Journal of electrocardiology最新文献

英文中文

Duration of electrocardiographic TPEAK-TEND interval in ischemia: Dispersion of repolarization vs. myocardium area at risk 缺血时心电图TPEAK-TEND间期的持续时间：复极离散度与危险心肌面积

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-09-13 DOI: 10.1016/j.jelectrocard.2025.154129

Alexander S. Poselyaninov , Alena S. Tsvetkova , Pyotr V. Khomenko , Maria E. Grubbe , Alexey O. Ovechkin , Olesya G. Bernikova , Marina M. Demidova , Jan E. Azarov , Pyotr G. Platonov

Introduction

Tpeak-Tend interval (Tpe) is considered to be an ECG reflection of the dispersion of repolarization (DOR), and as such has been proposed as a predictor of arrhythmias. In ischemia, robustness of the Tpe-DOR relationship may suffer from variability of the myocardium at risk (MaR) area. In the present study, we evaluated the contribution of DOR and MaR to single‑lead and multi‑lead Tpe durations.

Methods

Ischemia was induced by 40-min proximal or distal ligations of the left anterior descending coronary artery in 27 anesthetized pigs. In 48 intramyocardial leads, end of repolarization times (RTs) were determined as the instant of dV/dt max during T-wave, and DOR was calculated as the difference between RTmax and RTmin. In standard 12‑lead ECGs, we determined a single‑lead Tpe (maximal value throughout all leads) and a multi‑lead Tpe as the difference between the earliest Tpeak and latest Tend throughout all leads. MaR was assessed by postmortem Evans blue staining.

Results

During 40-min ischemia, DOR and Tpe increased concurrently, but DOR was greater than Tpe at all time-points, especially during ischemia. In univariate linear regression analysis, maximal DOR during occlusion was significantly associated with maximal multi‑lead Tpe, but was not associated with single‑lead Tpe. MaR was significantly associated with maximal single‑lead Tpe, but not with multi‑lead Tpe or DOR.

Conclusion

Both multi‑lead and single‑lead Tpe underestimated DOR, especially at ischemia. Variation of the size of the ischemic region appeared to be an important factor in evaluating the single‑lead Tpe interval.

Tpe被认为是复极离散度（DOR）的心电图反映，因此已被提出作为心律失常的预测指标。在缺血时，Tpe-DOR关系的稳健性可能受到心肌危险区域（MaR）变异性的影响。在本研究中，我们评估了DOR和MaR对单导联和多导联类型持续时间的贡献。方法27头麻醉猪采用左冠状动脉前降支近端或远端结扎40 min诱导缺血。在48例心内导联中，以t波时dV/dt max瞬间为复极结束时间，以RTmax与RTmin之差计算DOR。在标准的12导联心电图中，我们确定了单导联ttype（所有导联的最大值）和多导联ttype作为所有导联中最早的Tpeak和最新的Tend之间的差异。死后Evans蓝染色评估MaR。结果在缺血40 min时，DOR和Tpe同时升高，但DOR在各时间点均大于Tpe，尤其是缺血时。在单变量线性回归分析中，闭塞期间最大DOR与最大多导联ttype显著相关，但与单导联ttype无关。MaR与最大单导联Tpe显著相关，但与多导联Tpe或DOR无关。结论多导联和单导联均低估了DOR，尤其是缺血时。缺血区大小的变化似乎是评价单导联型间期的一个重要因素。

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引用次数: 0

Which leads were swaped? 哪些线索被交换了？

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-09-12 DOI: 10.1016/j.jelectrocard.2025.154124

José Nunes de Alencar , Odair Soares Filho

A routine electrocardiogram revealed unexpected axis deviations. However, a repeat ECG with careful electrode placement yielded a different tracing. This report highlights how a seemingly routine technical error can profoundly alter ECG interpretation and clinical decision-making.

常规心电图显示意料之外的轴偏。然而，仔细放置电极的重复心电图产生了不同的追踪。本报告强调了一个看似常规的技术错误如何深刻地改变心电图解释和临床决策。

引用次数: 0

Triphasic QRS morphology: What is the mechanism? 三相QRS形态：机制是什么？

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-09-12 DOI: 10.1016/j.jelectrocard.2025.154128

Hans C. Helseth BA , William H. Frick MD

We present an electrocardiogram with triphasic QRS morphology variation and discuss the mechanism and clinical implications for this finding.

我们提出了一个心电图与三相QRS形态的变化，并讨论了机制和临床意义的这一发现。

引用次数: 0

Normokalemic Littmann sign due to STEMI Normokalemic Littmann向STEMI表示敬意。

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-09-12 DOI: 10.1016/j.jelectrocard.2025.154122

János Tomcsányi MD, PhD, Kristóf Tomcsányi MD

We present a patient case with anterior ST-elevation myocardial infarction (STEMI) with false double heart rate counting caused by computer error. Double counting heart rate typically indicates severe hyperkalemia (Littmann sign). However, this case highlights that Littmann sign may also be seen in acute ST-elevation MI (STEMI) due to peaked T-waves.

我们报告一例前st段抬高型心肌梗死（STEMI）患者，由于计算机错误导致双心率计数错误。重复计数心率通常表明严重的高钾血症（Littmann征）。然而，本病例强调，由于t波尖峰，急性st段抬高型心肌梗死（STEMI）也可能出现Littmann征象。

引用次数: 0

U wave manifesting in alternating beats: The bigeminal U wave. Can the U wave and the P wave be related? 以交替节拍表现的U型波：双音型U型波。U波和P波有关系吗？

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-09-09 DOI: 10.1016/j.jelectrocard.2025.154110

Francesco Luzza MD, Francesco Catanzariti MD, Michela Navarra MD, Pietro Pugliatti MD

引用次数: 0

Alternating bundle branch block with alternating PR interval 交替PR间隔的交替束支块

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-09-09 DOI: 10.1016/j.jelectrocard.2025.154108

Sudipta Mondal (MD, DM, PDF-EP), Anubhav Chatterjee (MBBS), Tapan Kr Matia (MD, DrNB), Nadeem Afroz Muslim (MD, DM)

A sexagenarian man presented to the emergency department with one episode of syncope. The electrocardiogram (ECG) revealed an alternating bundle branch block with alternating PR interval. Cardiac biomarkers were negative, and the echocardiogram revealed a structurally normal heart. What is the mechanism?

一位六十多岁的男性因一次晕厥而被送到急诊科。心电图示交变束支阻滞伴交变PR间期。心脏生物标志物阴性，超声心动图显示心脏结构正常。它的机制是什么？

引用次数: 0

Evaluation of AI ECG age in the prediction of cardiovascular diseases and risk factors: Exploratory data analysis 人工智能心电图年龄在预测心血管疾病及其危险因素中的评价：探索性数据分析。

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-09-08 DOI: 10.1016/j.jelectrocard.2025.154123

Kellen Sumwiza , Antonio H. Ribeiro , Gerard Rushingabigwi , Pierre Bakunzibake , Celestin Twizere

Cardiovascular diseases (CVDs) are the most widespread cause of death across the world, and this aspect requires a better risk stratification method. Effectively, this paper tests the potential of the artificial intelligence (AI)-predicted electrocardiogram (ECG) age as a novel CVD risk predictor biomarker. We used the CODE-15 % data (over 344,000 ECG records with clinical annotation) to create a logistic regression model that incorporated age predicted from ECG, as well as demographic and comorbidity variables, to evaluate cardiovascular outcomes. The model performed better with ECG-predicted age than using chronological age alone, with a 92 % receiver operating characteristic curve area (AUROC) for atrial fibrillation (AF) detection, compared to 88 % when chronological age was used alone. From the results, the ECG-predicted age showed a stronger correlation with AF (r = 0.17), bundle branch blocks (r = 0.14), and Chagas disease (r = 0.074) than chronological age. Sex-specific patterns were also observed; male sex had an increased risk of sinus bradycardia (odds ratio [OR]: 3.090), while female sex had a lower risk of having a left bundle branch block (LBBB) OR: 0.885) with the variable of ECG-predicted age. These results demonstrate how ECG-predicted age may be used as a biologically meaningful indicator for cardiovascular risk assessment.

This study advances personalized medicine by offering a cost-effective and scalable method for detecting CVD, particularly in under-resourced regions that lack conventional biomarkers.

心血管疾病（cvd）是世界上最普遍的死亡原因，这方面需要更好的风险分层方法。本文有效地测试了人工智能（AI）预测心电图（ECG）年龄作为新型心血管疾病风险预测生物标志物的潜力。我们使用code - 15%的数据（超过344,000条带有临床注释的心电图记录）创建了一个逻辑回归模型，该模型结合了心电图预测的年龄，以及人口统计学和合并症变量，以评估心血管结果。与单独使用实足年龄相比，ecg预测年龄的模型表现更好，房颤（AF）检测的受试者工作特征曲线面积（AUROC）为92%，而单独使用实足年龄时为88%。结果显示，心电图预测年龄与房颤（r = 0.17）、束支阻滞（r = 0.14）和恰加斯病（r = 0.074）的相关性强于实足年龄。性别差异模式也被观察到；随着心电图预测年龄的变化，男性窦性心动过缓的风险增加（比值比[OR]: 3.090），而女性左束支传导阻滞（LBBB）的风险较低（比值比[OR]: 0.885）。这些结果表明，心电图预测的年龄可以作为心血管风险评估的有生物学意义的指标。这项研究通过提供一种具有成本效益和可扩展的检测心血管疾病的方法，特别是在缺乏传统生物标志物的资源不足地区，推进了个性化医疗。

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引用次数: 0

The de Winter electrocardiographic pattern reflects anatomical-electrophysiological-related ischemia—not a signature of remote ischemic preconditioning de Winter心电图模式反映解剖-电生理相关的缺血，而不是远端缺血预处理的特征

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-09-06 DOI: 10.1016/j.jelectrocard.2025.154111

Zhong-Qun Zhan

引用次数: 0

Interatrial block predicts left atrial appendage thrombus in nonvalvular atrial fibrillation 房间传导阻滞预测非瓣膜性心房颤动左房附件血栓

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-09-01 DOI: 10.1016/j.jelectrocard.2025.154112

Elmas Kaplan MD , Firdevs Aysenur Ekizler MD , Halenur Saribas MD , Omac Tufekcioglu MD

Background

Interatrial block (IAB) is an electrocardiographic manifestation of atrial conduction delay and structural remodeling. While it has been linked to atrial fibrillation (AF) and thromboembolic events, its potential role in predicting left atrial appendage (LAA) thrombus formation remains underexplored. This study aimed to investigate the association between IAB and the presence of LAA thrombus in patients with nonvalvular AF (NVAF) or atrial flutter referred for rhythm control procedures.

Methods

In this retrospective observational study, 750 patients with NVAF who underwent transesophageal echocardiography (TEE) prior to catheter ablation or cardioversion were evaluated. P-wave parameters were measured from digitally amplified 12‑lead ECGs, and IAB was defined according to current consensus criteria. Patients were stratified by the presence of LAA thrombus, and multivariate logistic regression was used to identify independent predictors.

Results

LAA thrombus was detected in 10.8 % of patients. Those with thrombus were older and had higher thromboembolic risk scores, more frequent history of stroke, and lower left ventricular ejection fraction (LVEF). Interatrial block was observed in 85.2 % and advanced IAB in 44.4 % of patients with thrombus. In multivariate analysis, IAB (OR: 2.698; p = 0.008), larger LA diameter, lower LVEF, and greater P-wave dispersion were independently associated with thrombus presence.

Conclusion

IAB is independently associated with LAA thrombus in NVAF patients and may serve as a noninvasive marker to identify individuals at higher thromboembolic risk, potentially guiding the need for TEE before rhythm control.

背景房间传导阻滞（IAB）是心房传导延迟和结构重构的心电图表现。虽然它与心房颤动（AF）和血栓栓塞事件有关，但其在预测左心房附件（LAA）血栓形成方面的潜在作用仍未得到充分探讨。本研究旨在探讨非瓣膜性房颤（NVAF）或心房扑动患者的IAB与LAA血栓存在之间的关系。方法回顾性观察750例非瓣膜性房颤患者，在导管消融或转复前行食管超声心动图（TEE）检查。通过数字放大的12导联心电图测量p波参数，并根据目前的共识标准定义IAB。根据LAA血栓的存在对患者进行分层，并使用多因素logistic回归来确定独立预测因素。结果10.8%的患者检出slaa血栓。血栓患者年龄较大，血栓栓塞风险评分较高，卒中史更频繁，左室射血分数（LVEF）较低。85.2%的血栓患者出现房间传导阻滞，44.4%的血栓患者出现晚期IAB。在多变量分析中，IAB （OR: 2.698; p = 0.008）、较大的LA直径、较低的LVEF和较大的p波离散度与血栓存在独立相关。结论iab与非瓣膜性房颤患者LAA血栓独立相关，可作为一种非侵入性标志物，识别血栓栓塞风险较高的个体，可能指导患者在控制心律之前是否需要TEE。

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引用次数: 0

A case of diagnostic challenge: Wide QRS complex tachycardia caused by rare etiologies. 诊断挑战一例：罕见病因引起的宽QRS复杂心动过速。

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-09-01 Epub Date: 2025-08-05 DOI: 10.1016/j.jelectrocard.2025.154095

Lifang Xu, Honglin Ni, Zhicheng Gao, Xianchao Sun

Rapid atrioventricular nodal non-reentrant tachycardia (DAVNNT) with intraventricular differential conduction-induced wide QRS tachycardia (WCT) is often misdiagnosed as ventricular tachycardia (VT) due to its distinctive atrioventricular conduction characteristics, making timely and accurate diagnosis and treatment challenging. This case report describes a 42-year-old female patient who presented with recurrent palpitations, with a dynamic electrocardiogram documenting a WCT that mimicked VT. Esophageal electrophysiological studies revealed a 1:2 atrioventricular conduction pattern. Intracardiac electrophysiological examination confirmed the diagnosis of DAVNNT, which was successfully treated with radiofrequency ablation. This case highlights that WCT with fewer P waves than QRS complexes can occur in DAVNNT, similar to VT. By logical inference a 1:2 atrioventricular conduction pattern, together with suspected interpolated ventricular or junctional premature contractions exhibiting variable QRS morphology, may serve as key diagnostic clues for DAVNNT.

快速房室结性非折返性心动过速（DAVNNT）合并室内差导性宽QRS心动过速（WCT）由于其独特的房室传导特征，常被误诊为室性心动过速（VT），给及时准确的诊断和治疗带来了挑战。本病例报告描述了一名42岁的女性患者，她表现为反复心悸，动态心电图显示WCT模拟室性心动过速。食管电生理研究显示1:2房室传导模式。心内电生理检查证实了DAVNNT的诊断，并成功地进行了射频消融治疗。本病例表明，与室性心动心动相似，DAVNNT中也可能出现P波少于QRS复合物的WCT。通过逻辑推断，1:2房室传导模式，以及可疑的室性内插入或结期早搏，表现出可变的QRS形态，可能是DAVNNT的关键诊断线索。

引用次数: 0

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Journal of electrocardiology

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