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The association between ST-segment depressions and sudden cardiac deaths and arrests after acute coronary syndrome 急性冠状动脉综合征后st段压低与心源性猝死和骤停之间的关系
IF 1.2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-11-01 Epub Date: 2025-10-11 DOI: 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.
研究目的:急性冠脉综合征(ACS)患者心电图st段下降与较高的死亡率相关。但是,其与心源性猝死(SCDs)或心源性骤停(SCAs)的关系尚未被研究。我们分析了ACS患者血管造影后心电图st段下降与SCD和SCA长期发病率之间的关系。方法:回顾性分析8565例ACS患者的资料,中位随访时间为7.1年。根据st段凹陷的位置,分层后比较血管造影后心电图出现st段凹陷患者(n = 1957)和未出现st段凹陷患者(n = 6608)。scd和sca事件的裁决使用了各种来源,详细说明了导致事件的情况。关联分析采用亚分布回归(Fine-Gray)模型。结果:在年龄和性别调整分析中,侧、下、下st段压低与SCD和SCA的长期风险相关(p值)。结论:ACS患者血管造影后心电图显示的侧、下、下st段压低与SCD和SCA的长期风险显著升高相关。
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引用次数: 0
Narrow QRS tachycardia? What is the diagnosis? 窄QRS心动过速?诊断结果是什么?
IF 1.2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-11-01 Epub Date: 2025-10-08 DOI: 10.1016/j.jelectrocard.2025.154146
Victoria Fanucci B.S. , Utkarsh Kohli M.D
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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 Pub Date : 2025-11-01 Epub Date: 2025-11-02 DOI: 10.1016/j.jelectrocard.2025.154152
Albert Roig MD , Antonio Thomaz de Andrade MD , Pedro Yuri Paiva Lima MD
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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 Pub Date : 2025-11-01 Epub Date: 2025-11-04 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。
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引用次数: 0
QT and RR interval analysis in genetic cardiac diseases using the AccuQT and advanced heart rate variability methods 使用AccuQT和高级心率变异性方法分析遗传性心脏病的QT和RR间期
IF 1.2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-11-01 Epub Date: 2025-08-24 DOI: 10.1016/j.jelectrocard.2025.154098
Aliisa Lönnrot , Matias Kanniainen , Teemu Pukkila , Mary Vaarpu , Katriina Aalto-Setälä , Esa Räsänen
The QT interval is a key indicator in assessing arrhythmia risk, evaluating drug safety, and supporting clinical diagnosis in cardiology. The QT interval is significantly influenced by heart rate so it must be accurately corrected to ensure reliable clinical interpretation. Conventional correction formulas, such as Bazett's formula, are widely utilized but often criticized for inaccuracies, either under- or overcorrecting QT intervals in different physiological conditions. The recently developed AccuQT method, utilizing transfer entropy for QT correction, has demonstrated superior consistency in healthy populations and improved accuracy in diagnosing long QT syndrome (LQTS) compared to conventional approaches.
In this study, we evaluate the AccuQT method using 24-h Holter recordings from patients with various genetic heart diseases, including hypertrophic cardiomyopathy (HCM) and LQTS, compared to the healthy controls. Additionally, we analyzed heart rate variability with the recently developed scaled-dependent detrended fluctuation analysis (DFA).
The mean QTc using the AccuQT method in the patient group was significantly longer (476 ms) than in the healthy population (410 ms), as expected. The Bazett's formula resulted in significantly longer mean QTc in the healthy population (460 ms) and in patient group (490 ms). The DFA scaling exponent was lower at short scales for patient group compared to healthy controls. It also detected a difference between HCM patients with clinical disease and asymptomatic gene carriers with no signs of the disease.
In conclusion, the AccuQT method provides reliable QT interval correction in patients with genetic cardiac diseases, demonstrating superior precision compared to Bazett's formula. AccuQT effectively captures time-dependent QT interval changes, enhancing diagnostic accuracy. Additionally, scale-dependent DFA analysis shows promise in differentiating patients with clinical hypertrophic cardiomyopathy from asymptomatic gene carriers, suggesting potential utility in earlier identification of at-risk individuals.
QT间期是评估心律失常风险、评价药物安全性和支持临床诊断的关键指标。QT间期受心率显著影响,因此必须准确校正以确保可靠的临床解释。传统的校正公式,如Bazett公式,被广泛使用,但经常因不准确而受到批评,在不同的生理条件下,QT间期校正不足或过度。最近开发的AccuQT方法,利用转移熵进行QT校正,与传统方法相比,在健康人群中表现出优越的一致性,并提高了诊断长QT综合征(LQTS)的准确性。在这项研究中,我们使用包括肥厚性心肌病(HCM)和LQTS在内的各种遗传性心脏病患者的24小时动态心电图记录来评估AccuQT方法,并将其与健康对照进行比较。此外,我们分析了心率变异性与最近发展的尺度依赖的无趋势波动分析(DFA)。正如预期的那样,患者组使用AccuQT方法的平均QTc (476 ms)明显长于健康人群(410 ms)。Bazett公式导致健康人群(460 ms)和患者组(490 ms)的平均QTc显著延长。与健康对照组相比,患者组在短量表上的DFA评分指数较低。它还检测到有临床疾病的HCM患者和没有疾病迹象的无症状基因携带者之间的差异。总之,AccuQT方法为遗传性心脏病患者提供了可靠的QT间期校正,与Bazett公式相比,显示出更高的精确度。AccuQT有效捕获时间依赖性QT间期变化,提高诊断准确性。此外,依赖于量表的DFA分析显示有希望区分临床肥厚性心肌病患者和无症状基因携带者,这表明在早期识别高危个体方面具有潜在的效用。
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引用次数: 0
Diagnostic accuracy of atrial fibrillation by computerized electrocardiogram analysis versus cardiologist interpretation 计算机心电图分析对房颤诊断的准确性与心脏病专家的解释。
IF 1.2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-11-01 Epub Date: 2025-10-18 DOI: 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.
背景:计算机化心电图(ECG)解释的进步提高了效率,但对房颤(AF)的诊断准确性仍然存在担忧。错误分类可能导致不适当的治疗和不良后果。目的:比较计算机心电判读与心内科医生过读对房颤的诊断准确性,并评估诊断错误的临床后果。方法:我们对2017年9月至11月在退伍军人事务加勒比医疗保健系统获得的5000张心电图进行了回顾性研究。所有心电图最初均由自动化软件解释。905组心电图在护理时出现过读。另外,两名委员会认证的心脏病专家以盲法独立审查了所有5000例心电图,并完成了标准化的解释表格。采用2-比例z检验和McNemar检验比较诊断指标。逻辑回归确定了误分类的预测因素。临床记录回顾治疗结果。结果:计算机解释鉴定出803例(16%)心房颤动相关心电图;其中,70%为真AF, 11%为假阳性,19%为假阴性。心脏科医生的解释显示出更高的准确性:敏感性87%对78%,特异性99%对97%,PPV 98%对86%,NPV 99%对97%(均为p)。结论:AF的计算机化心电图解释容易出现诊断错误。心脏病专家过度阅读可以提高准确性,并可能减少可预防的伤害。摘要:计算机心电判读误诊心房颤动30%,漏诊11%,漏诊19%。心脏病专家的过度阅读显示出更高的准确性(87%的敏感性,99%的特异性),最大限度地减少了假阳性和阴性。在41%的错误计算机解释中,提供者未能识别错误,导致抗凝延迟,治疗不当,两次血栓栓塞事件和一次出血相关住院。心室起搏、不确定的节律和心动过速是误分类的关键预测因素。这些发现强调了自动ECG分析的局限性,并支持结构化心脏病专家过度阅读,以防止诊断错误并改善AF检测中的患者预后。
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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 Pub Date : 2025-11-01 Epub 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。
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引用次数: 0
Novel presentation of CACNA1C variant as neonatal complete atrioventricular block, heart failure and non-compaction cardiomyopathy with oligogenic influences 新生儿完全性房室传导阻滞、心力衰竭和非压实性心肌病伴少源性影响的CACNA1C变异的新表现。
IF 1.2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-11-01 Epub Date: 2025-09-30 DOI: 10.1016/j.jelectrocard.2025.154139
Sydney R. Rooney MD , Brock Karolcik MD , Shawn West MD , Christopher Follansbee MD , Mousumi Moulik MD , Gaurav Arora MD
Pathogenic CACNA1C variants are associated with long QT syndrome, cardiac conduction disorders (CCD), short QT or Brugada syndromes, sudden cardiac death, and rarely hypertrophic cardiomyopathy. Neonatal complete AV block (CAVB) has not been previously reported in patients with CACNA1C-mutations. We present a neonate with CAVB, severe heart failure, and non-compaction cardiomyopathy, found to have a de novo, likely pathogenic, heterozygous CACNA1C variant and heterozygous variants of uncertain significance (VUS) in TNNI3K, GATA6, and PDHK1 genes. This case expands the CACNA1C-associated phenotype to include neonatal CAVB and suggests a potential oligogenic contribution to severe neonatal cardiac disease.
致病性CACNA1C变异与长QT综合征、心传导障碍(CCD)、短QT综合征或Brugada综合征、心源性猝死以及肥厚性心肌病有关。新生儿完全AV阻滞(CAVB)在cacna1c突变患者中尚未报道。我们报告了一个患有CAVB、严重心力衰竭和非压实性心肌病的新生儿,发现其在TNNI3K、GATA6和PDHK1基因中具有新发的、可能致病的杂合CACNA1C变异和不确定意义的杂合变异(VUS)。本病例将cacna1c相关表型扩展到包括新生儿CAVB,并提示可能的低基因性对严重新生儿心脏病的贡献。
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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 Pub Date : 2025-11-01 Epub Date: 2025-09-09 DOI: 10.1016/j.jelectrocard.2025.154110
Francesco Luzza MD, Francesco Catanzariti MD, Michela Navarra MD, Pietro Pugliatti MD
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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 Pub Date : 2025-11-01 Epub Date: 2025-09-06 DOI: 10.1016/j.jelectrocard.2025.154111
Zhong-Qun Zhan
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引用次数: 0
期刊
Journal of electrocardiology
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