Pub Date : 2025-01-10DOI: 10.1016/j.jelectrocard.2025.153876
Md Moklesur Rahman , Massimo Walter Rivolta , Martino Vaglio , Pierre Maison-Blanche , Fabio Badilini , Roberto Sassi
Background
Detecting subtle patterns of atrial fibrillation (AF) and irregularities in Holter recordings is intricate and unscalable if done manually. Artificial intelligence-based techniques can be beneficial. In fact, with the rapid advancement of AI, deep learning (DL) demonstrated the capability to identify AF from ECGs with significant performance. However, further development and validation on larger cohorts is still needed.
Purpose
The main purpose of this study was to develop a Residual-attention DL model by considering a large cohort of 2‑lead Holter recordings.
Methods
We developed a residual DL model by collecting a large dataset of 661 Holter recordings, which was labeled manually by an expert cardiologist. The DL model leveraged attention mechanisms, allowing it to capture long-range dependencies and intricate temporal relationships crucial for identifying subtle patterns indicative of AF.
Results
Experimental results demonstrated that our model achieved a sensitivity (detection of AF) of and a specificity of , with an AUC-ROC of on our dataset. Additionally, when evaluated with an external test dataset, specifically IRIDIA-AF, our DL model obtained , , and . Finally, when compared under similar experimental conditions with other state-of-the-art models, our DL model achieved slightly better performance overall.
Conclusion
The Residual-attention DL model we proposed offers a promising solution for AF detection. The validation on external datasets contributes to its potential for deployment in clinical settings, providing clinicians with a valuable decision support system.
{"title":"Residual-attention deep learning model for atrial fibrillation detection from Holter recordings","authors":"Md Moklesur Rahman , Massimo Walter Rivolta , Martino Vaglio , Pierre Maison-Blanche , Fabio Badilini , Roberto Sassi","doi":"10.1016/j.jelectrocard.2025.153876","DOIUrl":"10.1016/j.jelectrocard.2025.153876","url":null,"abstract":"<div><h3>Background</h3><div>Detecting subtle patterns of atrial fibrillation (AF) and irregularities in Holter recordings is intricate and unscalable if done manually. Artificial intelligence-based techniques can be beneficial. In fact, with the rapid advancement of AI, deep learning (DL) demonstrated the capability to identify AF from ECGs with significant performance. However, further development and validation on larger cohorts is still needed.</div></div><div><h3>Purpose</h3><div>The main purpose of this study was to develop a Residual-attention DL model by considering a large cohort of 2‑lead Holter recordings.</div></div><div><h3>Methods</h3><div>We developed a residual DL model by collecting a large dataset of 661 Holter recordings, which was labeled manually by an expert cardiologist. The DL model leveraged attention mechanisms, allowing it to capture long-range dependencies and intricate temporal relationships crucial for identifying subtle patterns indicative of AF.</div></div><div><h3>Results</h3><div>Experimental results demonstrated that our model achieved a sensitivity (detection of AF) of <span><math><mi>Se</mi><mo>=</mo><mn>0.928</mn></math></span> and a specificity of <span><math><mi>Sp</mi><mo>=</mo><mn>0.915</mn></math></span>, with an AUC-ROC of <span><math><mi>AUC</mi><mo>=</mo><mn>0.967</mn></math></span> on our dataset. Additionally, when evaluated with an external test dataset, specifically IRIDIA-AF, our DL model obtained <span><math><mi>Se</mi><mo>=</mo><mn>0.942</mn></math></span>, <span><math><mi>Sp</mi><mo>=</mo><mn>0.932</mn></math></span>, and <span><math><mi>AUC</mi><mo>=</mo><mn>0.965</mn></math></span>. Finally, when compared under similar experimental conditions with other state-of-the-art models, our DL model achieved slightly better performance overall.</div></div><div><h3>Conclusion</h3><div>The Residual-attention DL model we proposed offers a promising solution for AF detection. The validation on external datasets contributes to its potential for deployment in clinical settings, providing clinicians with a valuable decision support system.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"89 ","pages":"Article 153876"},"PeriodicalIF":1.3,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006470","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 : 2025-01-09DOI: 10.1016/j.jelectrocard.2025.153877
Stefan Kurath-Koller M.D., Ph.D , Martin Manninger M.D., Ph.D , Daniel Scherr M.D. , Hannes Sallmon M.D.
We report wide QRS complexes appearing in conjunction with prolonged R-R intervals in a 5- year old patient with situs ambiguous and mirror image dextrocardia, who had undergone ASD and VSD closure at of the age of one. We present differential diagnoses of intermittent spontaneous QRS widening and refer to ECG lead positioning in mirror image dextrocardia patients.
{"title":"ECG challenge: Intermittent wide QRS complexes in heterotaxy syndrome","authors":"Stefan Kurath-Koller M.D., Ph.D , Martin Manninger M.D., Ph.D , Daniel Scherr M.D. , Hannes Sallmon M.D.","doi":"10.1016/j.jelectrocard.2025.153877","DOIUrl":"10.1016/j.jelectrocard.2025.153877","url":null,"abstract":"<div><div>We report wide QRS complexes appearing in conjunction with prolonged R-R intervals in a 5- year old patient with situs ambiguous and mirror image dextrocardia, who had undergone ASD and VSD closure at of the age of one. We present differential diagnoses of intermittent spontaneous QRS widening and refer to ECG lead positioning in mirror image dextrocardia patients.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"89 ","pages":"Article 153877"},"PeriodicalIF":1.3,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-04DOI: 10.1016/j.jelectrocard.2024.153863
Ibrahim Antoun PhD , Xin Li PhD , Zakkariya Vali FRCP , Ahmed Abdelrazik MSc , Riyaz Somani PhD , G. André Ng PhD
Background
Pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) can be performed using one-shot cryoballoon ablation (cryo) or point-by-point radiofrequency ablation (RF). This study compares the changes in P-wave parameters between both ablation methods.
Methods
This single-centre retrospective study included contact force RF and second-generation cryo for PAF between 2018 and 2019. Procedure success was defined by freedom of ECG-documented AF at 12 months. Digital 12‑leads ECGs with 1–50 hertz bandpass filters were monitored directly during the procedure. Corrected P-wave duration (PWDc), P-wave voltage (PWV), P-wave dispersion (PWDisp), and P-wave terminal force in V1 (PTFV1) were measured and compared between RF and cryo. Additional ablations outside pulmonary veins were excluded.
Results
The final analysis included 226 patients, and the freedom of AF rate was similar at the 12-month follow-up between RF and cryo (76 % vs 74 %, P = 0.12). PWDc and PWV increased and decreased, respectively in both arms. PTFV1 decreased in RF (−3.3 mm.s to −4.6 mm.s, P < 0.001) and cryo (−3.4 mm.s to −5.3 mm.s,P = 0.002). There were similar changes after RF and cryo in PWDc (F11, 1032 = 0.80, P = 0.85), PWV (F11, 1032 = 0.19,P = 0.06), and PWDisp (F11, 1032 = 0.16,P = 0.34) and PTFV1 (P = 0.39). Increased PWDc was correlated with failure of RF (hazard ratio [2.3], 95 % confidence interval [CI]: 1.4–5.9, p = 0.01) and cryo (HR: 2.1, 95 % CI (1.3–4.6), p = 0.02). Results were similar when patients on antiarrhythmic drugs were excluded.
Conclusion
RF and cryo caused similar freedom of AF rate at 12 months in PAF and similar P-wave parameter changes.
背景：肺静脉隔离（PVI）治疗阵发性心房颤动（PAF）可采用一次性冷冻球囊消融（cryo）或逐点射频消融（RF）。本研究比较了两种烧蚀方法的p波参数变化。方法：本研究采用2018 - 2019年接触力RF和第二代冷冻技术进行单中心回顾性研究。手术成功的定义是12个月时心电图记录的房颤的自由度。在手术过程中直接监测带有1-50赫兹带通滤波器的数字12导联心电图。测量校正后的p波持续时间（PWDc）、p波电压（PWV）、p波色散（PWDisp）和V1的p波末端力（PTFV1），并比较RF和冷冻的差异。排除了肺静脉外的其他消融。结果：最终分析纳入226例患者，RF和冷冻12个月随访时房颤自由率相似（76% vs 74%, P = 0.12）。两组PWDc和PWV分别升高和降低。PTFV1减少射频(-3.3 mm.s mm.s至-4.6,P 1032 = 0.80, P = 0.85),采集(到1032 = 0.19,P = 0.06),和PWDisp(到1032 = 0.16,P = 0.34)和PTFV1 (P = 0.39)。PWDc升高与RF失败（风险比[2.3]，95%可信区间[CI]: 1.4 ~ 5.9, p = 0.01）和冷冻失败（风险比：2.1,95% CI (1.3 ~ 4.6), p = 0.02）相关。当排除服用抗心律失常药物的患者时，结果相似。结论：射频和低温导致PAF患者12月房颤自由相似，p波参数变化相似。
{"title":"Comparison of P-wave parameter changes after radiofrequency ablation and cryoballoon ablation for paroxysmal atrial fibrillation: An observational cohort study","authors":"Ibrahim Antoun PhD , Xin Li PhD , Zakkariya Vali FRCP , Ahmed Abdelrazik MSc , Riyaz Somani PhD , G. André Ng PhD","doi":"10.1016/j.jelectrocard.2024.153863","DOIUrl":"10.1016/j.jelectrocard.2024.153863","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) can be performed using one-shot cryoballoon ablation (cryo) or point-by-point radiofrequency ablation (RF). This study compares the changes in P-wave parameters between both ablation methods.</div></div><div><h3>Methods</h3><div>This single-centre retrospective study included contact force RF and second-generation cryo for PAF between 2018 and 2019. Procedure success was defined by freedom of ECG-documented AF at 12 months. Digital 12‑leads ECGs with 1–50 hertz bandpass filters were monitored directly during the procedure. Corrected P-wave duration (PWDc), P-wave voltage (PWV), P-wave dispersion (PWDisp), and P-wave terminal force in V1 (PTFV1) were measured and compared between RF and cryo. Additional ablations outside pulmonary veins were excluded.</div></div><div><h3>Results</h3><div>The final analysis included 226 patients, and the freedom of AF rate was similar at the 12-month follow-up between RF and cryo (76 % vs 74 %, <em>P</em> = 0.12). PWDc and PWV increased and decreased, respectively in both arms. PTFV1 decreased in RF (−3.3 mm.s to −4.6 mm.s, <em>P</em> < 0.001) and cryo (−3.4 mm.s to −5.3 mm.s,<em>P</em> = 0.002). There were similar changes after RF and cryo in PWDc (F<sub>11, 1032</sub> = 0.80, <em>P</em> = 0.85), PWV (F<sub>11, 1032</sub> = 0.19,<em>P</em> = 0.06), and PWDisp (F<sub>11, 1032</sub> = 0.16,<em>P</em> = 0.34) and PTFV1 (<em>P</em> = 0.39). Increased PWDc was correlated with failure of RF (hazard ratio [2.3], 95 % confidence interval [CI]: 1.4–5.9, <em>p</em> = 0.01) and cryo (HR: 2.1, 95 % CI (1.3–4.6), <em>p</em> = 0.02). Results were similar when patients on antiarrhythmic drugs were excluded.</div></div><div><h3>Conclusion</h3><div>RF and cryo caused similar freedom of AF rate at 12 months in PAF and similar P-wave parameter changes.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"89 ","pages":"Article 153863"},"PeriodicalIF":1.3,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.jelectrocard.2024.153851
Yuval Avidan MD , Vsevolod Tabachnikov MD , Orel Ben Court MD , Razi Khoury MD , Amir Aker MD
Introduction
Atrial fibrillation (AF) is the most common arrhythmia in clinical practice, yet interpretation concerns among healthcare providers persist. Confounding factors contribute to false-positive and false-negative AF diagnoses, leading to potential omissions. Artificial intelligence advancements show promise in electrocardiogram (ECG) interpretation. We sought to examine the diagnostic accuracy of ChatGPT-4omni (GPT-4o), equipped with image evaluation capabilities, in interpreting ECGs with confounding factors and compare its performance to that of physicians.
Methods
Twenty ECG cases, divided into Group A (10 cases of AF or atrial flutter) and Group B (10 cases of sinus or another atrial rhythm), were crafted into multiple-choice questions. Total of 100 practitioners (25 from each: emergency medicine, internal medicine, primary care, and cardiology) were tasked to identify the underlying rhythm. Next, GPT-4o was prompted in five separate sessions.
Results
GPT-4o performed inadequately, averaging 3 (±2) in Group A questions and 5.40 (±1.34) in Group B questions. Upon examining the accuracy of the total ECG questions, no significant difference was found between GPT-4o, internists, and primary care physicians (p = 0.952 and = 0.852, respectively). Cardiologists outperformed other medical disciplines and GPT-4o (p < 0.001), while emergency physicians followed in accuracy, though comparison to GPT-4o only indicated a trend (p = 0.068).
Conclusion
GPT-4o demonstrated suboptimal accuracy with significant under- and over-recognition of AF in ECGs with confounding factors. Despite its potential as a supportive tool for ECG interpretation, its performance did not surpass that of medical practitioners, underscoring the continued importance of human expertise in complex diagnostics.
{"title":"In the face of confounders: Atrial fibrillation detection – Practitioners vs. ChatGPT","authors":"Yuval Avidan MD , Vsevolod Tabachnikov MD , Orel Ben Court MD , Razi Khoury MD , Amir Aker MD","doi":"10.1016/j.jelectrocard.2024.153851","DOIUrl":"10.1016/j.jelectrocard.2024.153851","url":null,"abstract":"<div><h3>Introduction</h3><div>Atrial fibrillation (AF) is the most common arrhythmia in clinical practice, yet interpretation concerns among healthcare providers persist. Confounding factors contribute to false-positive and false-negative AF diagnoses, leading to potential omissions. Artificial intelligence advancements show promise in electrocardiogram (ECG) interpretation. We sought to examine the diagnostic accuracy of ChatGPT-4omni (GPT-4o), equipped with image evaluation capabilities, in interpreting ECGs with confounding factors and compare its performance to that of physicians.</div></div><div><h3>Methods</h3><div>Twenty ECG cases, divided into Group A (10 cases of AF or atrial flutter) and Group B (10 cases of sinus or another atrial rhythm), were crafted into multiple-choice questions. Total of 100 practitioners (25 from each: emergency medicine, internal medicine, primary care, and cardiology) were tasked to identify the underlying rhythm. Next, GPT-4o was prompted in five separate sessions.</div></div><div><h3>Results</h3><div>GPT-4o performed inadequately, averaging 3 (±2) in Group A questions and 5.40 (±1.34) in Group B questions. Upon examining the accuracy of the total ECG questions, no significant difference was found between GPT-4o, internists, and primary care physicians (<em>p</em> = 0.952 and = 0.852, respectively). Cardiologists outperformed other medical disciplines and GPT-4o (<em>p</em> < 0.001), while emergency physicians followed in accuracy, though comparison to GPT-4o only indicated a trend (<em>p</em> = 0.068).</div></div><div><h3>Conclusion</h3><div>GPT-4o demonstrated suboptimal accuracy with significant under- and over-recognition of AF in ECGs with confounding factors. Despite its potential as a supportive tool for ECG interpretation, its performance did not surpass that of medical practitioners, underscoring the continued importance of human expertise in complex diagnostics.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"88 ","pages":"Article 153851"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818416","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 : 2025-01-01DOI: 10.1016/j.jelectrocard.2024.153854
Uğur Küçük MD (Assistant Professor) , Pınar Mutlu MD (Assistant Professor) , Arzu Mirici MD (Professor) , Uğur Özpınar MD , Selin Beyza Özpınar MD
Background
Chronic Obstructive Pulmonary Disease (COPD) is associated with left atrial (LA) dyfunction, which may contribute to adverse cardiovascular outcomes. This study investigates the predictive value of lately identified morphology-voltage-P wave duration electrocardiography (MVP ECG) score for detecting early LA dysfunction in COPD patients.
Methods
In this cross-sectional study, 101 COPD patients were enrolled. All patients underwent speckle tracking echocardiography and were classified into two groups based on their LA functions.
Results
Our findings demonstrate significant variations in Peak Atrial Longitudinal Strain (PALS) values among COPD patients, with a mean PALS of 28.74 ± 1.81 % for the group with normal LA function and 18.44 ± 1.87 % for the group with abnormal LA function (p < 0.001). Despite similar LA diameters across groups, these variations indicate subclinical LA pathogenesis. ROC curve analysis indicated that an MVP ECG score greater than 2.5 predicted abnormal LA function with a sensitivity of 65 % and a specificity of 91 % (area under the curve [AUC]: 0.873; p < 0.001), suggesting its utility in identifying atrial damage and remodeling.
Conclusions
The MVP ECG score shows promise as a tool for early detection of atrial remodeling in COPD patients.
{"title":"Identifying early left atrial dysfunction in COPD patients using ECG morphology-voltage-P wave duration score","authors":"Uğur Küçük MD (Assistant Professor) , Pınar Mutlu MD (Assistant Professor) , Arzu Mirici MD (Professor) , Uğur Özpınar MD , Selin Beyza Özpınar MD","doi":"10.1016/j.jelectrocard.2024.153854","DOIUrl":"10.1016/j.jelectrocard.2024.153854","url":null,"abstract":"<div><h3>Background</h3><div>Chronic Obstructive Pulmonary Disease (COPD) is associated with left atrial (LA) dyfunction, which may contribute to adverse cardiovascular outcomes. This study investigates the predictive value of lately identified morphology-voltage-P wave duration electrocardiography (MVP ECG) score for detecting early LA dysfunction in COPD patients.</div></div><div><h3>Methods</h3><div>In this cross-sectional study, 101 COPD patients were enrolled. All patients underwent speckle tracking echocardiography and were classified into two groups based on their LA functions.</div></div><div><h3>Results</h3><div>Our findings demonstrate significant variations in Peak Atrial Longitudinal Strain (PALS) values among COPD patients, with a mean PALS of 28.74 ± 1.81 % for the group with normal LA function and 18.44 ± 1.87 % for the group with abnormal LA function (<em>p</em> < 0.001). Despite similar LA diameters across groups, these variations indicate subclinical LA pathogenesis. ROC curve analysis indicated that an MVP ECG score greater than 2.5 predicted abnormal LA function with a sensitivity of 65 % and a specificity of 91 % (area under the curve [AUC]: 0.873; <em>p</em> < 0.001), suggesting its utility in identifying atrial damage and remodeling.</div></div><div><h3>Conclusions</h3><div>The MVP ECG score shows promise as a tool for early detection of atrial remodeling in COPD patients.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"88 ","pages":"Article 153854"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894713","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 : 2025-01-01DOI: 10.1016/j.jelectrocard.2024.153848
Andrei D. Margulescu MD, PhD , Diluka Amila Premawardhana , Dewi E. Thomas MD
Background
The prevalence and severity of QT interval prolongation (long QT, LQT) in takotsubo syndrome (TS) is not well described.
Methods
This is a retrospective cohort study of all patients admitted in our Centre between January 2019 and December 2023 with confirmed TS. QT interval corrected for heart rate (QTc) (Bazzett formula) was measured manually in all available ECGs. Presence of other ECG abnormalities (T-wave inversion (TWI), ST segment elevation (STE), ST segment depression (STD)) were also recorded.
Results
Fifty-eight patients were included, all women (68 ± 11 years). Fifty-six patients (96.6 %) had classical, apical ballooning form of TS. Symptoms included chest pain (93.1 %), dyspnoea (10.3 %), and others (5.2 %). Triggers were present in 70.7 % of patients. Three-hundred-and-thirty ECGs were analysed. LQT was infrequent in the first 3 h after symptom onset (23.5 % of patients), and was only mild. However, between 24 and 48 h after symptom onset, 90.9 % of patients developed LQT, which was severe (≥500 ms) in 63.6 % of patients. LQT prevalence decreased afterwards but QTc did not return to normal in 40.0 % of patients, and remained severely prolonged in 11.4 % of patients beyond 96 h. ECG was normal in 40.5 % of patients in the first 6 h. TWI was the predominant ECG change, and its prevalence increased from 16.7 % within the first 6 h to 76.9 % after 7 days. STE was present in 31.4 % of patients in the first 96 h, but was rare in isolation. Isolated STD did not occur.
Conclusion
LQT is almost universally seen in patients with TS within the first 96 h after symptom onset, and is severe in the majority. ECGs abnormalities in TS are highly dynamic, but ECGs are frequently normal in the first 6 h after symptom onset. Patients should be monitored for at least 96 h after symptom onset, and until QTc falls below 500 ms.
{"title":"Prevalence and severity of QT prolongation and other ECG abnormalities in takotsubo syndrome","authors":"Andrei D. Margulescu MD, PhD , Diluka Amila Premawardhana , Dewi E. Thomas MD","doi":"10.1016/j.jelectrocard.2024.153848","DOIUrl":"10.1016/j.jelectrocard.2024.153848","url":null,"abstract":"<div><h3>Background</h3><div>The prevalence and severity of QT interval prolongation (long QT, LQT) in takotsubo syndrome (TS) is not well described.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study of all patients admitted in our Centre between January 2019 and December 2023 with confirmed TS. QT interval corrected for heart rate (QTc) (Bazzett formula) was measured manually in all available ECGs. Presence of other ECG abnormalities (T-wave inversion (TWI), ST segment elevation (STE), ST segment depression (STD)) were also recorded.</div></div><div><h3>Results</h3><div>Fifty-eight patients were included, all women (68 ± 11 years). Fifty-six patients (96.6 %) had classical, apical ballooning form of TS. Symptoms included chest pain (93.1 %), dyspnoea (10.3 %), and others (5.2 %). Triggers were present in 70.7 % of patients. Three-hundred-and-thirty ECGs were analysed. LQT was infrequent in the first 3 h after symptom onset (23.5 % of patients), and was only mild. However, between 24 and 48 h after symptom onset, 90.9 % of patients developed LQT, which was severe (≥500 ms) in 63.6 % of patients. LQT prevalence decreased afterwards but QTc did not return to normal in 40.0 % of patients, and remained severely prolonged in 11.4 % of patients beyond 96 h. ECG was normal in 40.5 % of patients in the first 6 h. TWI was the predominant ECG change, and its prevalence increased from 16.7 % within the first 6 h to 76.9 % after 7 days. STE was present in 31.4 % of patients in the first 96 h, but was rare in isolation. Isolated STD did not occur.</div></div><div><h3>Conclusion</h3><div>LQT is almost universally seen in patients with TS within the first 96 h after symptom onset, and is severe in the majority. ECGs abnormalities in TS are highly dynamic, but ECGs are frequently normal in the first 6 h after symptom onset. Patients should be monitored for at least 96 h after symptom onset, and until QTc falls below 500 ms.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"88 ","pages":"Article 153848"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769347","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 : 2025-01-01DOI: 10.1016/j.jelectrocard.2024.153853
Kristina Torngren MD , Aleksei Savelev MD , Erik Ljungström MD, PhD , Pyotr G. Platonov MD, PhD (Professor)
ECG in Brugada syndrome (BrS) is characterized by a ST-segment elevation in the right precordial leads. Overlap between ST-segment changes in BrS and ischemia may lead to diagnostic challenges.
We report a case of a male patient presented with recurrent chest pain episodes and ST elevation in the right precordial leads consistent with Brugada ECG pattern type 1 and was clinically diagnosed with BrS at the age of 30 years. During follow up the patient developed acute myocardial infarction with pronounced ST depression in the right precordial leads, masking the Brugada pattern of the baseline ECG.
{"title":"Case presentation of acute ischemia induced ST-depression masking Brugada syndrome ECG pattern in a relatively young patient","authors":"Kristina Torngren MD , Aleksei Savelev MD , Erik Ljungström MD, PhD , Pyotr G. Platonov MD, PhD (Professor)","doi":"10.1016/j.jelectrocard.2024.153853","DOIUrl":"10.1016/j.jelectrocard.2024.153853","url":null,"abstract":"<div><div>ECG in Brugada syndrome (BrS) is characterized by a ST-segment elevation in the right precordial leads. Overlap between ST-segment changes in BrS and ischemia may lead to diagnostic challenges.</div><div>We report a case of a male patient presented with recurrent chest pain episodes and ST elevation in the right precordial leads consistent with Brugada ECG pattern type 1 and was clinically diagnosed with BrS at the age of 30 years. During follow up the patient developed acute myocardial infarction with pronounced ST depression in the right precordial leads, masking the Brugada pattern of the baseline ECG.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"88 ","pages":"Article 153853"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.jelectrocard.2024.153836
Cees A. Swenne Ph.D. , Vladimir Shusterman M.D., Ph.D.
Neurocardiology is a broad interdisciplinary specialty investigating how the cardiovascular and nervous systems interact. In this brief introductory review, we describe several key aspects of this interaction with specific attention to cardiovascular effects.
The review introduces basic anatomy and discusses physiological mechanisms and effects that play crucial roles in the interaction of the cardiovascular and nervous systems, namely: the cardiac neuraxis, the taxonomy of the nervous system, integration of sensory input in the brainstem, influences of the autonomic nervous system (ANS) on heart and vasculature, the neural pathways and functioning of the arterial baroreflex, receptors and ANS effects in the walls of blood vessels, receptors and ANS effects in excitable cells in the heart, ANS effects on heart rate and sympathovagal balance, endo-epicardial inhomogeneity, ANS effects with a balanced vagal and sympathetic stimulation, sympathovagal interaction, arterial baroreflex, baroreflex sensitivity and heart rate variability, arrhythmias and the arterial baroreflex, the cardiopulmonary baroreflex, the exercise pressor reflex, exercise-recovery hysteresis, mental stress, cardiac-cardiac reflexes, the cardiac sympathetic afferent reflex (CSAR), and neuromodulation. Also, the potential role of the discussed mechanisms in cardiovascular disorders will be touched upon.
神经心脏病学是一门广泛的跨学科专业，研究心血管系统和神经系统如何相互作用。在这篇简短的介绍性综述中，我们将描述这种相互作用的几个关键方面，并特别关注对心血管的影响。这篇综述介绍了基本解剖学，并讨论了在心血管和神经系统相互作用中发挥关键作用的生理机制和效应，即心脏神经轴、神经系统的分类、脑干感觉输入的整合、自律神经系统（ANS）对心脏和血管的影响、动脉血压反射的神经通路和功能、血管壁上的受体和 ANS 的影响、心脏兴奋细胞上的受体和 ANS 的影响、ANS 对心率和交感神经平衡的影响、心内-心外不均匀性、迷走神经和交感神经平衡刺激下的 ANS 效应、交感-迷走神经相互作用、动脉巴反射、巴反射敏感性和心率变异性、心律失常和动脉巴反射、心肺巴反射、运动加压反射、运动-恢复滞后、精神压力、心-心反射、心脏交感传入反射（CSAR）和神经调节。此外，还将讨论所讨论的机制在心血管疾病中的潜在作用。
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Pub Date : 2025-01-01DOI: 10.1016/j.jelectrocard.2024.153835
Xiuyan Lu , Qiuhuan Wang , Xiujie Sun , Yibing Shao , Wenbo Jiang
Objective
The present study was conducted to assess the accuracy and reliability of portable 12‑lead electrocardiography (ECG) devices in patients with heart disease.
Materials and methods
This single-center, prospective, blinded study enrolled 62 patients between September and October 2023 from the Heart Center of a Class III hospital. In sequential tests on each patient, heart rate (HR) and the PR, QT, QTc and QRS intervals of ECG recordings obtained with a portable 12‑lead device (Weheal, CN) were compared with those obtained via conventional 12‑lead ECG. ECG parameters were read in batches by 3 blinded electrophysiologists. Two-tailed paired t-tests were used to compare the continuous variables. Agreement was evaluated via Bland–Altman plots.
Results
Sixty-two patients were included. HR and the QT, QTc and QRS intervals from the portable 12‑lead electrocardiogram recordings were essentially the same as those obtained via conventional ECG. Bland–Altman analysis revealed no significant differences in these values, indicating suitable agreement between the 2 measurements. The PR interval was 176.89 ± 29.53 ms in the portable group and 161.56 ± 17.78 ms in the standard group, which was statistically (p < 0.001) but not clinically significant.
Conclusions
ECG recordings obtained with a portable 12‑lead device (Weheal, CN) allow for accurate HR, PR, QT, QTc and QRS assessments. Considering its simplicity, this approach has advantages over conventional ECG and can provide an alternative for evaluating patients outside the hospital. How to improve patients' acceptance of portable ECG machines still needs further research.
{"title":"Clinical value of portable 12‐lead electrocardiography devices in patients with heart disease: A validation study","authors":"Xiuyan Lu , Qiuhuan Wang , Xiujie Sun , Yibing Shao , Wenbo Jiang","doi":"10.1016/j.jelectrocard.2024.153835","DOIUrl":"10.1016/j.jelectrocard.2024.153835","url":null,"abstract":"<div><h3>Objective</h3><div>The present study was conducted to assess the accuracy and reliability of portable 12‑lead electrocardiography (ECG) devices in patients with heart disease.</div></div><div><h3>Materials and methods</h3><div>This single-center, prospective, blinded study enrolled 62 patients between September and October 2023 from the Heart Center of a Class III hospital. In sequential tests on each patient, heart rate (HR) and the PR, QT, QTc and QRS intervals of ECG recordings obtained with a portable 12‑lead device (Weheal, CN) were compared with those obtained via conventional 12‑lead ECG. ECG parameters were read in batches by 3 blinded electrophysiologists. Two-tailed paired <em>t-</em>tests were used to compare the continuous variables. Agreement was evaluated via Bland–Altman plots.</div></div><div><h3>Results</h3><div>Sixty-two patients were included. HR and the QT, QTc and QRS intervals from the portable 12‑lead electrocardiogram recordings were essentially the same as those obtained via conventional ECG. Bland–Altman analysis revealed no significant differences in these values, indicating suitable agreement between the 2 measurements. The PR interval was 176.89 ± 29.53 ms in the portable group and 161.56 ± 17.78 ms in the standard group, which was statistically (<em>p</em> < 0.001) but not clinically significant.</div></div><div><h3>Conclusions</h3><div>ECG recordings obtained with a portable 12‑lead device (Weheal, CN) allow for accurate HR, PR, QT, QTc and QRS assessments. Considering its simplicity, this approach has advantages over conventional ECG and can provide an alternative for evaluating patients outside the hospital. How to improve patients' acceptance of portable ECG machines still needs further research.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"88 ","pages":"Article 153835"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785827","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}
A septuagenarian man underwent dual chamber pacemaker (DDDR – Boston Scientific Massachusetts, U.S.) insertion for a complete heart block. Intra-procedural lead parameters were within normal limits. Frequent multisite origin premature ventricular complexes were noted even on pre-procedural electrocardiogram (ECG). On the follow-up ECG one pacing spike on the QRS of the first beat was followed by two pacing spikes on the T wave with a total of three pacing spikes on the whole QRST of the first complex. What is the mechanism?
一名七旬老人因完全性心脏传导阻滞接受了双腔起搏器（DDDR - 美国马萨诸塞州波士顿科学公司）植入手术。术中导联参数在正常范围内。即使在术前心电图（ECG）上也发现了频繁的多源性室性早搏。在随访心电图上，第一个搏动的 QRS 上出现一个起搏尖峰，随后 T 波上出现两个起搏尖峰，第一个复律的整个 QRST 上总共出现三个起搏尖峰。其机制是什么？
{"title":"Triple pacing spikes on QRST: What is the mechanism?","authors":"Sudipta Mondal MD, DM, N. Sharath MD, Jyothi Vijay MD, DM, Narayanan Namboodiri MD, DM","doi":"10.1016/j.jelectrocard.2024.153849","DOIUrl":"10.1016/j.jelectrocard.2024.153849","url":null,"abstract":"<div><div>A septuagenarian man underwent dual chamber pacemaker (DDDR – Boston Scientific Massachusetts, U.S.) insertion for a complete heart block. Intra-procedural lead parameters were within normal limits. Frequent multisite origin premature ventricular complexes were noted even on pre-procedural electrocardiogram (ECG). On the follow-up ECG one pacing spike on the QRS of the first beat was followed by two pacing spikes on the T wave with a total of three pacing spikes on the whole QRST of the first complex. What is the mechanism?</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"88 ","pages":"Article 153849"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817892","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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