Pub Date : 2025-12-07DOI: 10.1016/j.jelectrocard.2025.154173
Giuseppe Mascia , Josep Brugada , Elena Arbelo , Andrea Minghini , Lorenzo Bianchi , Luca Barca , Nicola Pierucci , Cinzia Monaco , Paolo Di Donna , Italo Porto
A short-QT interval is a potential electrocardiographic finding, while short-QT syndrome (SQTS) is a rare, inherited channelopathy characterized by pathological shortening of the action potential duration leading to an increased risk of life-threatening arrhythmias. In contrast to the long QT syndrome (LQTS), data on the prevalence, diagnosis, risk stratification, treatment and prognosis of short-QT syndrome are scarce. Understanding the true risk of adverse events in exercise population or sporting activities by the patient with short-QT on 12‑leads electrocardiogram is complex: here, we summarize current knowledge and raise questions regarding the challenging relationship between the difficult SQTS diagnosis and exercise practice.
{"title":"Exercise practice and short-QT interval on ECG","authors":"Giuseppe Mascia , Josep Brugada , Elena Arbelo , Andrea Minghini , Lorenzo Bianchi , Luca Barca , Nicola Pierucci , Cinzia Monaco , Paolo Di Donna , Italo Porto","doi":"10.1016/j.jelectrocard.2025.154173","DOIUrl":"10.1016/j.jelectrocard.2025.154173","url":null,"abstract":"<div><div>A short-QT interval is a potential electrocardiographic finding, while short-QT syndrome (SQTS) is a rare, inherited channelopathy characterized by pathological shortening of the action potential duration leading to an increased risk of life-threatening arrhythmias. In contrast to the long QT syndrome (LQTS), data on the prevalence, diagnosis, risk stratification, treatment and prognosis of short-QT syndrome are scarce. Understanding the true risk of adverse events in exercise population or sporting activities by the patient with short-QT on 12‑leads electrocardiogram is complex: here, we summarize current knowledge and raise questions regarding the challenging relationship between the difficult SQTS diagnosis and exercise practice.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"94 ","pages":"Article 154173"},"PeriodicalIF":1.2,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733855","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 : 2025-12-06DOI: 10.1016/j.jelectrocard.2025.154174
R. Brandon Stacey MD, MS , Ronald J. Prineas MD, PhD , Zhu-Ming Zhang MD, MPH , Bruce M. Psaty MD, PhD , Wayne Rosamond PhD , Lynne Wagenknecht DrPH , Elsayed Z. Soliman MD, MSc, MS
Introduction
It is unclear how differences in the electrocardiographic (ECG) definition of myocardial infarction (MI) impact detection rates and prognostic significance of silent MI (SMI).
Methods
This analysis included 9188 participants (57.4 % women, 20 % black, age 62.6 ± 6.0 years) enrolled in the Atherosclerosis Risk in Communities study who had serial ECGs obtained between visit 1 (1987–1989) and visit 4 (1996–1998). Exclusions included known cardiovascular disease (CVD) prior to visit 1, ECG findings of MI or bundle branch block (BBB) at visit 1, or an adjudicated fatal and non-fatal MI events between visits 1 and 4. Using the Minnesota Code (MC) ECG Classification and in the absence of adjudicated MI, the following SMI definitions were derived: Standard MC MI [major Q-wave abnormality, or minor Q-wave abnormality plus major ST/T abnormality], only major Q-wave abnormality, standard significant serial Q-wave changes [Q1 to Q7], expanded MC serial Q-wave changes[Q1 to Q8], standard MC significant serial Q-wave changes or Standard MC significant serial ST/T changes, and evolving MC BBB. Cox proportional hazard models were used to examine the association of different definitions of SMI (compared to no new MI or evolving BBB) with fatal or non-fatal MI events ascertained after visit 4 until December 2016.
Results
The prevalence of SMI ranged from 0.6 % to 7.0 % depending on the ECG criteria defining SMI. Presence of SMI was predictive of fatal/non-fatal MI regardless of the definition but with varying levels of association. Standard MC expanded serial Q-wave changes had the strongest adjusted relationship [Hazard Ratio: 2.53 (95 % Confidence Interval (CI): 1.60–4.01)] while evolving BBB had the weakest adjusted association [HR: 1.39 (95 % CI: 0.80–2.40)].
Conclusions
The prevalence and prognostic significance of SMI are impacted by the ECG criteria defining MI. A uniform approach(s) for detection of SMI in population studies which builds on the available standard definitions that fit different research scenarios is needed.
{"title":"Electrocardiographic criteria for silent myocardial infarction: Impact of different definitions on detection rates and prognostic significance in the atherosclerosis risk in communities (ARIC) study: A comparison with evolving bundle branch blocks","authors":"R. Brandon Stacey MD, MS , Ronald J. Prineas MD, PhD , Zhu-Ming Zhang MD, MPH , Bruce M. Psaty MD, PhD , Wayne Rosamond PhD , Lynne Wagenknecht DrPH , Elsayed Z. Soliman MD, MSc, MS","doi":"10.1016/j.jelectrocard.2025.154174","DOIUrl":"10.1016/j.jelectrocard.2025.154174","url":null,"abstract":"<div><h3>Introduction</h3><div>It is unclear how differences in the electrocardiographic (ECG) definition of myocardial infarction (MI) impact detection rates and prognostic significance of silent MI (SMI).</div></div><div><h3>Methods</h3><div>This analysis included 9188 participants (57.4 % women, 20 % black, age 62.6 ± 6.0 years) enrolled in the Atherosclerosis Risk in Communities study who had serial ECGs obtained between visit 1 (1987–1989) and visit 4 (1996–1998). Exclusions included known cardiovascular disease (CVD) prior to visit 1, ECG findings of MI or bundle branch block (BBB) at visit 1, or an adjudicated fatal and non-fatal MI events between visits 1 and 4. Using the Minnesota Code (MC) ECG Classification and in the absence of adjudicated MI, the following SMI definitions were derived: Standard MC MI [major Q-wave abnormality, or minor Q-wave abnormality plus major ST/T abnormality], only major Q-wave abnormality, standard significant serial Q-wave changes [Q1 to Q7], expanded MC serial Q-wave changes[Q1 to Q8], standard MC significant serial Q-wave changes or Standard MC significant serial ST/T changes, and evolving MC BBB. Cox proportional hazard models were used to examine the association of different definitions of SMI (compared to no new MI or evolving BBB) with fatal or non-fatal MI events ascertained after visit 4 until December 2016.</div></div><div><h3>Results</h3><div>The prevalence of SMI ranged from 0.6 % to 7.0 % depending on the ECG criteria defining SMI. Presence of SMI was predictive of fatal/non-fatal MI regardless of the definition but with varying levels of association. Standard MC expanded serial Q-wave changes had the strongest adjusted relationship [Hazard Ratio: 2.53 (95 % Confidence Interval (CI): 1.60–4.01)] while evolving BBB had the weakest adjusted association [HR: 1.39 (95 % CI: 0.80–2.40)].</div></div><div><h3>Conclusions</h3><div>The prevalence and prognostic significance of SMI are impacted by the ECG criteria defining MI. A uniform approach(s) for detection of SMI in population studies which builds on the available standard definitions that fit different research scenarios is needed.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"94 ","pages":"Article 154174"},"PeriodicalIF":1.2,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733854","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 : 2025-11-29DOI: 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。
{"title":"Atrial repolarization in patients with left ventricular dysfunction","authors":"Neha Pulath, Ramanathan Velayutham, Anish Bhargav, J. Barathkrishnan, Raja J. Selvaraj","doi":"10.1016/j.jelectrocard.2025.154160","DOIUrl":"10.1016/j.jelectrocard.2025.154160","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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, <em>p</em> = 0.008).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"94 ","pages":"Article 154160"},"PeriodicalIF":1.2,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145682159","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 : 2025-11-26DOI: 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。
{"title":"Diagnostic accuracy of 18-lead versus 12-lead electrocardiography in acute coronary syndrome: A systematic review and meta-analysis","authors":"Almaz Rehman Koolikad, Syed Ahmad Khan, Muhammad Shahzaib, Bushra Arif, Shivam Singla, Bhavna Singla, Muhammad Subhan, Abida Perveen, Jahanzeb Malik","doi":"10.1016/j.jelectrocard.2025.154161","DOIUrl":"10.1016/j.jelectrocard.2025.154161","url":null,"abstract":"<div><h3>Objective</h3><div>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).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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; <em>p</em> < 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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"94 ","pages":"Article 154161"},"PeriodicalIF":1.2,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145668673","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 : 2025-11-19DOI: 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。
{"title":"Associations of non-alcoholic fatty liver disease with arrhythmic disorders and electrocardiogram traits: A Mendelian randomization study","authors":"Panji Wang , Ruixia Yuan , Yuan Meng , Hengdao Liu , Shenzhen Gong , Zhaowei Sun , Hailong Tao","doi":"10.1016/j.jelectrocard.2025.154158","DOIUrl":"10.1016/j.jelectrocard.2025.154158","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>Inverse-variance weighted method showed a statistically significant association between genetically predicted NAFLD and LBBB (OR: 1.261, 95% CI: 1.066-1.491, <em>p</em> = 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.</div></div><div><h3>Conclusion</h3><div>The study indicates a causal relationship between genetically predicted NAFLD and LBBB, suggesting that NAFLD may influence cardiac electrical activity.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"94 ","pages":"Article 154158"},"PeriodicalIF":1.2,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145661459","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 : 2025-11-19DOI: 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.
{"title":"Ventricular fibrillation, atrial fibrillation, early repolarization and dynamic QT shortening: An unusual presentation of a storm","authors":"Abhinav B. Anand DM, Mohsin S. Shaikh MD, Pratap J. Nathani DM, Yash Y. Lokhandwala DM","doi":"10.1016/j.jelectrocard.2025.154159","DOIUrl":"10.1016/j.jelectrocard.2025.154159","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"94 ","pages":"Article 154159"},"PeriodicalIF":1.2,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145594699","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}
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.
{"title":"ECG interpretation for pre-participation screening in athletes","authors":"Francesca Graziano MD , Alessandro Zorzi MD, PhD , Domenico Corrado MD, PhD","doi":"10.1016/j.jelectrocard.2025.154157","DOIUrl":"10.1016/j.jelectrocard.2025.154157","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"94 ","pages":"Article 154157"},"PeriodicalIF":1.2,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145594698","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 : 2025-11-13DOI: 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.
{"title":"Septal notch plus loss of the septal q wave: A potential early ECG sign suggestive of interstitial septal fibrosis in heart disease","authors":"Zhong-Qun Zhan MD , Xin-Yi Yu BMed","doi":"10.1016/j.jelectrocard.2025.154155","DOIUrl":"10.1016/j.jelectrocard.2025.154155","url":null,"abstract":"<div><h3>Background</h3><div>Early detection of interstitial septal fibrosis remains challenging. We describe a novel ECG pattern that may represent an early marker of fibrotic conduction changes.</div></div><div><h3>Case findings</h3><div>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.</div></div><div><h3>Interpretation</h3><div>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.</div></div><div><h3>Limitations</h3><div>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.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"94 ","pages":"Article 154155"},"PeriodicalIF":1.2,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145682160","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 : 2025-11-01DOI: 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.
{"title":"Case report: Unusual focal atrial tachycardia from the left inferior pulmonary vein in a pediatric patient treated by high-power short duration catheter ablation","authors":"Marta Telishevska MD, Sarah Lengauer MD, Meike Schwendt MD, Isabel Deisenhofer MD, Gabriele Hessling MD","doi":"10.1016/j.jelectrocard.2025.154156","DOIUrl":"10.1016/j.jelectrocard.2025.154156","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154156"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145549475","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 : 2025-11-01DOI: 10.1016/j.jelectrocard.2025.154152
Albert Roig MD , Antonio Thomaz de Andrade MD , Pedro Yuri Paiva Lima MD
{"title":"Two beats for one: A hidden fire in the conduction system","authors":"Albert Roig MD , Antonio Thomaz de Andrade MD , Pedro Yuri Paiva Lima MD","doi":"10.1016/j.jelectrocard.2025.154152","DOIUrl":"10.1016/j.jelectrocard.2025.154152","url":null,"abstract":"","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154152"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145458834","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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