Journal of electrocardiology最新文献

英文中文

Atrial repolarization in patients with left ventricular dysfunction 左心室功能不全患者心房复极

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-11-29 DOI: 10.1016/j.jelectrocard.2025.154160

Neha Pulath, Ramanathan Velayutham, Anish Bhargav, J. Barathkrishnan, Raja J. Selvaraj

Background

Atrial depolarization is represented by the P wave on the electrocardiogram (ECG), while atrial repolarization (Ta wave) is usually obscured by the QRS complex. In patients with third-degree atrioventricular block, the Ta wave can be observed and studied. Although atrial repolarization has been described in healthy subjects and in those with paroxysmal atrial fibrillation, it has not been studied in left ventricular dysfunction.

Methods

Patients with pacemaker implanted for third-degree AV block were studied. Group 1 included patients with normal ejection fraction (LVEF ≥55 %), and group 2 included patients with reduced ejection fraction (LVEF ≤40 %). Pacemakers were programmed to VVI pacing at 40 bpm, and six standard 12‑lead ECGs were recorded. P waves not followed by QRS complex for 500 ms were identified. PTa segments were extracted, averaged, and analyzed for duration, amplitude, axis and dispersion.

Results

Of 31 enrolled patients, 25 were included in the final analysis (13 in group 1, 12 in group 2). The mean PTa duration was 482 ± 36 ms and was not different between the groups. P wave duration, Ta amplitude, and Ta axis also were not different. Ta axis was northwest in all patients, opposite to the direction of atrial depolarisation. PTa dispersion was significantly higher in group 2 (74 ± 21 ms) compared to group 1 (54 ± 14 ms, p = 0.008).

Conclusion

PTa wave amplitude, duration, and axis are not altered in left ventricular dysfunction. PTa dispersion is increased in these patients and may be a marker of elevated risk for atrial arrhythmias.

心房去极化由心电图上的P波表示，而心房再极化（Ta波）通常被QRS复合体所掩盖。在三度房室传导阻滞患者中，可以观察和研究Ta波。虽然在健康受试者和阵发性心房颤动患者中已经有过心房复极的描述，但在左心室功能障碍中还没有研究过。方法对三度房室传导阻滞患者植入起搏器进行研究。第1组为射血分数正常（LVEF≥55%）患者，第2组为射血分数降低（LVEF≤40%）患者。起搏器设定为每分钟40次的VVI起搏，并记录6个标准的12导联心电图。在500 ms内未发现QRS复合体的P波。提取PTa片段，平均，并分析其持续时间，振幅，轴和弥散度。结果31例入组患者中，25例纳入最终分析（1组13例，2组12例）。平均PTa持续时间为482±36 ms，各组间差异无统计学意义。P波持续时间、Ta振幅和Ta轴也无差异。所有患者Ta轴均向西北方向，与心房去极化方向相反。2组PTa弥散度（74±21 ms）显著高于1组（54±14 ms, p = 0.008）。结论pta波振幅、持续时间和轴向在左心功能障碍中未发生改变。PTa弥散度在这些患者中增加，可能是心房心律失常风险升高的标志。

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引用次数: 0

Diagnostic accuracy of 18-lead versus 12-lead electrocardiography in acute coronary syndrome: A systematic review and meta-analysis 18导联与12导联心电图对急性冠状动脉综合征的诊断准确性：系统回顾和荟萃分析。

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-11-26 DOI: 10.1016/j.jelectrocard.2025.154161

Almaz Rehman Koolikad, Syed Ahmad Khan, Muhammad Shahzaib, Bushra Arif, Shivam Singla, Bhavna Singla, Muhammad Subhan, Abida Perveen, Jahanzeb Malik

Objective

To evaluate the diagnostic accuracy and clinical impact of 18‑lead electrocardiography compared with conventional 12‑lead ECG in patients with suspected acute coronary syndromes (ACS).

Methods

A systematic review and meta-analysis were conducted by searching PubMed, Embase, Scopus, and the Cochrane Library from inception to August 2025. Eligible studies compared 18‑lead with 12‑lead ECG using angiography, biomarkers, or imaging as reference standards. Data were extracted to construct 2 × 2 tables where available, and pooled sensitivity, specificity, and risk ratios were calculated using random-effects models. Risk of bias was assessed with QUADAS-2, and certainty of evidence was graded with GRADE.

Results

Seven studies met the inclusion criteria, of which four provided extractable diagnostic accuracy data (n ≈ 535). Across studies, 18‑lead ECG significantly improved sensitivity for posterior myocardial infarction (≈80–85 % vs 55–65 % with 12‑lead) and right ventricular infarction (≈78 % vs 58 %) while preserving specificity (≈90 %). Pooled analysis demonstrated a 34 % relative improvement in diagnostic yield (RR 1.34, 95 % CI 1.18–1.55; p < 0.01). Approximately 10–15 % of patients initially classified as NSTEMI were reclassified as STEMI-equivalents using 18‑lead recordings. Evidence of earlier catheterization laboratory activation was noted in emergency department cohorts.

Conclusion

Eighteen‑lead ECG enhances detection of posterior and right ventricular infarctions without loss of specificity and supports earlier intervention. Broader clinical adoption and outcome-focused trials are warranted.

目的：评价18导联心电图与常规12导联心电图对疑似急性冠脉综合征（ACS）的诊断准确性及临床意义。方法：通过检索PubMed、Embase、Scopus和Cochrane Library自成立至2025年8月的文献进行系统评价和meta分析。符合条件的研究比较了18导联和12导联心电图，使用血管造影、生物标志物或成像作为参考标准。在可能的情况下，提取数据构建2 × 2表，并使用随机效应模型计算合并敏感性、特异性和风险比。偏倚风险采用QUADAS-2进行评估，证据的确定性采用GRADE分级。结果：7项研究符合纳入标准，其中4项提供可提取的诊断准确性数据（n≈535）。在所有研究中，18导联心电图显著提高了对后置心肌梗死（≈80- 85% vs 55- 65%）和右心室梗死（≈78% vs 58%）的敏感性，同时保留了特异性（≈90%）。合并分析显示，诊断率相对提高34% （RR 1.34, 95% CI 1.18-1.55; p）。结论：十八导联心电图增强了对后室和右室梗死的检测，而不丧失特异性，支持早期干预。更广泛的临床应用和以结果为重点的试验是必要的。

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引用次数: 0

Associations of non-alcoholic fatty liver disease with arrhythmic disorders and electrocardiogram traits: A Mendelian randomization study 非酒精性脂肪性肝病与心律失常和心电图特征的关联：孟德尔随机研究

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-11-19 DOI: 10.1016/j.jelectrocard.2025.154158

Panji Wang , Ruixia Yuan , Yuan Meng , Hengdao Liu , Shenzhen Gong , Zhaowei Sun , Hailong Tao

Introduction

Observational studies indicate a link between arrhythmias, electrocardiogram (ECG) characteristics, and non-alcoholic fatty liver disease (NAFLD). However, it is uncertain whether NAFLD acts merely as a risk marker or directly contributes to the development and progression of these arrhythmic disorders. Mendelian randomization (MR) was employed to investigate the causal relationship of NAFLD on arrhythmias and ECG traits.

Methods

A two-sample Mendelian randomization (MR) analysis was performed to examine the causal relationship of genetically predicted NAFLD (imaging and biopsy confirmed NAFLD) on arrhythmias [i.e., atrial fibrillation (AF), left bundle branch block (LBBB), right bundle branch block (RBBB), and atrioventricular block (AVB)] and ECG traits [i.e., P wave duration (PWD), PR interval, QT interval, and QRS duration]. We utilized the inverse variance weighted method as the principal analytical approach, supplemented by a range of sensitivity analyses.

Results

Inverse-variance weighted method showed a statistically significant association between genetically predicted NAFLD and LBBB (OR: 1.261, 95% CI: 1.066-1.491, p = 0.0068). However, there was insufficient evidence to support a significant association between genetically predicted NAFLD and other arrhythmias or electrocardiographic characteristics. Sensitivity analyses revealed low heterogeneity and the absence of horizontal pleiotropy, suggesting that the findings are robust.

Conclusion

The study indicates a causal relationship between genetically predicted NAFLD and LBBB, suggesting that NAFLD may influence cardiac electrical activity.

观察性研究表明心律失常、心电图（ECG）特征和非酒精性脂肪性肝病（NAFLD）之间存在联系。然而，目前尚不确定NAFLD是否仅作为风险标志或直接导致这些心律失常的发生和进展。采用孟德尔随机化（MR）研究NAFLD与心律失常和心电图特征的因果关系。方法：采用两样本孟德尔随机化（MR）分析，研究遗传预测NAFLD（影像学和活检证实NAFLD）与心律失常（即心房颤动（AF）、左束支传导阻滞（LBBB）、右束支传导阻滞（RBBB）和房室传导阻滞（AVB））和心电图特征（即P波持续时间（PWD）、PR间期、QT间期和QRS持续时间）之间的因果关系。我们采用反方差加权法作为主要分析方法，辅以一系列敏感性分析。结果：反方差加权法显示遗传预测NAFLD与LBBB之间有统计学意义的相关性（OR: 1.261, 95% CI: 1.066 ~ 1.491, p = 0.0068）。然而，没有足够的证据支持遗传预测NAFLD与其他心律失常或心电图特征之间的显著关联。敏感性分析显示低异质性和水平多效性的缺失，表明研究结果是可靠的。结论：本研究提示遗传预测的NAFLD与LBBB之间存在因果关系，提示NAFLD可能影响心电活动。

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引用次数: 0

Ventricular fibrillation, atrial fibrillation, early repolarization and dynamic QT shortening: An unusual presentation of a storm 心室颤动，心房颤动，早期复极和动态QT缩短：风暴的不寻常的表现

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-11-19 DOI: 10.1016/j.jelectrocard.2025.154159

Abhinav B. Anand DM, Mohsin S. Shaikh MD, Pratap J. Nathani DM, Yash Y. Lokhandwala DM

The coexistence of atrial fibrillation (AF) and ventricular fibrillation (VF) in a structurally normal heart is a rare presentation. We describe a case of a previously healthy, 30-year-old man presenting with a family history of sudden cardiac death. The ECG during admission showed early repolarization pattern and he spontaneously developed AF, junctional rhythm and VF and dynamic QT shortening with prominent U waves during the arrhythmic storm. Genetic testing revealed novel heterozygous missense substitution p.Ile73Val in exon 2 of the CACNA1C gene.

心房颤动（AF）和心室颤动（VF）共存在一个结构正常的心脏是一个罕见的表现。我们描述一个病例以前健康，30岁的男子提出的家族史心脏性猝死。入院时心电图显示早复极模式，心律不齐风暴期间自发发生心房颤动、结律动、室颤及动态QT缩短，U波明显。基因检测发现CACNA1C基因2外显子出现新的杂合错义替换p.i ile73val。

引用次数: 0

ECG interpretation for pre-participation screening in athletes 运动员赛前筛查的心电图解读

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-11-19 DOI: 10.1016/j.jelectrocard.2025.154157

Francesca Graziano MD , Alessandro Zorzi MD, PhD , Domenico Corrado MD, PhD

The role of electrocardiography (ECG) in pre-participation screening (PPS) has long been debated, but accumulating evidence supports its importance in detecting cardiovascular diseases associated with sudden cardiac death (SCD). Its systematic use has contributed to a reduction in SCD incidence among athletes. Over the past two decades, interpretation standards have evolved, culminating in the International Criteria, which classify ECG findings as normal, borderline, or abnormal. Training-related and vagal tone–related changes are recognized as physiological variants, borderline alterations represent intermediate findings that require careful contextual interpretation, and abnormal patterns constitute true red flags that always warrant further investigation. Additional challenges concern special populations, including children, women, and master athletes, where training-induced remodeling and ECG expression may differ from young male cohorts on which the current criteria are based. While the International Criteria remain the reference framework, future updates are needed to refine thresholds, incorporate emerging evidence, and adapt to diverse athletic populations, with the ultimate goal of improving diagnostic accuracy and preventing SCD.

心电图（ECG）在参与前筛查（PPS）中的作用一直存在争议，但越来越多的证据支持其在检测心源性猝死（SCD）相关心血管疾病中的重要性。它的系统使用有助于减少运动员的SCD发病率。在过去的二十年中，解释标准不断发展，最终形成了国际标准，将ECG表现分为正常、边缘或异常。训练相关和迷走神经张力相关的变化被认为是生理变异，边缘变化代表中间结果，需要仔细的上下文解释，异常模式构成真正的危险信号，总是需要进一步调查。额外的挑战涉及特殊人群，包括儿童、妇女和优秀运动员，在这些人群中，训练诱导的重构和ECG表达可能与当前标准所依据的年轻男性群体不同。虽然国际标准仍然是参考框架，但未来需要更新以完善阈值，纳入新出现的证据，并适应不同的运动人群，最终目标是提高诊断准确性和预防SCD。

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引用次数: 0

Septal notch plus loss of the septal q wave: A potential early ECG sign suggestive of interstitial septal fibrosis in heart disease 室间隔缺口加室间隔q波缺失：提示心脏病间质性室间隔纤维化的潜在早期心电图征象

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-11-13 DOI: 10.1016/j.jelectrocard.2025.154155

Zhong-Qun Zhan MD , Xin-Yi Yu BMed

Background

Early detection of interstitial septal fibrosis remains challenging. We describe a novel ECG pattern that may represent an early marker of fibrotic conduction changes.

Case findings

We evaluated a case demonstrating a triphasic QRS sequence evolving from narrow QRS (88 ms) to complete LBBB-like pattern (160 ms) within three beats. Notable features included: (i) a subtle notch within the initial 20 ms of QRS in leads II, V5 and V6; (ii) disappearance of physiological septal q waves in V5–V6; (iii) multiple notches in leads II, V4-V6; and (iv) late-QRS notching in leads III, aVL, aVF. These findings differed significantly from true LBBB criteria.

Interpretation

This ECG pattern may represent functional conduction alternans within fibrotic myocardium rather than anatomical His-Purkinje block. The presence of preserved rapid early forces, absence of mandatory mid-QRS notching in lateral leads, and reduced lateral voltage suggests myocardial conduction slowing rather than true complete LBBB.

Limitations

This is a single-case observation without confirmatory cardiac MRI or histopathology. Computer modeling referenced was not performed by our group. The proposed mechanism remains hypothetical and requires validation in prospective cohorts.

背景间质间隔纤维化的超声检测仍然具有挑战性。我们描述了一种新的心电图模式，它可能代表了纤维化传导改变的早期标志。我们评估了一个病例，该病例显示三相QRS序列在三拍内从窄QRS （88 ms）演变为完整的lbbb样模式（160 ms）。值得注意的特征包括：(i)在导联II， V5和V6的QRS的最初20 ms内有一个微妙的缺口；（ii） V5-V6生理间隔q波消失；（iii）引线II的多个缺口，V4-V6；（iv）导联III、aVL、aVF的qrs后期陷波。这些结果明显不同于真正的LBBB标准。解释：这种心电图模式可能代表了纤维化心肌的功能性传导交替，而不是解剖性的his -浦肯野传导阻滞。快速早期力的保留、侧导联中无强制性qrs陷波、侧电压降低提示心肌传导减慢，而不是真正的完全LBBB。局限性：这是一个没有心脏MRI或组织病理学证实的单例观察。本组未进行计算机建模参考。所提出的机制仍然是假设的，需要在前瞻性队列中进行验证。

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引用次数: 0

Case report: Unusual focal atrial tachycardia from the left inferior pulmonary vein in a pediatric patient treated by high-power short duration catheter ablation 病例报告：一名儿童患者经高功率短时间导管消融治疗后出现左下肺静脉异常局灶性房性心动过速。

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-11-01 DOI: 10.1016/j.jelectrocard.2025.154156

Marta Telishevska MD, Sarah Lengauer MD, Meike Schwendt MD, Isabel Deisenhofer MD, Gabriele Hessling MD

We describe an unusual case of focal atrial tachycardia (FAT) from the left inferior pulmonary vein (PV) in a 12- year old boy treated successfully by high power short duration (HPSD) ablation. The patient was referred to our center for ablation of incessant FAT with recurrent transient degeneration into atrial fibrillation. The electrophysiological study revealed FAT with a micro-reentrant like activation from the left inferior PV. To reduce the risk of complications to surrounding structures, isolation of the left pulmonary veins was performed using HPSD (65 W, 6–15 s) ablation. During a follow-up period of 12 months, the patient remained in stable sinus rhythm.

我们描述了一个罕见的病例局灶性房性心动过速（FAT）从左下肺静脉（PV）在12岁的男孩成功治疗高功率短时间（HPSD）消融。该患者被转介到我们的中心接受持续的脂肪消融，并复发性短暂变性为心房颤动。电生理研究显示，FAT在左下PV处具有微回入样激活。为了降低周围结构并发症的风险，采用HPSD （65 W, 6-15 s）消融术隔离左肺静脉。随访12个月，患者保持稳定的窦性心律。

引用次数: 0

Two beats for one: A hidden fire in the conduction system 两拍一拍：传导系统有暗火。

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-11-01 DOI: 10.1016/j.jelectrocard.2025.154152

Albert Roig MD , Antonio Thomaz de Andrade MD , Pedro Yuri Paiva Lima MD

引用次数: 0

An uncommon ECG presentation of post-Fontan patient: ECG challenge fontan后患者不常见的心电图表现：心电图挑战。

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-11-01 DOI: 10.1016/j.jelectrocard.2025.154151

Atul Kaushik , Aparna Jaswal , Anita Saxena , Akshay Aggrawal

We report a 26-year patient with univentricular physiology who underwent bidirectional Glenn with left pulmonary artery plasty followed by pulmonary artery stenting and finally underwent fenestrated extra-cardiac Fontan operation at age of 5 years. He was asymptomatic with an interesting ECG with atrial ectopic at presentation. We try to explain the basic mechanism and patterns of arrythmias in post-Fontan patients.

我们报告了一位26岁的单心室生理患者，他接受了双向Glenn和左肺动脉成形术，然后是肺动脉支架置入术，最后在5岁时接受了开窗心外Fontan手术。他无症状，心电图显示心房异位。我们试图解释fontan后患者心律失常的基本机制和模式。

引用次数: 0

An integrated fractional stockwell transform with atrous convolutions aided vision transformer based capsule network for fetal ECG arrhythmia detection 基于分数斯托克韦尔变换辅助视觉变换的胶囊网络胎儿心电心律失常检测。

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-11-01 DOI: 10.1016/j.jelectrocard.2025.154126

P Siva Priya , P Rajesh Kumar , G. Srinivas , Prasad Reddy PVGD

One of the most difficult but important steps in assessing the fetus's health is the diagnosis of fetal cardiac abnormalities using fetal electrocardiograms (FECG). In order to provide accurate information regarding the fetus's condition, FECG monitoring is required. Severe fetal arrhythmia can cause heart failure or even death. This paper presents a Non-Causal Adaptive Filter that extracts the FECG through multiple error estimation. The maternal channel ECG in the chest will be used as the reference input, and the abdominal ECG will be used as the primary input for this filter. The clean FECG signals will be transformed into time-frequency (T-F) images using a fractional Stockwell transform after the FECG signals have been extracted. Using the Stockwell and fractional Fourier transforms, it can simultaneously display the time and fractional-frequency data in the time-fractional-frequency plane. The ability to detect fetal ECG arrhythmias with a clear physical interpretation is more significant. The resulting images are fed into the Atrous Convolutions aided Vision Transformer based Capsule Network (AConvVTCapNet) model, which detects fetal ECG arrhythmias. In this instance, Atrous convolutions efficiently compute dense feature maps, allowing the network to have wider receptive fields. The proposed model's parameters are adjusted using a new Opposition based Fire Hawk Optimization (OFHO) technique, which is carried out by the capsule network during the classification process. The proposed method obtained 98.23 % accuracy and 98.25 % specificity in the fetal ECG arrhythmia detection process.

评估胎儿健康最困难但最重要的步骤之一是使用胎儿心电图（FECG）诊断胎儿心脏异常。为了提供胎儿状况的准确信息，需要进行feg监测。严重的胎儿心律失常会导致心力衰竭甚至死亡。本文提出了一种非因果自适应滤波器，通过多次误差估计提取feg。该滤波器将以胸部母体通道心电图作为参考输入，腹部心电图作为主要输入。在FECG信号被提取后，干净的FECG信号将使用分数斯托克韦尔变换转换成时频（T-F）图像。利用斯托克韦尔变换和分数阶傅里叶变换，可以在时间-分数-频率平面上同时显示时间和分数-频率数据。通过清晰的物理解释来检测胎儿心电图心律失常的能力更为重要。生成的图像被输入到基于亚特罗卷积辅助视觉变压器的胶囊网络（AConvVTCapNet）模型中，该模型用于检测胎儿心电心律失常。在这种情况下，亚特罗斯卷积有效地计算密集的特征映射，允许网络有更宽的接受域。模型参数的调整采用了一种新的基于对立的火鹰优化（OFHO）技术，该技术由胶囊网络在分类过程中进行。该方法在胎儿心电心律失常检测过程中准确率为98.23%，特异性为98.25%。

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