of 88.9%, with negative and positive predictive values of 84.2% and 77.8%, respectively. Agreement with the gold standard was moderate (kappa = 0.60; p < 0.001). ROC curve analysis demonstrated good discriminative performance (area under the curve = 0.81), superior to QRS duration (area under the curve = 0.71) for identifying LV mechanical dyssynchrony.
Conclusions
The optimal ESI cutoff was 0.42. ESI correlated consistently and significantly with LVMD, indicating that it may be a more sensitive functional marker than QRS duration, especially in cases without evident dyssynchrony. The ESI is a simple, accessible tool for complementary assessment of ventricular electromechanical synchrony.
{"title":"Correlation between Electrical Synchrony Index values measured by Synchromax® and left ventricular mechanical dispersion assessed by strain echocardiography","authors":"Hugo Villarroel-Ábrego , Raúl Norberto Garillo , Daniela Benzano Bumaguin , Bernardo Neuhaus Lignati , Andrés Di Leoni Ferrari","doi":"10.1016/j.jelectrocard.2026.154203","DOIUrl":"10.1016/j.jelectrocard.2026.154203","url":null,"abstract":"<div><h3>Background</h3><div>Left ventricular (LV) mechanical dyssynchrony results from nonuniform myocardial activation, leading to inefficient LV contraction and worse clinical outcomes. Synchromax® is a noninvasive system that performs real-time spatial variance analysis of QRS complexes from a standard electrocardiogram, generating an electrical synchrony index (ESI) that may be a potential marker of LV mechanical dyssynchrony. This study evaluated the efficacy of the ESI in predicting LV mechanical dyssynchrony compared to the gold standard: LV mechanical dispersion (LVMD) > 60 ms as measured by speckle-tracking strain echocardiography.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted with consecutive adult patients undergoing echocardiography in San Salvador, El Salvador. Clinical, electrocardiographic (rhythm, QRS duration, ESI), and echocardiographic (LVMD, LV ejection fraction, global longitudinal strain) data were collected.</div></div><div><h3>Results</h3><div>Eighty-four studies from 83 patients were analyzed. Mean ESI was 0.36 ± 0.31 and mean LVMD was 58.4 ± 27.1 ms. The ESI showed a sensitivity of 70.0% and a specificity of 88.9%, with negative and positive predictive values of 84.2% and 77.8%, respectively. Agreement with the gold standard was moderate (kappa = 0.60; <em>p</em> < 0.001). ROC curve analysis demonstrated good discriminative performance (area under the curve = 0.81), superior to QRS duration (area under the curve = 0.71) for identifying LV mechanical dyssynchrony.</div></div><div><h3>Conclusions</h3><div>The optimal ESI cutoff was 0.42. ESI correlated consistently and significantly with LVMD, indicating that it may be a more sensitive functional marker than QRS duration, especially in cases without evident dyssynchrony. The ESI is a simple, accessible tool for complementary assessment of ventricular electromechanical synchrony.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"95 ","pages":"Article 154203"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131065","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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