Pub Date : 2025-09-01Epub Date: 2025-08-05DOI: 10.1016/j.jelectrocard.2025.154094
Nan Shi, Iris Liu, George Klein, Pavel Antiperovitch
Slow-fast or typical atrioventricular nodal reentrant tachycardia (AVNRT) is the most common cause of paroxysmal supraventricular tachycardia (SVT). A surface electrocardiogram (ECG) V1 RP interval of less than or equal to 90 ms has been cited as an upper cut-off for maximum RP observed in AVNRT. This criterion was defined using ventriculoatrial (VA) time measured from intracardiac electrograms (EGMs), namely the interval from the onset of QRS to the rapid deflection of the atrial electrogram at the high right atrial (HRA) electrode. Specifically, this was considered at the limit of the shortest one can observe in atrioventricular reentrant tachycardia (AVRT), hence indicating a diagnosis of AVNRT. In this study, we analyzed surface ECGs during tachycardia onset from 200 electrophysiology study (EPS)-confirmed cases of SVT, of which 142 (71 %) were diagnosed as AVNRT. We report that an RP interval ≤ 90 ms demonstrated improved diagnostic performance over ≤70 ms cutoff (≤90 ms: sensitivity of 97.2 % [95 % CI: 93.0-99.2] and specificity of 96.6 % [95 % CI: 88.1-99.6]; ≤70 ms: sensitivity 81.7 % [95 % CI: 74.3-87.7], specificity 98.3 % [95 % CI: 90.8-99.9]). Using a 90 ms RP threshold would reduce the false negative rate from 13 % to 2 %, potentially improving the accuracy of surface ECG-based SVT diagnosis. Overall, our findings support the use of ECG V1 RP ≤ 90 ms cutoff as a diagnostic marker of typical AVNRT.
{"title":"Utility of the surface electrocardiogram RP interval cutoff for diagnosis of atrioventricular nodal reentrant tachycardia.","authors":"Nan Shi, Iris Liu, George Klein, Pavel Antiperovitch","doi":"10.1016/j.jelectrocard.2025.154094","DOIUrl":"10.1016/j.jelectrocard.2025.154094","url":null,"abstract":"<p><p>Slow-fast or typical atrioventricular nodal reentrant tachycardia (AVNRT) is the most common cause of paroxysmal supraventricular tachycardia (SVT). A surface electrocardiogram (ECG) V1 RP interval of less than or equal to 90 ms has been cited as an upper cut-off for maximum RP observed in AVNRT. This criterion was defined using ventriculoatrial (VA) time measured from intracardiac electrograms (EGMs), namely the interval from the onset of QRS to the rapid deflection of the atrial electrogram at the high right atrial (HRA) electrode. Specifically, this was considered at the limit of the shortest one can observe in atrioventricular reentrant tachycardia (AVRT), hence indicating a diagnosis of AVNRT. In this study, we analyzed surface ECGs during tachycardia onset from 200 electrophysiology study (EPS)-confirmed cases of SVT, of which 142 (71 %) were diagnosed as AVNRT. We report that an RP interval ≤ 90 ms demonstrated improved diagnostic performance over ≤70 ms cutoff (≤90 ms: sensitivity of 97.2 % [95 % CI: 93.0-99.2] and specificity of 96.6 % [95 % CI: 88.1-99.6]; ≤70 ms: sensitivity 81.7 % [95 % CI: 74.3-87.7], specificity 98.3 % [95 % CI: 90.8-99.9]). Using a 90 ms RP threshold would reduce the false negative rate from 13 % to 2 %, potentially improving the accuracy of surface ECG-based SVT diagnosis. Overall, our findings support the use of ECG V1 RP ≤ 90 ms cutoff as a diagnostic marker of typical AVNRT.</p>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"92 ","pages":"154094"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816762","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 : 2025-09-01Epub Date: 2025-08-05DOI: 10.1016/j.jelectrocard.2025.154092
Francesco Luzza, Francesco Catanzariti, Michela Navarra, Pietro Pugliatti
The U wave is a deflection of the electrocardiogram whose genesis and clinical significance are yet unclear. It usually appears at the end of each ventricular complex in a selected lead. This study presents a unique case where the U wave appeared exclusively in beat-to-beat alternating cardiac cycles, so as to give rise to a pattern of " bigeminal U wave". Moreover, the presence of the U wave appeared to be related to the previous duration of the cardiac cycle correlating with lengthening of the cardiac cycle, while it did occur after shortening of the cardiac cycle. We can hypothesize that prolonged action potentials in ventricular M cells might contribute to this phenomenon.
{"title":"U wave manifesting in alternating beats: The bigeminal U wave.","authors":"Francesco Luzza, Francesco Catanzariti, Michela Navarra, Pietro Pugliatti","doi":"10.1016/j.jelectrocard.2025.154092","DOIUrl":"10.1016/j.jelectrocard.2025.154092","url":null,"abstract":"<p><p>The U wave is a deflection of the electrocardiogram whose genesis and clinical significance are yet unclear. It usually appears at the end of each ventricular complex in a selected lead. This study presents a unique case where the U wave appeared exclusively in beat-to-beat alternating cardiac cycles, so as to give rise to a pattern of \" bigeminal U wave\". Moreover, the presence of the U wave appeared to be related to the previous duration of the cardiac cycle correlating with lengthening of the cardiac cycle, while it did occur after shortening of the cardiac cycle. We can hypothesize that prolonged action potentials in ventricular M cells might contribute to this phenomenon.</p>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"92 ","pages":"154092"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804239","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 : 2025-09-01DOI: 10.1016/j.jelectrocard.2025.154105
Muhammet Salih Ateş , Erdoğan Sökmen
Background
Ischemia with non-obstructive coronary arteries (INOCA) represents a diagnostic and therapeutic challenge, often related to coronary microvascular dysfunction (CMD). Identifying non-invasive electrocardiographic markers that predict ischemia in this population remains a clinical priority. P-wave peak time (PWPT), reflecting atrial conduction delay, has been linked to ischemic pathophysiology.
Methods
This retrospective, observational study included 444 patients who underwent coronary angiography with normal epicardial arteries followed by SPECT myocardial perfusion imaging (MPI) due to persistent anginal symptoms. Patients were classified into three groups based on the percentage of reversible left ventricular ischemia: <5 %, 5–10 %, and > 10 %. P-wave indices—including PWPT in leads DII and V1—were measured digitally by two independent observers. Multivariate logistic regression identified independent predictors of >10 % ischemia. ROC analysis assessed the discriminative power of PWPT.
Results
PWPT-DII and PWPT-V1 were significantly prolonged in patients with >10 % ischemia (63 ± 8 ms and 58 ± 9 ms, respectively) compared to patients with <5 % ischemia (55 ± 7 ms and 50 ± 8 ms; both p < 0.001). PWPT-DII yielded an AUC of 0.82 (95 % CI 0.77–0.86), outperforming PWPT-V1 (AUC 0.76). In multivariate models, PWPT-DII (OR 1.15, 95 % CI 1.08–1.23), PWPT-V1 (OR 1.10, 95 % CI 1.03–1.17), age, diabetes mellitus, and E/e' ratio emerged as independent predictors of significant ischemia.
Conclusions
Prolonged PWPT, particularly in lead DII, was observed to be independently associated with myocardial ischemia in INOCA. Incorporating PWPT into standard ECG interpretation may aid in risk stratification and early identification of CMD in patients with normal coronary angiograms but ongoing ischemic symptoms.
{"title":"Electrocardiographic P-wave peak time predicts significant ischemia in INOCA patients: A pilot study","authors":"Muhammet Salih Ateş , Erdoğan Sökmen","doi":"10.1016/j.jelectrocard.2025.154105","DOIUrl":"10.1016/j.jelectrocard.2025.154105","url":null,"abstract":"<div><h3>Background</h3><div>Ischemia with non-obstructive coronary arteries (INOCA) represents a diagnostic and therapeutic challenge, often related to coronary microvascular dysfunction (CMD). Identifying non-invasive electrocardiographic markers that predict ischemia in this population remains a clinical priority. P-wave peak time (PWPT), reflecting atrial conduction delay, has been linked to ischemic pathophysiology.</div></div><div><h3>Methods</h3><div>This retrospective, observational study included 444 patients who underwent coronary angiography with normal epicardial arteries followed by SPECT myocardial perfusion imaging (MPI) due to persistent anginal symptoms. Patients were classified into three groups based on the percentage of reversible left ventricular ischemia: <5 %, 5–10 %, and > 10 %. P-wave indices—including PWPT in leads DII and V1—were measured digitally by two independent observers. Multivariate logistic regression identified independent predictors of >10 % ischemia. ROC analysis assessed the discriminative power of PWPT.</div></div><div><h3>Results</h3><div>PWPT-DII and PWPT-V1 were significantly prolonged in patients with >10 % ischemia (63 ± 8 ms and 58 ± 9 ms, respectively) compared to patients with <5 % ischemia (55 ± 7 ms and 50 ± 8 ms; both <em>p</em> < 0.001). PWPT-DII yielded an AUC of 0.82 (95 % CI 0.77–0.86), outperforming PWPT-V1 (AUC 0.76). In multivariate models, PWPT-DII (OR 1.15, 95 % CI 1.08–1.23), PWPT-V1 (OR 1.10, 95 % CI 1.03–1.17), age, diabetes mellitus, and E/e' ratio emerged as independent predictors of significant ischemia.</div></div><div><h3>Conclusions</h3><div>Prolonged PWPT, particularly in lead DII, was observed to be independently associated with myocardial ischemia in INOCA. Incorporating PWPT into standard ECG interpretation may aid in risk stratification and early identification of CMD in patients with normal coronary angiograms but ongoing ischemic symptoms.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"92 ","pages":"Article 154105"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008301","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 : 2025-09-01Epub Date: 2025-08-08DOI: 10.1016/j.jelectrocard.2025.154090
Jonas L Isaksen, Dominik Linz, Jørgen K Kanters
{"title":"Clinically useful evaluation of reconstruction techniques and use of Einthoven's Law.","authors":"Jonas L Isaksen, Dominik Linz, Jørgen K Kanters","doi":"10.1016/j.jelectrocard.2025.154090","DOIUrl":"10.1016/j.jelectrocard.2025.154090","url":null,"abstract":"","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"92 ","pages":"154090"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812033","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 an elderly woman who presented with cardiac arrest due to complete heart block. She developed progressive T-wave inversions in leads V3–V6 due to pacinginduced cardiac memory, accompanied by marked QTc prolongation. These repolarization abnormalities occurred despite normal electrolytes and non-obstructive coronary angiography and culminated in polymorphic ventricular tachycardia. This case highlights cardiac memory as an underrecognized proarrhythmic substrate in bradyarrhythmia and the importance of serial ECG monitoring to detect evolving repolarization changes and mitigate arrhythmic risk.
{"title":"An elderly woman with bradycardia and progressive repolarization abnormalities","authors":"Kapil Rajendran , Arun Jude Alphonse , Vinayakumar Desabandhu","doi":"10.1016/j.jelectrocard.2025.154109","DOIUrl":"10.1016/j.jelectrocard.2025.154109","url":null,"abstract":"<div><div>We report an elderly woman who presented with cardiac arrest due to complete heart block. She developed progressive T-wave inversions in leads V3–V6 due to pacinginduced cardiac memory, accompanied by marked QTc prolongation. These repolarization abnormalities occurred despite normal electrolytes and non-obstructive coronary angiography and culminated in polymorphic ventricular tachycardia. This case highlights cardiac memory as an underrecognized proarrhythmic substrate in bradyarrhythmia and the importance of serial ECG monitoring to detect evolving repolarization changes and mitigate arrhythmic risk.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154109"},"PeriodicalIF":1.2,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933788","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 : 2025-08-30DOI: 10.1016/j.jelectrocard.2025.154107
Gabriela Miana Paixão MD,PhD , Nathalia Coelho de Castro Nunes MD, MSc , Milena Soriano Marcolino MD, PhD , Emilly Malveira MSc , Paulo Rodrigues Gomes MSc , Peter W. Macfarlane DSc, FRCP , Antonio Luiz Pinho Ribeiro MD, PhD
Introduction
Left ventricular hypertrophy (LVH) is associated with complex structural changes in the myocardium, which may alter the electrocardiogram (ECG). The ECG is the initial test for patients with suspected heart disease. Electrocardiographic criteria for LVH diagnosis have a low sensitivity compared to the echocardiogram (ECHO). The advent of tele-ECG and the availability of automatic analysis systems have made the large-scale use of electrocardiography possible. However, there are only a few studies on the prevalence and prognosis of LVH automatically detected in the ECG.
Objective
To evaluate the association between the Glasgow program score for LVH in the ECG and overall mortality in an electronic cohort of primary care patients in Brazil.
Methods
Patients from the CODE (Clinical Outcomes in Digital Electrocardiology) cohort, older than 18 years, who underwent digital ECG recording from 2010 to 2017, were included. The University of Glasgow Automated ECG Interpretation program was used to analyze the ECGs. ECG LVH was classified into definite LVH if the LVH-Glasgow score was≥6.3, probable LVH if the score was between 5.0 and 6.3, possible LVH if the score was between 4.0 and 5.0, and no LVH if the score was <4.0. To assess the relationship between the LVH-Glasgow score and mortality, Cox regression adjusted for age, sex, and comorbidities was used.
Results
The CODE database included 1,558,415 patients, with 1,389,331 patients over 18 years old. Technically unsatisfactory ECGs that could compromise the analysis were excluded. The Glasgow program automatically excludes the diagnosis of LVH if LBBB, WPW, or pacemaker rhythm have been detected before the tests for LVH are undertaken. The prevalence of an abnormal LVH-Glasgow score (≥4.0) was 18.5 %. At a median follow-up of 3.47 years, the general population's all-cause mortality rate was 2.68 %. After multivariate adjustment, the presence of definite LVH had a higher risk of overall mortality (95 % CI; HR 1.64 (1.59–1.69)); probable LVH (95 % CI; HR 1.18 (1. 14-1.23)) and possible LVH (95 % CI; HR 1.09 (1.05–1.13)) were also associated with increasing risk of death.
Conclusions
The LVH-Glasgow score can be a prognostic tool in ECG analysis. In this population, a higher score was associated with a higher risk of overall mortality.
{"title":"Left ventricular hypertrophy in the automatic electrocardiogram report and mortality risk","authors":"Gabriela Miana Paixão MD,PhD , Nathalia Coelho de Castro Nunes MD, MSc , Milena Soriano Marcolino MD, PhD , Emilly Malveira MSc , Paulo Rodrigues Gomes MSc , Peter W. Macfarlane DSc, FRCP , Antonio Luiz Pinho Ribeiro MD, PhD","doi":"10.1016/j.jelectrocard.2025.154107","DOIUrl":"10.1016/j.jelectrocard.2025.154107","url":null,"abstract":"<div><h3>Introduction</h3><div>Left ventricular hypertrophy (LVH) is associated with complex structural changes in the myocardium, which may alter the electrocardiogram (ECG). The ECG is the initial test for patients with suspected heart disease. Electrocardiographic criteria for LVH diagnosis have a low sensitivity compared to the echocardiogram (ECHO). The advent of tele-ECG and the availability of automatic analysis systems have made the large-scale use of electrocardiography possible. However, there are only a few studies on the prevalence and prognosis of LVH automatically detected in the ECG.</div></div><div><h3>Objective</h3><div>To evaluate the association between the Glasgow program score for LVH in the ECG and overall mortality in an electronic cohort of primary care patients in Brazil.</div></div><div><h3>Methods</h3><div>Patients from the CODE (Clinical Outcomes in Digital Electrocardiology) cohort, older than 18 years, who underwent digital ECG recording from 2010 to 2017, were included. The University of Glasgow Automated ECG Interpretation program was used to analyze the ECGs. ECG LVH was classified into definite LVH if the LVH-Glasgow score was≥6.3, probable LVH if the score was between 5.0 and 6.3, possible LVH if the score was between 4.0 and 5.0, and no LVH if the score was <4.0. To assess the relationship between the LVH-Glasgow score and mortality, Cox regression adjusted for age, sex, and comorbidities was used.</div></div><div><h3>Results</h3><div>The CODE database included 1,558,415 patients, with 1,389,331 patients over 18 years old. Technically unsatisfactory ECGs that could compromise the analysis were excluded. The Glasgow program automatically excludes the diagnosis of LVH if LBBB, WPW, or pacemaker rhythm have been detected before the tests for LVH are undertaken. The prevalence of an abnormal LVH-Glasgow score (≥4.0) was 18.5 %. At a median follow-up of 3.47 years, the general population's all-cause mortality rate was 2.68 %. After multivariate adjustment, the presence of definite LVH had a higher risk of overall mortality (95 % CI; HR 1.64 (1.59–1.69)); probable LVH (95 % CI; HR 1.18 (1. 14-1.23)) and possible LVH (95 % CI; HR 1.09 (1.05–1.13)) were also associated with increasing risk of death.</div></div><div><h3>Conclusions</h3><div>The LVH-Glasgow score can be a prognostic tool in ECG analysis. In this population, a higher score was associated with a higher risk of overall mortality.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154107"},"PeriodicalIF":1.2,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144997607","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 : 2025-08-26DOI: 10.1016/j.jelectrocard.2025.154097
Mesut Tomakin , Ali Aygun , Ibrahim Caltekin , Adem Koksal , Rahime Sahin Turan , Mehmet Seyfettin Sarıbas
Background
Hypertensive crisis (HC) is recognized as a contributing factor in the development of cardiac arrhythmias. This study aims to assess Tp-e interval, Tp-e/QT (TQR), and Tp-e/QTc (TQcR) ratios in patients experiencing hypertensive urgency and emergency, in order to evaluate the potential risk of ventricular arrhythmias.
Methods
A prospective study was conducted involving HC patients admitted to a tertiary hospital's emergency department between June 1, 2022, and June 30, 2024. Patients were categorized into three groups: hypertensive emergency, hypertensive urgency, and control group. Data collected included demographic characteristics, vital signs, laboratory results, and electrocardiography (ECG) parameters such as Tp-e interval, TQR, and TQcR.
Results
Among the 235 eligible patients, 57 % were female and 43 % male. The hypertensive urgency group included 130 patients, the emergency group 45, and the control group 60. Statistically significant differences in Tp-e, TQR, and TQcR values were observed across all groups (p < 0.001). These metrics demonstrated moderate positive correlations with both systolic and diastolic blood pressures.
Conclusion
Increased Tp-e, TQR, and TQcR values identified in HC patients suggest a heightened risk for ventricular arrhythmias. These findings support the routine evaluation of these ECG.
{"title":"Evaluation of Tp-e interval, Tp-e/QT and Tp-e/QTc ratios in patients with hypertensive crisis","authors":"Mesut Tomakin , Ali Aygun , Ibrahim Caltekin , Adem Koksal , Rahime Sahin Turan , Mehmet Seyfettin Sarıbas","doi":"10.1016/j.jelectrocard.2025.154097","DOIUrl":"10.1016/j.jelectrocard.2025.154097","url":null,"abstract":"<div><h3>Background</h3><div>Hypertensive crisis (HC) is recognized as a contributing factor in the development of cardiac arrhythmias. This study aims to assess Tp-e interval, Tp-e/QT (TQR), and Tp-e/QTc (TQcR) ratios in patients experiencing hypertensive urgency and emergency, in order to evaluate the potential risk of ventricular arrhythmias.</div></div><div><h3>Methods</h3><div>A prospective study was conducted involving HC patients admitted to a tertiary hospital's emergency department between June 1, 2022, and June 30, 2024. Patients were categorized into three groups: hypertensive emergency, hypertensive urgency, and control group. Data collected included demographic characteristics, vital signs, laboratory results, and electrocardiography (ECG) parameters such as Tp-e interval, TQR, and TQcR.</div></div><div><h3>Results</h3><div>Among the 235 eligible patients, 57 % were female and 43 % male. The hypertensive urgency group included 130 patients, the emergency group 45, and the control group 60. Statistically significant differences in Tp-e, TQR, and TQcR values were observed across all groups (<em>p</em> < 0.001). These metrics demonstrated moderate positive correlations with both systolic and diastolic blood pressures.</div></div><div><h3>Conclusion</h3><div>Increased Tp-e, TQR, and TQcR values identified in HC patients suggest a heightened risk for ventricular arrhythmias. These findings support the routine evaluation of these ECG.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154097"},"PeriodicalIF":1.2,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989804","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 Wolff-Parkinson-White (WPW) pattern is an electrocardiographic finding resulting from conduction via an accessory pathway, which can mimic acute myocardial infarction (AMI), particularly when negative delta waves resemble Q waves and the repolarization abnormalities cause ST-segment elevations that mimic STEMI. We report the case of a 65-year-old woman who presented with acute retrosternal chest pain and an ECG showing both delta waves and inferior ST-segment elevations, raising concern for possible MI. However, a deep inspiration maneuver, known to influence autonomic tone, led to partial resolution of the delta waves and ST elevations, suggesting a non-ischemic etiology. Coronary angiography revealed normal coronary arteries, and upper endoscopy ultimately identified severe gastropathy and Helicobacter pylori infection as the cause of her symptoms. The patient was successfully treated with lansoprazole and antibiotics and remained symptom-free on follow-up. This case highlights the potential diagnostic utility of deep inspiration in differentiating accessory pathway-mediated ST changes from those of true myocardial infarction.
wolff -帕金森- white （WPW）模式是一种由辅助通路传导引起的心电图结果，可以模拟急性心肌梗死（AMI），特别是当负δ波类似于Q波时，复极异常导致st段升高，模拟STEMI。我们报告了一名65岁女性的病例，她表现为急性胸骨后胸痛，心电图显示三角波和下ST段升高，引起了对心肌梗死可能的关注。然而，深吸气操作，已知会影响自主神经张力，导致部分三角波和ST段升高，提示非缺血性病因。冠状动脉造影显示冠状动脉正常，上腔镜检查最终确定严重胃病和幽门螺杆菌感染为其症状的原因。患者经兰索拉唑和抗生素治疗成功，随访无症状。该病例强调了深吸气在区分副通路介导的ST改变和真正的心肌梗死方面的潜在诊断价值。
{"title":"Deep inspiration as a diagnostic maneuver to differentiate accessory pathway-induced ST elevation from inferior myocardial infarction: A case report","authors":"Motahare Hatami , Hamed Vahidi , Arsalan Salari , Asghar Mohamadi , Somayeh Bashiri Aliabadi , Fatemeh Baharvand","doi":"10.1016/j.jelectrocard.2025.154106","DOIUrl":"10.1016/j.jelectrocard.2025.154106","url":null,"abstract":"<div><div>The Wolff-Parkinson-White (WPW) pattern is an electrocardiographic finding resulting from conduction via an accessory pathway, which can mimic acute myocardial infarction (AMI), particularly when negative delta waves resemble Q waves and the repolarization abnormalities cause ST-segment elevations that mimic STEMI. We report the case of a 65-year-old woman who presented with acute retrosternal chest pain and an ECG showing both delta waves and inferior ST-segment elevations, raising concern for possible MI. However, a deep inspiration maneuver, known to influence autonomic tone, led to partial resolution of the delta waves and ST elevations, suggesting a non-ischemic etiology. Coronary angiography revealed normal coronary arteries, and upper endoscopy ultimately identified severe gastropathy and <em>Helicobacter pylori</em> infection as the cause of her symptoms. The patient was successfully treated with lansoprazole and antibiotics and remained symptom-free on follow-up. This case highlights the potential diagnostic utility of deep inspiration in differentiating accessory pathway-mediated ST changes from those of true myocardial infarction.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154106"},"PeriodicalIF":1.2,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145358146","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 : 2025-08-25DOI: 10.1016/j.jelectrocard.2025.154103
Muhammad Khubaib Iftikhar , Qurat ul ain Iftikhar, Mirza Muhammad Ali Baig
{"title":"QT correction beyond mathematics: A call for outcome-based validation of formulae","authors":"Muhammad Khubaib Iftikhar , Qurat ul ain Iftikhar, Mirza Muhammad Ali Baig","doi":"10.1016/j.jelectrocard.2025.154103","DOIUrl":"10.1016/j.jelectrocard.2025.154103","url":null,"abstract":"","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154103"},"PeriodicalIF":1.2,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144997608","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 : 2025-08-24DOI: 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.
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