Pub 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":"2026-01-07","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 : 2026-01-07DOI: 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":"2026-01-07","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 : 2026-01-06DOI: 10.1016/j.jelectrocard.2026.154192
Solomon Kim MPH , Beshoy Saad BA , Gary Chu MD
Background
Individual electrocardiographic abnormalities associate with reduced left ventricular ejection fraction (LVEF), but whether multiple continuous ECG parameters provide synergistic predictive value compared to single parameters or binary scoring remains incompletely characterized.
Methods
QRS duration, PR interval, and heart rate-corrected QT interval (QTc) from ECGs were analyzed in 89,630 paired ECG-echocardiogram studies from the EchoNext database. After systematic evaluation of missing data patterns revealing significant selection bias, the cohort was divided into training (70%, n = 62,741) and validation (30%, n = 26,889) sets using stratified sampling. Seven logistic regression models were developed, all adjusted for age and sex. Models were evaluated using bootstrap confidence intervals with 1000 iterations and 5-fold stratified cross-validation.
Results
The full continuous model achieved fair discrimination (AUC 0.710, 95% CI 0.699–0.714) compared to QTc alone (AUC 0.695, ΔAUC = 0.016, p < 0.001). Among individual parameters, QTc demonstrated strongest association (AUC 0.695), followed by QRS duration (AUC 0.673) and PR interval (AUC 0.603). LVEF ≤45% prevalence increased from 15.9% (0 abnormalities) to 30.6% (1 abnormality), 49.5% (2 abnormalities), and 58.3% (3 abnormalities) (Cochran-Armitage Z = 76.0, p < 0.001). At the optimal threshold, the model achieved sensitivity 59.9%, specificity 72.6%, positive predictive value 37.9%, and negative predictive value 86.7%. All models showed excellent calibration slopes (range 0.963–1.043). Cross-validation confirmed stability (CV AUC 0.706 ± 0.006).
Conclusions
Combined continuous ECG parameters provide predictive value for reduced LVEF compared to individual parameters or binary classifications. However, selection bias from non-random missing data (42.0% vs 21.8% outcome prevalence in incomplete vs complete cases, p < 0.001) suggests findings likely underestimate true associations.
个体心电图异常与左室射血分数（LVEF）降低有关，但与单一参数或二元评分相比，多个连续心电图参数是否提供协同预测价值仍未完全确定。方法分析EchoNext数据库89,630对心电图超声心动图研究中心电图sqrs持续时间、PR间期和心率校正QT间期（QTc）。在对显示显著选择偏倚的缺失数据模式进行系统评估后，采用分层抽样将队列分为训练组（70%,n = 62,741）和验证组（30%,n = 26,889）。开发了7个逻辑回归模型，均对年龄和性别进行了调整。模型使用1000次迭代的自举置信区间和5倍分层交叉验证进行评估。结果与单独使用QTc （AUC 0.695， ΔAUC = 0.016, p < 0.001）相比，全连续模型实现了公平的区分（AUC 0.710, 95% CI 0.699-0.714）。在各参数中，QTc相关性最强（AUC为0.695），QRS持续时间（AUC为0.673）和PR间隔（AUC为0.603）次之。LVEF≤45%的患病率从15.9%（0例）增加到30.6%（1例）、49.5%（2例）和58.3%（3例）（Cochran-Armitage Z = 76.0, p < 0.001）。在最佳阈值下，该模型的敏感性为59.9%，特异性为72.6%，阳性预测值为37.9%，阴性预测值为86.7%。所有模型均具有良好的校准斜率（0.963 ~ 1.043）。交叉验证证实了稳定性（CV AUC 0.706±0.006）。结论与单项参数或二元分类相比，连续心电图参数组合对LVEF降低有较好的预测价值。然而，来自非随机缺失数据的选择偏倚（不完整病例和完整病例的结果患病率分别为42.0%和21.8%,p < 0.001）表明研究结果可能低估了真实关联。
{"title":"Cumulative electrocardiogram abnormalities predict left ventricular ejection fraction reduction: EchoNext database analysis","authors":"Solomon Kim MPH , Beshoy Saad BA , Gary Chu MD","doi":"10.1016/j.jelectrocard.2026.154192","DOIUrl":"10.1016/j.jelectrocard.2026.154192","url":null,"abstract":"<div><h3>Background</h3><div>Individual electrocardiographic abnormalities associate with reduced left ventricular ejection fraction (LVEF), but whether multiple continuous ECG parameters provide synergistic predictive value compared to single parameters or binary scoring remains incompletely characterized.</div></div><div><h3>Methods</h3><div>QRS duration, PR interval, and heart rate-corrected QT interval (QTc) from ECGs were analyzed in 89,630 paired ECG-echocardiogram studies from the EchoNext database. After systematic evaluation of missing data patterns revealing significant selection bias, the cohort was divided into training (70%, <em>n</em> = 62,741) and validation (30%, <em>n</em> = 26,889) sets using stratified sampling. Seven logistic regression models were developed, all adjusted for age and sex. Models were evaluated using bootstrap confidence intervals with 1000 iterations and 5-fold stratified cross-validation.</div></div><div><h3>Results</h3><div>The full continuous model achieved fair discrimination (AUC 0.710, 95% CI 0.699–0.714) compared to QTc alone (AUC 0.695, ΔAUC = 0.016, <em>p</em> < 0.001). Among individual parameters, QTc demonstrated strongest association (AUC 0.695), followed by QRS duration (AUC 0.673) and PR interval (AUC 0.603). LVEF ≤45% prevalence increased from 15.9% (0 abnormalities) to 30.6% (1 abnormality), 49.5% (2 abnormalities), and 58.3% (3 abnormalities) (Cochran-Armitage Z = 76.0, <em>p</em> < 0.001). At the optimal threshold, the model achieved sensitivity 59.9%, specificity 72.6%, positive predictive value 37.9%, and negative predictive value 86.7%. All models showed excellent calibration slopes (range 0.963–1.043). Cross-validation confirmed stability (CV AUC 0.706 ± 0.006).</div></div><div><h3>Conclusions</h3><div>Combined continuous ECG parameters provide predictive value for reduced LVEF compared to individual parameters or binary classifications. However, selection bias from non-random missing data (42.0% vs 21.8% outcome prevalence in incomplete vs complete cases, <em>p</em> < 0.001) suggests findings likely underestimate true associations.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"95 ","pages":"Article 154192"},"PeriodicalIF":1.2,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145940568","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 : 2026-01-06DOI: 10.1016/j.jelectrocard.2026.154191
Alejandro Jesús Bermejo Valdés
We used three-dimensional (3D) electrocardiography (ECG) to track the J-wave in V6 through viewing planes inaccessible to standard ECG. Across three identified J-loop phenotypes, we found that the planar morphology of the end QRS deflection, whether J-wave or slurring, depended on projection and was interconvertible under rotation. Although traditionally attributed to phase-1 of the action potential, the 3D J-loop showed that the J-wave becomes concealed and occupies depolarization regions in V1. Here, we examine this discrepancy and show that 3D ECG can more accurately reinterpret the electrophysiological and pathological phenomena associated with early repolarization.
{"title":"Unmasking the J-wave: 3D ECG shows terminal depolarization mimicking early repolarization","authors":"Alejandro Jesús Bermejo Valdés","doi":"10.1016/j.jelectrocard.2026.154191","DOIUrl":"10.1016/j.jelectrocard.2026.154191","url":null,"abstract":"<div><div>We used three-dimensional (3D) electrocardiography (ECG) to track the J-wave in V6 through viewing planes inaccessible to standard ECG. Across three identified J-loop phenotypes, we found that the planar morphology of the end QRS deflection, whether J-wave or slurring, depended on projection and was interconvertible under rotation. Although traditionally attributed to phase-1 of the action potential, the 3D J-loop showed that the J-wave becomes concealed and occupies depolarization regions in V1. Here, we examine this discrepancy and show that 3D ECG can more accurately reinterpret the electrophysiological and pathological phenomena associated with early repolarization.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"95 ","pages":"Article 154191"},"PeriodicalIF":1.2,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979127","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 : 2026-01-02DOI: 10.1016/j.jelectrocard.2025.154183
Mustafa Yenerçağ , Metin Çoksevim , Mustafa Kürşat Şahin , Serkan Sivri , Faruk Boyaci , Güney Erdogan , Berkant Öztürk , Mustafa Yilmaz , Mustafa Berkay Yilmaz
Introduction
Wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) is a progressive infiltrative cardiomyopathy characterized by extracellular deposition of misfolded transthyretin protein. This condition has been associated with an increased risk of ventricular arrhythmias. Electrocardiographic repolarization indices such as Tp-e interval and Tp-e/QT ratios are emerging as markers of arrhythmic risk. This study aimed to evaluate ventricular repolarization parameters in ATTRwt-CM patients compared to healthy individuals.
Methods
95 newly diagnosed ATTRwt-CM patients and 95 age- and sex-matched healthy controls were enrolled between August 2023 and August 2025. Electrocardiographic parameters, including Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios, were measured. Left ventricular mass index (LVMI), left atrial volume index (LAVI), and left ventricular diastolic function parameters were evaluated via echocardiography.
Results
The Tp-e interval (81.7 ± 4.6 ms vs. 71.1 ± 5.7 ms; p < 0.001), Tp-e/QT ratio (0.21 ± 0.01 vs. 0.19 ± 0.02; p < 0.001), and Tp-e/QTc ratio (0.18 ± 0.01 vs. 0.17 ± 0.01; p < 0.001) were significantly prolonged in the ATTRwt-CM group. A significant positive correlation was observed between Tp-e indices and LVMI, LAVI, mean E/e' ratio, and NT-proBNP levels.
Conclusion
Our study showed that Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio, which are evaluated electrocardiographically in patients with ATTRwt-CM, were prolonged compared with normal healthy individuals. A positive correlation was determined between repolarization parameters and markers of myocardial remodeling. We believe that pre-treatment evaluation of repolarization parameters in ATTRwt-CM patients would be beneficial for predicting ventricular arrhythmia risk.
{"title":"Electrocardiographic assessment of ventricular repolarization variables in patients with wild-type transthyretin amyloid cardiomyopathy","authors":"Mustafa Yenerçağ , Metin Çoksevim , Mustafa Kürşat Şahin , Serkan Sivri , Faruk Boyaci , Güney Erdogan , Berkant Öztürk , Mustafa Yilmaz , Mustafa Berkay Yilmaz","doi":"10.1016/j.jelectrocard.2025.154183","DOIUrl":"10.1016/j.jelectrocard.2025.154183","url":null,"abstract":"<div><h3>Introduction</h3><div>Wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) is a progressive infiltrative cardiomyopathy characterized by extracellular deposition of misfolded transthyretin protein. This condition has been associated with an increased risk of ventricular arrhythmias. Electrocardiographic repolarization indices such as Tp-e interval and Tp-e/QT ratios are emerging as markers of arrhythmic risk. This study aimed to evaluate ventricular repolarization parameters in ATTRwt-CM patients compared to healthy individuals.</div></div><div><h3>Methods</h3><div>95 newly diagnosed ATTRwt-CM patients and 95 age- and sex-matched healthy controls were enrolled between August 2023 and August 2025. Electrocardiographic parameters, including Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios, were measured. Left ventricular mass index (LVMI), left atrial volume index (LAVI), and left ventricular diastolic function parameters were evaluated via echocardiography.</div></div><div><h3>Results</h3><div>The Tp-e interval (81.7 ± 4.6 ms vs. 71.1 ± 5.7 ms; <em>p</em> < 0.001), Tp-e/QT ratio (0.21 ± 0.01 vs. 0.19 ± 0.02; p < 0.001), and Tp-e/QTc ratio (0.18 ± 0.01 vs. 0.17 ± 0.01; p < 0.001) were significantly prolonged in the ATTRwt-CM group. A significant positive correlation was observed between Tp-e indices and LVMI, LAVI, mean E/e' ratio, and NT-proBNP levels.</div></div><div><h3>Conclusion</h3><div>Our study showed that Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio, which are evaluated electrocardiographically in patients with ATTRwt-CM, were prolonged compared with normal healthy individuals. A positive correlation was determined between repolarization parameters and markers of myocardial remodeling. We believe that pre-treatment evaluation of repolarization parameters in ATTRwt-CM patients would be beneficial for predicting ventricular arrhythmia risk.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"95 ","pages":"Article 154183"},"PeriodicalIF":1.2,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145940569","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 : 2026-01-01DOI: 10.1016/j.jelectrocard.2025.154182
Ahmet Taha Sahin , Oznur Keskin , Serhat Kesriklioglu , Nuraiym Moloshova , Hasan Kan , Muhammet Fatih Kaleli , Busra Ozyesil , Ahmet Salvarci , Leyla Feyzullayeva , Ahmet Lutfu Sertdemir , Enes Elvin Gul
Background
Left bundle branch area pacing (LBBAP) has emerged as a promising physiological pacing strategy. Due to capture of either posterior or anterior fascicles there might be electrocardiograhic (ECG) changes associated with it. However, the prevalence and clinical relevance of left septal fascicular block (LSFB) following LBBAP remain poorly understood, with available data limited to isolated case reports.
Methods
This prospective, single-center study included 137 consecutive patients who underwent LBBAP between February 2024 and March 2025. Standard 12‑lead ECGs were obtained at baseline, at 24 h and one month post-implantation, with LSFB defined by established electrocardiographic criteria. Clinical, echocardiographic, biomarker, and procedural data were collected.
Results
Mean age was 67.4 ± 12.4 years. LSFB was identified in 40 patients (29 %) and was mostly common in patients with ischemic cardiomyopathy (52.5 % vs. 34.0 %, p = 0.04). Although post-implantation troponin levels showed a significant increase compared to baseline, patients with LSFB had similar level of increase in troponin compared to patients without (∆Troponin 34.3 vs 34.0, p = 0.52). Procedural success rates and pacing parameters were comparable between groups.
Conclusion
LSFB is a relatively common and clinically relevant finding after LBBAP, strongly associated with ischemic cardiomyopathy. These findings suggest LSFB may represent a marker of underlying ischemic vulnerability and warrant further investigation in larger multicenter cohorts.
背景：左束分支区域起搏（LBBAP）已成为一种很有前途的生理起搏策略。由于后或前肌束的捕获，可能会出现与之相关的心电图（ECG）变化。然而，LBBAP后左间隔肌束阻滞（LSFB）的患病率和临床相关性仍然知之甚少，可用的数据仅限于孤立病例报告。方法：这项前瞻性单中心研究纳入了在2024年2月至2025年3月期间接受LBBAP治疗的137例连续患者。在基线、植入后24小时和1个月获得标准12导联心电图，并根据既定的心电图标准定义LSFB。收集临床、超声心动图、生物标志物和手术数据。结果：平均年龄67.4±12.4岁。LSFB在40例患者（29%）中被发现，在缺血性心肌病患者中最常见（52.5%比34.0%,p = 0.04）。虽然植入后肌钙蛋白水平与基线相比有显著增加，但与未植入的患者相比，LSFB患者的肌钙蛋白增加水平相似（∆肌钙蛋白34.3 vs 34.0, p = 0.52）。两组手术成功率和起搏参数具有可比性。结论：LSFB是LBBAP术后较为常见且具有临床相关性的发现，与缺血性心肌病密切相关。这些发现表明，LSFB可能是潜在的缺血性易感性的标志，值得在更大的多中心队列中进一步研究。
{"title":"Prevalence and clinical relevance of left septal fascicular block following conduction system pacing","authors":"Ahmet Taha Sahin , Oznur Keskin , Serhat Kesriklioglu , Nuraiym Moloshova , Hasan Kan , Muhammet Fatih Kaleli , Busra Ozyesil , Ahmet Salvarci , Leyla Feyzullayeva , Ahmet Lutfu Sertdemir , Enes Elvin Gul","doi":"10.1016/j.jelectrocard.2025.154182","DOIUrl":"10.1016/j.jelectrocard.2025.154182","url":null,"abstract":"<div><h3>Background</h3><div>Left bundle branch area pacing (LBBAP) has emerged as a promising physiological pacing strategy. Due to capture of either posterior or anterior fascicles there might be electrocardiograhic (ECG) changes associated with it. However, the prevalence and clinical relevance of left septal fascicular block (LSFB) following LBBAP remain poorly understood, with available data limited to isolated case reports.</div></div><div><h3>Methods</h3><div>This prospective, single-center study included 137 consecutive patients who underwent LBBAP between February 2024 and March 2025. Standard 12‑lead ECGs were obtained at baseline, at 24 h and one month post-implantation, with LSFB defined by established electrocardiographic criteria. Clinical, echocardiographic, biomarker, and procedural data were collected.</div></div><div><h3>Results</h3><div>Mean age was 67.4 ± 12.4 years. LSFB was identified in 40 patients (29 %) and was mostly common in patients with ischemic cardiomyopathy (52.5 % vs. 34.0 %, <em>p</em> = 0.04). Although post-implantation troponin levels showed a significant increase compared to baseline, patients with LSFB had similar level of increase in troponin compared to patients without (∆Troponin 34.3 vs 34.0, <em>p</em> = 0.52). Procedural success rates and pacing parameters were comparable between groups.</div></div><div><h3>Conclusion</h3><div>LSFB is a relatively common and clinically relevant finding after LBBAP, strongly associated with ischemic cardiomyopathy. These findings suggest LSFB may represent a marker of underlying ischemic vulnerability and warrant further investigation in larger multicenter cohorts.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"94 ","pages":"Article 154182"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145862405","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 : 2026-01-01DOI: 10.1016/j.jelectrocard.2025.154133
Zhong-Qun Zhan MD
{"title":"Comment on “Deep inspiration as a diagnostic maneuver to differentiate accessory-pathway–induced ST elevation from inferior myocardial infarction”","authors":"Zhong-Qun Zhan MD","doi":"10.1016/j.jelectrocard.2025.154133","DOIUrl":"10.1016/j.jelectrocard.2025.154133","url":null,"abstract":"","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"94 ","pages":"Article 154133"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086294","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 : 2026-01-01DOI: 10.1016/j.jelectrocard.2025.154181
Eyyup Tusun M.D , Necmettin Korucuk M.D , Mustafa Çetin M.D , Ali Nizami Elmas M.D
Background
Coronary artery disease (CAD) is the leading cause of death worldwide. Fragmented QRS (fQRS) has emerged as a new prognostic marker in cardiovascular disease. Coronary computed tomography angiography (CCTA) is an effective method to diagnose obstructive CAD. The degree of stenosis determines the severity of the disease.
Methods
A total of 120 patients admitted to the cardiology outpatient clinic with angina pectoris symptoms were included in the study. The fQRS is defined as the presence of an additional R wave, notching of the R wave, notching of the nadir of the S wave in 2 contiguous leads, or the presence of more than one R' wave without a typical bundle branch block. CCTA was performed on patients with low-moderate risk. The patients were divided into two groups based on the presence (Group 1, n = 58 patients) or the absence (Group 2, n = 62 patients) of ≥70 % coronary artery stenosis.
Results
The baseline characteristics of the patients were not significantly different. Group 1 had a higher prevalence of DM, hyperlipidemia, smoking, and fQRS compared to Group 2 (p < 0.05, for all). When the subjects were divided into two groups, fQRS (+) and fQRS (−), a statistically significant difference was revealed between the two groups (p < 0.001). A positive correlation was found between fQRS and ≥ 70 % stenosis in CCTA. In the multivariate regression analysis, smoking and fQRS were independent predictors of ≥70 % stenosis in CCTA.
Conclusion
According to our study, fQRS, an important ECG finding, is associated with ≥70 % stenosis in CCTA and may be evaluated for the prediction of significant coronary stenosis.
{"title":"The predictive value of fragmented QRS for severe coronary stenosis in patients undergoing coronary CT angiography","authors":"Eyyup Tusun M.D , Necmettin Korucuk M.D , Mustafa Çetin M.D , Ali Nizami Elmas M.D","doi":"10.1016/j.jelectrocard.2025.154181","DOIUrl":"10.1016/j.jelectrocard.2025.154181","url":null,"abstract":"<div><h3>Background</h3><div>Coronary artery disease (CAD) is the leading cause of death worldwide. Fragmented QRS (fQRS) has emerged as a new prognostic marker in cardiovascular disease. Coronary computed tomography angiography (CCTA) is an effective method to diagnose obstructive CAD. The degree of stenosis determines the severity of the disease.</div></div><div><h3>Methods</h3><div>A total of 120 patients admitted to the cardiology outpatient clinic with angina pectoris symptoms were included in the study. The fQRS is defined as the presence of an additional R wave, notching of the R wave, notching of the nadir of the S wave in 2 contiguous leads, or the presence of more than one R' wave without a typical bundle branch block. CCTA was performed on patients with low-moderate risk. The patients were divided into two groups based on the presence (Group 1, <em>n</em> = 58 patients) or the absence (Group 2, <em>n</em> = 62 patients) of ≥70 % coronary artery stenosis.</div></div><div><h3>Results</h3><div>The baseline characteristics of the patients were not significantly different. Group 1 had a higher prevalence of DM, hyperlipidemia, smoking, and fQRS compared to Group 2 (<em>p</em> < 0.05, for all). When the subjects were divided into two groups, fQRS (+) and fQRS (−), a statistically significant difference was revealed between the two groups (<em>p</em> < 0.001). A positive correlation was found between fQRS and ≥ 70 % stenosis in CCTA. In the multivariate regression analysis, smoking and fQRS were independent predictors of ≥70 % stenosis in CCTA.</div></div><div><h3>Conclusion</h3><div>According to our study, fQRS, an important ECG finding, is associated with ≥70 % stenosis in CCTA and may be evaluated for the prediction of significant coronary stenosis.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"94 ","pages":"Article 154181"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145862453","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 : 2025-12-20DOI: 10.1016/j.jelectrocard.2025.154180
Xingjie Li, Yong Hu
A 77-year-old female patient had electrocardiographic (ECG) recordings of atrial premature beat (APB) bigeminy, junctional escape-capture bigeminy, and junctional reciprocal beat bigeminy at different time points. This case indicates that bigeminy is merely a similar “superficial phenomenon” but arises from distinct underlying mechanisms. Therefore, ECG analysis and diagnosis should not adopt a one-size-fits-all approach; instead, specific conditions require individualized assessment.
{"title":"Coexistence of three types of Bigeminy with different natures","authors":"Xingjie Li, Yong Hu","doi":"10.1016/j.jelectrocard.2025.154180","DOIUrl":"10.1016/j.jelectrocard.2025.154180","url":null,"abstract":"<div><div>A 77-year-old female patient had electrocardiographic (ECG) recordings of atrial premature beat (APB) bigeminy, junctional escape-capture bigeminy, and junctional reciprocal beat bigeminy at different time points. This case indicates that bigeminy is merely a similar “superficial phenomenon” but arises from distinct underlying mechanisms. Therefore, ECG analysis and diagnosis should not adopt a one-size-fits-all approach; instead, specific conditions require individualized assessment.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"94 ","pages":"Article 154180"},"PeriodicalIF":1.2,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145819510","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}
Background: Early electrocardiograph predates electronic amplification and therefore required innovative and highly sensitive instrumentation. Willem Einthoven's introduction of the string galvanometer in 1903 enabled recording of clinically useful electrocardiograms and established electrocardiography as a diagnostic method.
Objectives: To describe the provenance and technical features of a uniquely complete string-galvanometer system preserved in Lund, Sweden, and to review early commercial production and surviving string galvanometers manufactured before 1910.
Methods: The Lund electrocardiograph was examined and compared with historical photographs, documentation from Einthoven's laboratory, archival sources, and contemporary literature. Museum and institutional collections as well as manufacturers' records were surveyed for surviving old instruments.
Results: The Lund string galvanometer electrocardiograph, constructed in 1909 from Einthoven's original drawings, retains its optical, magnetic coil system, cooling, and recording components and closely matches documented laboratory models. Only two companies produced string galvanometers commercially by then: Professor Max Th. Edelmann's Physikalisch-mechanisches Institut (Munich, Germany) and the Cambridge Scientific Instrument Company (Cambridge, England). Cambridge sold only 14 devices before 1910, and no complete instrument is known to have survived; Edelmann's production is poorly documented, with only few examples preserved.
Conclusions: Intact electrocardiographs from the earliest period of electrocardiography are extremely rare. The Lund instrument represents one of the best-preserved surviving complete devices and underscores the importance of documenting and conserving early biomedical technology.
{"title":"Electrocardiographs before 1910: Manufacturers and surviving instruments","authors":"Olle Pahlm MD PhD , Bengt Uvelius MD PhD , Anders Widell MD PhD","doi":"10.1016/j.jelectrocard.2025.154178","DOIUrl":"10.1016/j.jelectrocard.2025.154178","url":null,"abstract":"<div><div>Background: Early electrocardiograph predates electronic amplification and therefore required innovative and highly sensitive instrumentation. Willem Einthoven's introduction of the string galvanometer in 1903 enabled recording of clinically useful electrocardiograms and established electrocardiography as a diagnostic method.</div><div>Objectives: To describe the provenance and technical features of a uniquely complete string-galvanometer system preserved in Lund, Sweden, and to review early commercial production and surviving string galvanometers manufactured before 1910.</div><div>Methods: The Lund electrocardiograph was examined and compared with historical photographs, documentation from Einthoven's laboratory, archival sources, and contemporary literature. Museum and institutional collections as well as manufacturers' records were surveyed for surviving old instruments.</div><div>Results: The Lund string galvanometer electrocardiograph, constructed in 1909 from Einthoven's original drawings, retains its optical, magnetic coil system, cooling, and recording components and closely matches documented laboratory models. Only two companies produced string galvanometers commercially by then: Professor Max Th. Edelmann's Physikalisch-mechanisches Institut (Munich, Germany) and the Cambridge Scientific Instrument Company (Cambridge, England). Cambridge sold only 14 devices before 1910, and no complete instrument is known to have survived; Edelmann's production is poorly documented, with only few examples preserved.</div><div>Conclusions: Intact electrocardiographs from the earliest period of electrocardiography are extremely rare. The Lund instrument represents one of the best-preserved surviving complete devices and underscores the importance of documenting and conserving early biomedical technology.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"94 ","pages":"Article 154178"},"PeriodicalIF":1.2,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145810046","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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