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}
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.
{"title":"An uncommon ECG presentation of post-Fontan patient: ECG challenge","authors":"Atul Kaushik , Aparna Jaswal , Anita Saxena , Akshay Aggrawal","doi":"10.1016/j.jelectrocard.2025.154151","DOIUrl":"10.1016/j.jelectrocard.2025.154151","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154151"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145481655","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.2025.154126
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.
{"title":"An integrated fractional stockwell transform with atrous convolutions aided vision transformer based capsule network for fetal ECG arrhythmia detection","authors":"P Siva Priya , P Rajesh Kumar , G. Srinivas , Prasad Reddy PVGD","doi":"10.1016/j.jelectrocard.2025.154126","DOIUrl":"10.1016/j.jelectrocard.2025.154126","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154126"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145389201","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.2025.154147
José Escabí-Mendoza MD, Norwin Rivera-Guzmán MD, Jaime Rivera-Babilonia MD, Jorge Martínez-Díaz MD, María R. Cochran-Pérez MD, Jonathan X. Rodríguez-Santiago MD, Gerardo Jovet-Toledo, Andrew Engel-Rodriguez MD
Background
Advancements in computerized electrocardiogram (ECG) interpretation have improved efficiency, but concerns remain regarding diagnostic accuracy for atrial fibrillation (AF). Misclassification may result in inappropriate treatment and adverse outcomes.
Objectives
To compare the diagnostic accuracy of computerized ECG interpretation versus cardiologist over-read for AF and evaluate the clinical consequences of diagnostic errors.
Methods
We conducted a retrospective study of 5000 ECGs obtained at the Veterans Affairs Caribbean Healthcare System between September and November 2017. All ECGs were initially interpreted by automated software. A subset of 905 ECGs underwent over-read at the time of care. Separately, two board-certified cardiologists independently reviewed all 5000 ECGs in a blinded fashion and completed standardized interpretation forms. Diagnostic metrics were compared using 2-proportion z-tests and McNemar's test. Logistic regression identified predictors of misclassification. Clinical records were reviewed for treatment consequences.
Results
Computerized interpretation identified 803 (16 %) AF-related ECGs; of these, 70 % were true AF, 11 % false positives, and 19 % false negatives. Cardiologist interpretation showed higher accuracy: sensitivity 87 % vs. 78 %, specificity 99 % vs. 97 %, PPV 98 % vs. 86 %, NPV 99 % vs. 97 % (all p < 0.01). Ventricular pacing (OR 10.2), undetermined rhythm (OR 13.4), and tachycardia (OR 1.8) independently predicted misclassification (p < 0.001). Among misclassified ECGs, 41 % of errors were unrecognized, leading to delayed anticoagulation (18 %), inappropriate initiation (12 %), and three adverse events.
Conclusions
Computerized ECG interpretation of AF is prone to diagnostic error. Cardiologist over-read improves accuracy and may reduce preventable harm.
Condensed abstract
Computerized ECG interpretation misclassified AF in 30 % of cases, 11 % overcalls and 19 % missed diagnoses. Cardiologist over-reading demonstrated superior accuracy (87 % sensitivity, 99 % specificity), minimizing both false positives and negatives. In 41 % of erroneous computer interpretations, providers failed to recognize the error, leading to delayed anticoagulation, inappropriate therapy, two thromboembolic events, and one bleeding-related hospitalization. Ventricular pacing, undetermined rhythms, and tachycardia were key predictors of misclassification. These findings highlight the limitations of automated ECG analysis and support structured cardiologist over-read to safeguard against diagnostic errors and improve patient outcomes in AF detection.
{"title":"Diagnostic accuracy of atrial fibrillation by computerized electrocardiogram analysis versus cardiologist interpretation","authors":"José Escabí-Mendoza MD, Norwin Rivera-Guzmán MD, Jaime Rivera-Babilonia MD, Jorge Martínez-Díaz MD, María R. Cochran-Pérez MD, Jonathan X. Rodríguez-Santiago MD, Gerardo Jovet-Toledo, Andrew Engel-Rodriguez MD","doi":"10.1016/j.jelectrocard.2025.154147","DOIUrl":"10.1016/j.jelectrocard.2025.154147","url":null,"abstract":"<div><h3>Background</h3><div>Advancements in computerized electrocardiogram (ECG) interpretation have improved efficiency, but concerns remain regarding diagnostic accuracy for atrial fibrillation (AF). Misclassification may result in inappropriate treatment and adverse outcomes.</div></div><div><h3>Objectives</h3><div>To compare the diagnostic accuracy of computerized ECG interpretation versus cardiologist over-read for AF and evaluate the clinical consequences of diagnostic errors.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of 5000 ECGs obtained at the Veterans Affairs Caribbean Healthcare System between September and November 2017. All ECGs were initially interpreted by automated software. A subset of 905 ECGs underwent over-read at the time of care. Separately, two board-certified cardiologists independently reviewed all 5000 ECGs in a blinded fashion and completed standardized interpretation forms. Diagnostic metrics were compared using 2-proportion z-tests and McNemar's test. Logistic regression identified predictors of misclassification. Clinical records were reviewed for treatment consequences.</div></div><div><h3>Results</h3><div>Computerized interpretation identified 803 (16 %) AF-related ECGs; of these, 70 % were true AF, 11 % false positives, and 19 % false negatives. Cardiologist interpretation showed higher accuracy: sensitivity 87 % vs. 78 %, specificity 99 % vs. 97 %, PPV 98 % vs. 86 %, NPV 99 % vs. 97 % (all <em>p</em> < 0.01). Ventricular pacing (OR 10.2), undetermined rhythm (OR 13.4), and tachycardia (OR 1.8) independently predicted misclassification (<em>p</em> < 0.001). Among misclassified ECGs, 41 % of errors were unrecognized, leading to delayed anticoagulation (18 %), inappropriate initiation (12 %), and three adverse events.</div></div><div><h3>Conclusions</h3><div>Computerized ECG interpretation of AF is prone to diagnostic error. Cardiologist over-read improves accuracy and may reduce preventable harm.</div></div><div><h3>Condensed abstract</h3><div>Computerized ECG interpretation misclassified AF in 30 % of cases, 11 % overcalls and 19 % missed diagnoses. Cardiologist over-reading demonstrated superior accuracy (87 % sensitivity, 99 % specificity), minimizing both false positives and negatives. In 41 % of erroneous computer interpretations, providers failed to recognize the error, leading to delayed anticoagulation, inappropriate therapy, two thromboembolic events, and one bleeding-related hospitalization. Ventricular pacing, undetermined rhythms, and tachycardia were key predictors of misclassification. These findings highlight the limitations of automated ECG analysis and support structured cardiologist over-read to safeguard against diagnostic errors and improve patient outcomes in AF detection.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154147"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145421903","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.2025.154153
Katherine M. Conners , Varun Divi , Elsayed Z. Soliman , Annie Green Howard , Eric A. Whitsel , Didong Li , Michelle L. Meyer , Shaaf Ahmad , Christy L. Avery , Faisal F. Syed
{"title":"Short-term repeatability of artificial intelligence estimated electrocardiographic age","authors":"Katherine M. Conners , Varun Divi , Elsayed Z. Soliman , Annie Green Howard , Eric A. Whitsel , Didong Li , Michelle L. Meyer , Shaaf Ahmad , Christy L. Avery , Faisal F. Syed","doi":"10.1016/j.jelectrocard.2025.154153","DOIUrl":"10.1016/j.jelectrocard.2025.154153","url":null,"abstract":"","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154153"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145512967","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.2025.154150
Melker Lundström , Carl-Johan Carlhäll , Andréas Bussman , Martin Brundin , Adam Palm , Victor F. Froelicher , Kristofer Hedman , Anna Carlén
Background
Electrocardiographic criteria for left ventricular hypertrophy (ECG-LVH) show poor diagnostic performance. Distance factors, such as the chest wall – left ventricle (CWLV) distance and subcutaneous adipose tissue (SAT) have been proposed as alternative modulators of ECG amplitudes both on a theoretical and a clinical basis. We aimed to investigate the independent associations of CWLV, SAT, and LVM with ECG amplitudes.
Methods
In this cross-sectional study using cardiac magnetic resonance (CMR) imaging in 49 healthy volunteers (22 female, mean age 37.1 years, median BMI 22.8 kg/m2), we analysed the CWLV distance, SAT and LVM in relation to QRS amplitudes from a resting 12‑lead ECG.
Results
In a multivariable regression model, CWLV distance, measured with excellent reliability (inter-observer ICC = 0.995, p < 0.001), was the strongest predictor of Sokolow-Lyon voltage (SV1 + RV5), followed by LVM (std. β = −0.48 and 0.38 respectively, both p < 0.002, adj. R2 = 0.53). SAT correlated with most ECG amplitudes to a similar degree as did LVM, but in the opposite direction. In females, CWLV distance but not LVM correlated with Sokolow-Lyon voltage.
Conclusions
We found that a non-cardiac variable (CWLV) was a stronger predictor of ECG amplitudes than was LVM, and that SAT was negatively correlated with ECG amplitudes, even in a sample with a normal median BMI. These findings suggest that distance factors may influence the ECG of non-obese persons and contribute to the limited accuracy of ECG-LVH criteria. Our findings also question the validity of Sokolow-Lyon voltage for assessment of LVM in females.
{"title":"The effect of anatomical factors on ECG amplitudes – a cardiac magnetic resonance study","authors":"Melker Lundström , Carl-Johan Carlhäll , Andréas Bussman , Martin Brundin , Adam Palm , Victor F. Froelicher , Kristofer Hedman , Anna Carlén","doi":"10.1016/j.jelectrocard.2025.154150","DOIUrl":"10.1016/j.jelectrocard.2025.154150","url":null,"abstract":"<div><h3>Background</h3><div>Electrocardiographic criteria for left ventricular hypertrophy (ECG-LVH) show poor diagnostic performance. Distance factors, such as the chest wall – left ventricle (CWLV) distance and subcutaneous adipose tissue (SAT) have been proposed as alternative modulators of ECG amplitudes both on a theoretical and a clinical basis. We aimed to investigate the independent associations of CWLV, SAT, and LVM with ECG amplitudes.</div></div><div><h3>Methods</h3><div>In this cross-sectional study using cardiac magnetic resonance (CMR) imaging in 49 healthy volunteers (22 female, mean age 37.1 years, median BMI 22.8 kg/m<sup>2</sup>), we analysed the CWLV distance, SAT and LVM in relation to QRS amplitudes from a resting 12‑lead ECG.</div></div><div><h3>Results</h3><div>In a multivariable regression model, CWLV distance, measured with excellent reliability (inter-observer ICC = 0.995, <em>p</em> < 0.001), was the strongest predictor of Sokolow-Lyon voltage (SV1 + RV5), followed by LVM (std. β = −0.48 and 0.38 respectively, both <em>p</em> < 0.002, adj. R<sup>2</sup> = 0.53). SAT correlated with most ECG amplitudes to a similar degree as did LVM, but in the opposite direction. In females, CWLV distance but not LVM correlated with Sokolow-Lyon voltage.</div></div><div><h3>Conclusions</h3><div>We found that a non-cardiac variable (CWLV) was a stronger predictor of ECG amplitudes than was LVM, and that SAT was negatively correlated with ECG amplitudes, even in a sample with a normal median BMI. These findings suggest that distance factors may influence the ECG of non-obese persons and contribute to the limited accuracy of ECG-LVH criteria. Our findings also question the validity of Sokolow-Lyon voltage for assessment of LVM in females.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154150"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145424510","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.2025.154149
Hieu Minh Bui MD , Binh Dao Thi Thanh PhD, MD , Anh Do Nguyen MD , Quyen The Nguyen MD
Background
Numerous electrocardiographic (ECG) criteria have been reported to predict the culprit artery in cases of inferior myocardial infarction (MI). This study aimed to identify the most reliable predictive criteria and assess their applicability in a cohort of patients with multivessel coronary disease.
Methods
This cross-sectional study included patients with inferior MI who underwent primary percutaneous coronary intervention between January 2019 and August 2024 at Gia Dinh Hospital. We evaluated 43 previously reported ECG criteria, algorithms, and scoring systems to determine whether the culprit artery was the right coronary artery (RCA) or the left circumflex artery (LCx). Subgroup analyses were performed based on the extent of coronary artery stenosis to assess the predictive value of ECG in multivessel coronary disease.
Results
We evaluated 431 inferior MI patients with an average age of 62.1 ± 12.2 years, with men comprising 76.1 %. There were 63 (14.6 %) patients with one-vessel coronary disease, 136 (31.6 %) with two-vessel coronary disease, and 232 (53.8 %) with three-vessel coronary disease. The ST elevation (STE) in lead III greater than in lead II was identified as the best predictor of RCA as the culprit artery, demonstrating a sensitivity of 92 %, specificity of 67 %, positive predictive value of 94 %, negative predictive value of 59 %, accuracy of 88 %, and an area under the curve (AUC) of 0.8 (95 % CI 0.74–0.85) with p < 0.001. When analyzing the multivessel coronary disease subgroup, the STE III > II criterion maintained its strong predictive ability, with a sensitivity of 92 %, a positive predictive value of 95 %, AUC of 0.8 (95 % CI 0.74–0.87) and p < 0.001.
Conclusions
The criterion of STE III > II remains a robust predictor for identifying the culprit artery in inferior MI, regardless of the presence of multivessel coronary disease.
背景：许多心电图（ECG）标准已被报道用于预测下壁心肌梗死（MI）病例的罪魁动脉。本研究旨在确定最可靠的预测标准，并评估其在多支冠状动脉疾病患者队列中的适用性。方法：本横断面研究包括2019年1月至2024年8月在Gia Dinh医院接受初级经皮冠状动脉介入治疗的下壁心肌梗死患者。我们评估了43个先前报道的ECG标准、算法和评分系统，以确定罪魁祸首动脉是右冠状动脉（RCA）还是左旋动脉（LCx）。根据冠状动脉狭窄程度进行亚组分析，评价心电图对多支冠状动脉病变的预测价值。结果：我们评估了431例下位性心肌梗死患者，平均年龄为62.1±12.2岁，男性占76.1%。单支冠心病63例（14.6%），双支冠心病136例（31.6%），三支冠心病232例（53.8%）。圣海拔(STE)铅三世大于铅二世被认定为最佳预测值RCA的罪魁祸首动脉,展示的敏感性为92%,特异性为67%,阳性预测值为94%,阴性预测值为59%,准确性为88%,和曲线下面积(AUC)为0.8 (95% CI 0.74 - -0.85)和p II标准维护其预测能力强,灵敏度为92%,阳性预测值为95%,AUC为0.8 （95% CI 0.74-0.87）和p结论：无论是否存在多支冠状动脉疾病，STE III > II标准仍然是识别下段心肌梗死罪魁动脉的可靠预测指标。
{"title":"Electrocardiographic prediction of the culprit vessel in inferior myocardial infarction with multivessel coronary disease","authors":"Hieu Minh Bui MD , Binh Dao Thi Thanh PhD, MD , Anh Do Nguyen MD , Quyen The Nguyen MD","doi":"10.1016/j.jelectrocard.2025.154149","DOIUrl":"10.1016/j.jelectrocard.2025.154149","url":null,"abstract":"<div><h3>Background</h3><div>Numerous electrocardiographic (ECG) criteria have been reported to predict the culprit artery in cases of inferior myocardial infarction (MI). This study aimed to identify the most reliable predictive criteria and assess their applicability in a cohort of patients with multivessel coronary disease.</div></div><div><h3>Methods</h3><div>This cross-sectional study included patients with inferior MI who underwent primary percutaneous coronary intervention between January 2019 and August 2024 at Gia Dinh Hospital. We evaluated 43 previously reported ECG criteria, algorithms, and scoring systems to determine whether the culprit artery was the right coronary artery (RCA) or the left circumflex artery (LCx). Subgroup analyses were performed based on the extent of coronary artery stenosis to assess the predictive value of ECG in multivessel coronary disease.</div></div><div><h3>Results</h3><div>We evaluated 431 inferior MI patients with an average age of 62.1 ± 12.2 years, with men comprising 76.1 %. There were 63 (14.6 %) patients with one-vessel coronary disease, 136 (31.6 %) with two-vessel coronary disease, and 232 (53.8 %) with three-vessel coronary disease. The ST elevation (STE) in lead III greater than in lead II was identified as the best predictor of RCA as the culprit artery, demonstrating a sensitivity of 92 %, specificity of 67 %, positive predictive value of 94 %, negative predictive value of 59 %, accuracy of 88 %, and an area under the curve (AUC) of 0.8 (95 % CI 0.74–0.85) with <em>p</em> < 0.001. When analyzing the multivessel coronary disease subgroup, the STE III > II criterion maintained its strong predictive ability, with a sensitivity of 92 %, a positive predictive value of 95 %, AUC of 0.8 (95 % CI 0.74–0.87) and <em>p</em> < 0.001.</div></div><div><h3>Conclusions</h3><div>The criterion of STE III > II remains a robust predictor for identifying the culprit artery in inferior MI, regardless of the presence of multivessel coronary disease.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154149"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145471133","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 : 2025-10-18DOI: 10.1016/j.jelectrocard.2025.154148
Gregory J. DiGirolamo Ph.D , Nikolaos Kakouros M.D , Federico Sorcini B.A , Sofia Patrizi Sorcini , Jenna Dupell , Erin K. Sands B.A , Max P. Rosen M.D
Objective
To investigate errors in the assessment of ST-elevation (STEs) myocardial infarctions on ECGs to determine if non-conscious processes successfully detect missed STEs, as evidenced by changes in how long and often physicians look at leads with STEs.
Materials and method
Eight experienced physicians interpreted 90 ECGs (45 STEs, 45 Normal) while eye movements were recorded. Physicians marked consciously recognized or considered STEs. No clinical context was provided.
Results
Physicians missed 18% of STEs. Eye-tracking showed longer (P = 0.02), more frequent (P = 0.02), and increased transitions (P = 0.02) to “missed” STE leads compared to Normal ECG leads.
Discussion
Non-conscious detection of STEs, including inter‑lead relationships, despite a lack of conscious recognition, suggests a sophisticated mechanism of wholistic detection, including culprit lesion sites by non-conscious processes.
Conclusion
Non-conscious detection of STEs supports non-conscious detection processing in medicine leading to more success than can be tracked by conscious report. Eye-tracking could enhance ECG interpretation and reduce diagnostic errors.
{"title":"Non-conscious detection of ST-segment elevation during physician ECG interpretation","authors":"Gregory J. DiGirolamo Ph.D , Nikolaos Kakouros M.D , Federico Sorcini B.A , Sofia Patrizi Sorcini , Jenna Dupell , Erin K. Sands B.A , Max P. Rosen M.D","doi":"10.1016/j.jelectrocard.2025.154148","DOIUrl":"10.1016/j.jelectrocard.2025.154148","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate errors in the assessment of ST-elevation (STEs) myocardial infarctions on ECGs to determine if non-conscious processes successfully detect missed STEs, as evidenced by changes in how long and often physicians look at leads with STEs.</div></div><div><h3>Materials and method</h3><div>Eight experienced physicians interpreted 90 ECGs (45 STEs, 45 Normal) while eye movements were recorded. Physicians marked consciously recognized or considered STEs. No clinical context was provided.</div></div><div><h3>Results</h3><div>Physicians missed 18% of STEs. Eye-tracking showed longer (<em>P</em> = 0.02), more frequent (P = 0.02), and increased transitions (P = 0.02) to “missed” STE leads compared to Normal ECG leads.</div></div><div><h3>Discussion</h3><div>Non-conscious detection of STEs, including inter‑lead relationships, despite a lack of conscious recognition, suggests a sophisticated mechanism of wholistic detection, including culprit lesion sites by non-conscious processes.</div></div><div><h3>Conclusion</h3><div>Non-conscious detection of STEs supports non-conscious detection processing in medicine leading to more success than can be tracked by conscious report. Eye-tracking could enhance ECG interpretation and reduce diagnostic errors.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154148"},"PeriodicalIF":1.2,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145358145","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 : 2025-10-11DOI: 10.1016/j.jelectrocard.2025.154145
Konsta Kivimäki , Hanna Pohjantähti , Jussi Hernesniemi , Leo-Pekka Lyytikäinen , Juho Tynkkynen , Jani Rankinen
Aims of the study
ST-segment depression in the electrocardiogram (ECG) of acute coronary syndrome (ACS) patients has been associated with higher mortality. But still, its association to sudden cardiac deaths (SCDs) or sudden cardiac arrests (SCAs) has not yet been investigated. We analyzed the association between ST-segment depression in the ECG after angiography and the long-term incidence of SCD and SCA among ACS patients.
Methods
Retrospective data of 8565 consecutive ACS patients with a median follow-up time of 7.1 years were analyzed retrospectively. Patients with (n = 1957) and without (n = 6608) ST-segment depression in ECG after angiography were compared after stratification according to the location of ST-segment depression. Incidents of SCDs and SCAs were adjudicated using various sources detailing the circumstances leading to the events. Subdistribution regression (Fine-Gray) models were used in the association analyses.
Results
Lateral, inferior, and inferolateral ST-segment depression were associated with the long-term risk for SCD and SCA in age- and sex-adjusted analyses (p-value <0.05). However, only lateral ST-segment depression was associated with a higher risk for SCD (HR 1.58, 95 % CI 1.13–2.20, p-value 0.007) and SCA (HR 1.48, 95 % CI 1.12–1.96, p-value 0.006) when additionally adjusted with several cardiovascular risk factors. The results remained significant in lateral and inferolateral ST-segment depression even after excluding patients with LVEF ≤35 % at baseline.
Conclusion
Lateral, inferolateral, and inferior ST-segment depressions in ECG after angiography in ACS patients are associated with a significantly higher long-term risk for SCD and SCA.
{"title":"The association between ST-segment depressions and sudden cardiac deaths and arrests after acute coronary syndrome","authors":"Konsta Kivimäki , Hanna Pohjantähti , Jussi Hernesniemi , Leo-Pekka Lyytikäinen , Juho Tynkkynen , Jani Rankinen","doi":"10.1016/j.jelectrocard.2025.154145","DOIUrl":"10.1016/j.jelectrocard.2025.154145","url":null,"abstract":"<div><h3>Aims of the study</h3><div>ST-segment depression in the electrocardiogram (ECG) of acute coronary syndrome (ACS) patients has been associated with higher mortality. But still, its association to sudden cardiac deaths (SCDs) or sudden cardiac arrests (SCAs) has not yet been investigated. We analyzed the association between ST-segment depression in the ECG after angiography and the long-term incidence of SCD and SCA among ACS patients.</div></div><div><h3>Methods</h3><div>Retrospective data of 8565 consecutive ACS patients with a median follow-up time of 7.1 years were analyzed retrospectively. Patients with (<em>n</em> = 1957) and without (<em>n</em> = 6608) ST-segment depression in ECG after angiography were compared after stratification according to the location of ST-segment depression. Incidents of SCDs and SCAs were adjudicated using various sources detailing the circumstances leading to the events. Subdistribution regression (Fine-Gray) models were used in the association analyses.</div></div><div><h3>Results</h3><div>Lateral, inferior, and inferolateral ST-segment depression were associated with the long-term risk for SCD and SCA in age- and sex-adjusted analyses (<em>p</em>-value <0.05). However, only lateral ST-segment depression was associated with a higher risk for SCD (HR 1.58, 95 % CI 1.13–2.20, <em>p</em>-value 0.007) and SCA (HR 1.48, 95 % CI 1.12–1.96, p-value 0.006) when additionally adjusted with several cardiovascular risk factors. The results remained significant in lateral and inferolateral ST-segment depression even after excluding patients with LVEF ≤35 % at baseline.</div></div><div><h3>Conclusion</h3><div>Lateral, inferolateral, and inferior ST-segment depressions in ECG after angiography in ACS patients are associated with a significantly higher long-term risk for SCD and SCA.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154145"},"PeriodicalIF":1.2,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145308229","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 : 2025-10-11DOI: 10.1016/j.jelectrocard.2025.154143
Suleyman Cagan Efe MD , Murat Karacam MD , Ali Furkan Tekatli MD , Baver Bozan MD , Mustafa Furkan Kilicarslan MD , Mustafa Kara MD , Muhammet Bulut MD , Tuba Unkun MD , Enver Yucel MD , Cem Doğan MD , Gulumser Sevgin Halil MD , Ozgur Yasar Akbal MD , Ali Karagoz MD
Background
Electrocardiography (ECG) provides valuable information for early diagnosis of myocardial infarction. It is known that the atria receive their blood supply primarily from branches originating from the proximal segments of the coronary arteries. This study aimed to evaluate whether P wave parameters on admission ECG can help determine proximal versus distal right coronary artery (RCA) occlusion in patients presenting with inferior myocardial infarction (IMI).
Methods
We retrospectively analyzed consecutive patients presenting with IMI to the emergency department between October 2022 and May 2023. After applying exclusion criteria, a total of 123 patients were included. Admission ECG parameters were analyzed in relation to the angiographically confirmed site of coronary occlusion.
Results
The study population was divided into two groups according to proximal or distal RCA occlusion. Demographic characteristics were similar between groups. Statistically significant differences were observed between groups in the following ECG parameters: QT dispersion, P wave terminal force, P wave peak time in leads V1 and V2, and ST elevation in lead V1.
In multivariable logistic regression analysis, ST elevation in lead V1 (OR 6.1; 95 % CI: 1.48–26.8; p = 0.013) and P wave peak time in lead V1 (OR 1.08; 95 % CI: 1.01–1.12; p = 0.008) were identified as independent predictors of proximal RCA occlusion. A added variable plot demonstrated that P wave peak time > 56 ms was significantly associated with increased probability of proximal coronary occlusion.
Conclusion
In patients presenting with inferior myocardial infarction, P wave peak time in lead V1 on admission ECG may serve as a useful, non-invasive marker in predicting proximal RCA occlusion.
背景：心电图（ECG）为早期诊断心肌梗死提供了有价值的信息。众所周知，心房的血液供应主要来自冠状动脉近段的分支。本研究旨在评估入院心电图P波参数是否有助于确定下段心肌梗死（IMI）患者近端与远端右冠状动脉（RCA）闭塞。方法：回顾性分析2022年10月至2023年5月期间急诊就诊的连续IMI患者。应用排除标准后，共纳入123例患者。分析入院心电图参数与造影确认的冠状动脉闭塞部位的关系。结果：根据RCA近端或远端咬合情况将研究人群分为两组。组间人口统计学特征相似。两组间心电图参数：QT离散度、P波末端力、V1导联和V2导联P波峰值时间、V1导联ST段抬高，差异均有统计学意义。在多变量logistic回归分析中，V1导联ST段抬高（OR 6.1; 95% CI: 1.48-26.8; p = 0.013）和V1导联p波峰值时间（OR 1.08; 95% CI: 1.01-1.12; p = 0.008）被确定为近端RCA闭塞的独立预测因子。增加的变量图显示，P波峰值时间bbb56ms与近端冠状动脉闭塞的可能性增加显著相关。结论：对于下位心肌梗死患者，入院心电图V1导联P波峰值时间可作为预测近端RCA闭塞的有效、无创指标。
{"title":"The value of P wave parameters in predicting proximal or distal right coronary artery occlusion in patients with inferior myocardial infarction","authors":"Suleyman Cagan Efe MD , Murat Karacam MD , Ali Furkan Tekatli MD , Baver Bozan MD , Mustafa Furkan Kilicarslan MD , Mustafa Kara MD , Muhammet Bulut MD , Tuba Unkun MD , Enver Yucel MD , Cem Doğan MD , Gulumser Sevgin Halil MD , Ozgur Yasar Akbal MD , Ali Karagoz MD","doi":"10.1016/j.jelectrocard.2025.154143","DOIUrl":"10.1016/j.jelectrocard.2025.154143","url":null,"abstract":"<div><h3>Background</h3><div>Electrocardiography (ECG) provides valuable information for early diagnosis of myocardial infarction. It is known that the atria receive their blood supply primarily from branches originating from the proximal segments of the coronary arteries. This study aimed to evaluate whether P wave parameters on admission ECG can help determine proximal versus distal right coronary artery (RCA) occlusion in patients presenting with inferior myocardial infarction (IMI).</div></div><div><h3>Methods</h3><div>We retrospectively analyzed consecutive patients presenting with IMI to the emergency department between October 2022 and May 2023. After applying exclusion criteria, a total of 123 patients were included. Admission ECG parameters were analyzed in relation to the angiographically confirmed site of coronary occlusion.</div></div><div><h3>Results</h3><div>The study population was divided into two groups according to proximal or distal RCA occlusion. Demographic characteristics were similar between groups. Statistically significant differences were observed between groups in the following ECG parameters: QT dispersion, P wave terminal force, P wave peak time in leads V1 and V2, and ST elevation in lead V1.</div><div>In multivariable logistic regression analysis, ST elevation in lead V1 (OR 6.1; 95 % CI: 1.48–26.8; <em>p</em> = 0.013) and P wave peak time in lead V1 (OR 1.08; 95 % CI: 1.01–1.12; <em>p</em> = 0.008) were identified as independent predictors of proximal RCA occlusion. A added variable plot demonstrated that P wave peak time > 56 ms was significantly associated with increased probability of proximal coronary occlusion.</div></div><div><h3>Conclusion</h3><div>In patients presenting with inferior myocardial infarction, P wave peak time in lead V1 on admission ECG may serve as a useful, non-invasive marker in predicting proximal RCA occlusion.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154143"},"PeriodicalIF":1.2,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145308230","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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