A 40-year-old man, after accidentally ingesting aconitine in a herbal remedy, suffered severe poisoning symptoms and was diagnosed with multiple arrhythmias. He quickly received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and hemoperfusion in the ICU, along with continuous renal replacement therapy (CRRT) to stabilize his internal environment. The treatment controlled the arrhythmias, restored heart function, and alleviated acidosis. The patient was discharged feeling well after 9 days. This combined therapy is valuable for severe aconitine poisoning, especially when specific antidotes are lacking, as it provides critical life support and effectively removes toxins.
{"title":"Application of Veno-Arterial ECMO Combined With Hemoperfusion in the Treatment of a Patient With Yunaconitine Poisoning: A Case Report","authors":"Zhuo Jiang, Yue Zhuang, Xueting Hu, Wei Chen, Fei Xia, Xiaoxia Hu, Aixiang Yang, Weiyi Tao","doi":"10.1111/anec.70051","DOIUrl":"https://doi.org/10.1111/anec.70051","url":null,"abstract":"<p>A 40-year-old man, after accidentally ingesting aconitine in a herbal remedy, suffered severe poisoning symptoms and was diagnosed with multiple arrhythmias. He quickly received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and hemoperfusion in the ICU, along with continuous renal replacement therapy (CRRT) to stabilize his internal environment. The treatment controlled the arrhythmias, restored heart function, and alleviated acidosis. The patient was discharged feeling well after 9 days. This combined therapy is valuable for severe aconitine poisoning, especially when specific antidotes are lacking, as it provides critical life support and effectively removes toxins.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70051","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jing-Xiu Li, Xin-Xin Di, Min Gao, Xue-Qi Li, Yan-Lin Wang, Jie Zheng
This article describes a 44-year-old female with Fabry disease presenting with a 7-year history of chest discomfort, extremity pain, and hypohidrosis. ECG revealed sinus bradycardia (52 bpm), a short PR interval (100 ms) with a delta wave, and a QRS complex (126 ms) showing a complete right bundle branch block. T-wave inversion and ST-segment depression were observed in leads I, AVL, II, aVF, and V2–V6. Genetic testing confirmed Fabry disease (GLA: c.700_702del). Short PR interval with left ventricular hypertrophy (LVH) poses a diagnostic challenge, requiring advanced imaging and genetic testing to differentiate Fabry disease from other cardiomyopathies.
{"title":"Chest Discomfort, Left Ventricular Hypertrophy, Global T-Wave Inversion, and Short PR Interval Points to a Particular Cardiac Condition. What Could Be the Diagnosis?","authors":"Jing-Xiu Li, Xin-Xin Di, Min Gao, Xue-Qi Li, Yan-Lin Wang, Jie Zheng","doi":"10.1111/anec.70048","DOIUrl":"https://doi.org/10.1111/anec.70048","url":null,"abstract":"<p>This article describes a 44-year-old female with Fabry disease presenting with a 7-year history of chest discomfort, extremity pain, and hypohidrosis. ECG revealed sinus bradycardia (52 bpm), a short PR interval (100 ms) with a delta wave, and a QRS complex (126 ms) showing a complete right bundle branch block. T-wave inversion and ST-segment depression were observed in leads I, AVL, II, aVF, and V2–V6. Genetic testing confirmed Fabry disease (GLA: c.700_702del). Short PR interval with left ventricular hypertrophy (LVH) poses a diagnostic challenge, requiring advanced imaging and genetic testing to differentiate Fabry disease from other cardiomyopathies.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Magdalena Okrajni, Pyotr Platonov, Iram Faqir Muhammad, Fredrik Holmqvist, Johan Economou Lundberg, Anders Persson, Cecilia Kennbäck, Jeffrey S. Healey, Gunnar Engström, Linda S. Johnson
Background
Arterial stiffness, measured using carotid-femoral pulse wave velocity (c-f PWV) and heart rate-corrected augmentation index (Aix75), is associated with cardiovascular disease, and in some studies incident atrial fibrillation (AF). In this cross-sectional study, we aimed to investigate whether arterial stiffness is associated with markers of atrial myopathy, which refers to structural and electrical changes in the atria that indicate increased AF risk.
Methods
We included 1050 participants (age 57 ± 4.3 years, 47% males) from the population-based Swedish CArdioPulmonary bioImage Study with c-f PWV and Aix75 data. A random subsample (n = 331) underwent echocardiography. The association between arterial stiffness and atrial myopathy markers was studied using multivariable-adjusted negative binomial regression models for premature atrial complexes (PACs) on 24 h ECG, linear regression for P-wave duration and left atrial volume index (LAVi), and logistic regression models for abnormal P-wave terminal force in V1 (PWTFV1) and P-wave axis.
Results
Arterial stiffness was associated with fewer PACs: incidence rate ratio (IRR) 0.45 (95% CI: 0.31 to 0.65, p < 0.001) per 1 m/s increase in c-f PWV and IRR 0.66 (95% CI: 0.49 to 0.89, p = 0.01) per % increase in Aix75. There was no association between arterial stiffness and P-wave indices, OR 1.09 (95% CI: 0.85 to 1.40), p = 0.50 for abnormal PWTFV1, and β −0.003 (−0.10 to 0.09), p = 0.95 for P-wave duration, both per 1 m/s increase in c-f PWV.
Conclusions
Arterial stiffness, measured as either c-f PWV or Aix75, was associated with fewer PACs, whereas no association was found with P-wave indices. The association between arterial stiffness and atrial myopathy is complex and merits further study.
{"title":"Arterial Stiffness and Markers of Atrial Myopathy","authors":"Magdalena Okrajni, Pyotr Platonov, Iram Faqir Muhammad, Fredrik Holmqvist, Johan Economou Lundberg, Anders Persson, Cecilia Kennbäck, Jeffrey S. Healey, Gunnar Engström, Linda S. Johnson","doi":"10.1111/anec.70044","DOIUrl":"10.1111/anec.70044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Arterial stiffness, measured using carotid-femoral pulse wave velocity (c-f PWV) and heart rate-corrected augmentation index (Aix75), is associated with cardiovascular disease, and in some studies incident atrial fibrillation (AF). In this cross-sectional study, we aimed to investigate whether arterial stiffness is associated with markers of atrial myopathy, which refers to structural and electrical changes in the atria that indicate increased AF risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included 1050 participants (age 57 ± 4.3 years, 47% males) from the population-based Swedish CArdioPulmonary bioImage Study with c-f PWV and Aix75 data. A random subsample (<i>n</i> = 331) underwent echocardiography. The association between arterial stiffness and atrial myopathy markers was studied using multivariable-adjusted negative binomial regression models for premature atrial complexes (PACs) on 24 h ECG, linear regression for P-wave duration and left atrial volume index (LAVi), and logistic regression models for abnormal P-wave terminal force in V1 (PWTFV1) and P-wave axis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Arterial stiffness was associated with fewer PACs: incidence rate ratio (IRR) 0.45 (95% CI: 0.31 to 0.65, <i>p</i> < 0.001) per 1 m/s increase in c-f PWV and IRR 0.66 (95% CI: 0.49 to 0.89, <i>p</i> = 0.01) per % increase in Aix75. There was no association between arterial stiffness and P-wave indices, OR 1.09 (95% CI: 0.85 to 1.40), <i>p</i> = 0.50 for abnormal PWTFV1, and <i>β</i> −0.003 (−0.10 to 0.09), <i>p</i> = 0.95 for P-wave duration, both per 1 m/s increase in c-f PWV.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Arterial stiffness, measured as either c-f PWV or Aix75, was associated with fewer PACs, whereas no association was found with P-wave indices. The association between arterial stiffness and atrial myopathy is complex and merits further study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohammad Hossein Nikoo, Roozbeh Narimani-Javid, Alireza Kamrava, Sasan Shafiei, Salma Nozhat, Hosein Fatemian, Ali Asadzadeh, Mehdi Motahari Moadab, Fatemeh Ghanbari, Alireza Arzhangzadeh
Background
Neurally mediated syncope (NMS) is the primary cause of temporary and self-limiting loss of consciousness. The tilt table test (TTT) has been consistently employed as a supplementary diagnostic tool for syncope evaluation. However, TTT requires specialized equipment, which is lacking in several emergency room and clinic environments. We hypothesized that patients susceptible to NMS may have higher parasympathetic tone. Thus, this study investigates the correlation between PR interval and Herat rate variability parameters as indicators of parasympathetic tone and TTT results.
Methods
We included 213 patients referred to our cardiology clinic with an impression of NMS in 2022 and 2023. Data was retrospectively collected from 24-h ambulatory electrocardiographic monitoring recordings, TTT results, and patients' history and physical examination records.
Results
The analysis of the PR interval revealed a mean duration of 155 ms (95% CI: 148.61, 161.39) in negative TTT patients and 164.21 ms (95% CI: 158.44, 169.97) in positive TTT patients, indicating a statistically significant difference between two groups (p = 0.035). We also found that patients with a PR interval duration exceeding 160 ms demonstrated a significantly higher prevalence of positive TTT compared to those with a PR interval duration of less than 160 ms (p < 0.001, OR: 3.911, 95% CI: 2.143, 7.140).
Conclusions
Our study suggests a PR interval longer than 160 milliseconds as a valuable tool for predicting TTT results and identifying patients at higher risk of NMS.
背景：神经介导性晕厥（NMS）是暂时性和自限性意识丧失的主要原因。倾斜台试验（TTT）一直被用作晕厥评估的辅助诊断工具。然而，TTT需要专门的设备，这在一些急诊室和诊所环境中是缺乏的。我们假设易受NMS影响的患者可能有更高的副交感神经张力。因此，本研究探讨了PR间隔和Herat率变异性参数作为副交感神经张力和TTT结果的指标之间的相关性。方法：我们纳入了2022年和2023年在我们心脏病科诊所转诊的213例有NMS印象的患者。回顾性收集24小时动态心电图监测记录、TTT结果、患者病史和体格检查记录。结果：TTT阴性患者PR间期平均为155 ms (95% CI: 148.61, 161.39)， TTT阳性患者PR间期平均为164.21 ms (95% CI: 158.44, 169.97)，两组间差异有统计学意义（p = 0.035）。我们还发现，与PR间隔时间小于160 ms的患者相比，PR间隔时间超过160 ms的患者TTT阳性发生率明显更高(p结论：我们的研究表明，PR间隔时间大于160 ms是预测TTT结果和识别NMS高风险患者的有价值工具。
{"title":"PR Interval as a Valuable Predictor of Tilt Table Test Results in Patients With Neurally Mediated Syncope","authors":"Mohammad Hossein Nikoo, Roozbeh Narimani-Javid, Alireza Kamrava, Sasan Shafiei, Salma Nozhat, Hosein Fatemian, Ali Asadzadeh, Mehdi Motahari Moadab, Fatemeh Ghanbari, Alireza Arzhangzadeh","doi":"10.1111/anec.70054","DOIUrl":"10.1111/anec.70054","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Neurally mediated syncope (NMS) is the primary cause of temporary and self-limiting loss of consciousness. The tilt table test (TTT) has been consistently employed as a supplementary diagnostic tool for syncope evaluation. However, TTT requires specialized equipment, which is lacking in several emergency room and clinic environments. We hypothesized that patients susceptible to NMS may have higher parasympathetic tone. Thus, this study investigates the correlation between PR interval and Herat rate variability parameters as indicators of parasympathetic tone and TTT results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included 213 patients referred to our cardiology clinic with an impression of NMS in 2022 and 2023. Data was retrospectively collected from 24-h ambulatory electrocardiographic monitoring recordings, TTT results, and patients' history and physical examination records.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The analysis of the PR interval revealed a mean duration of 155 ms (95% CI: 148.61, 161.39) in negative TTT patients and 164.21 ms (95% CI: 158.44, 169.97) in positive TTT patients, indicating a statistically significant difference between two groups (<i>p</i> = 0.035). We also found that patients with a PR interval duration exceeding 160 ms demonstrated a significantly higher prevalence of positive TTT compared to those with a PR interval duration of less than 160 ms (<i>p</i> < 0.001, OR: 3.911, 95% CI: 2.143, 7.140).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study suggests a PR interval longer than 160 milliseconds as a valuable tool for predicting TTT results and identifying patients at higher risk of NMS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This article describes a woman who presented to the hospital with recurrent chest pain. The electrocardiogram revealed positive and negative biphasic T waves in the anterior and inferior leads, which subsequently deepened. Upon recurrence of chest pain, the T waves reverted to upright. Coronary angiography indicated the presence of three-vessel coronary artery disease. The occurrence of Wellens' T wave sign in the precordial leads frequently suggests left anterior descending artery disease, while the presence of positive and negative biphasic T waves in the inferior wall leads may also indicate lesions in the right coronary artery or left circumflex artery.
{"title":"A Rare Case of Anterior Wall Combined With Inferior Wall Wellens Syndrome","authors":"Lei Zhang","doi":"10.1111/anec.70052","DOIUrl":"https://doi.org/10.1111/anec.70052","url":null,"abstract":"<p>This article describes a woman who presented to the hospital with recurrent chest pain. The electrocardiogram revealed positive and negative biphasic T waves in the anterior and inferior leads, which subsequently deepened. Upon recurrence of chest pain, the T waves reverted to upright. Coronary angiography indicated the presence of three-vessel coronary artery disease. The occurrence of Wellens' T wave sign in the precordial leads frequently suggests left anterior descending artery disease, while the presence of positive and negative biphasic T waves in the inferior wall leads may also indicate lesions in the right coronary artery or left circumflex artery.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143119883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yichi Yu, Xiaomin Yang, Xiaoming Lian, Yan Zhao, Bo Liu, Xiangfei Feng, Qunshan Wang, Yigang Li
Objective
To compare the paced QRS duration on different sites in age-, gender-, and indication-matched patients implanted with Micra leadless pacemakers and conventional transvenous pacemakers (TV-PM).
Method
A total of 82 patients from Xinhua Hospital, Shanghai Jiaotong University, were enrolled, including two groups of 41 patients matched according to gender, age, and pacemaker indications, who underwent Micra and TV-PM implantations, respectively. The baseline data of the patients, the pacing site described using three- and nine-partition methods, and the paced QRS duration on 12-lead electrocardiogram were then analyzed.
Results
Overall, patients in our population were on average 79.2 years of age and mostly male (75.6%). Atrioventricular node dysfunction was the most common indication (56.1%) for pacemaker therapy. Mid-septum, especially Site 5, is the implantation site for most patients in both groups. Micra (145 ms) and TV-PM (133 ms) both had the narrowest-paced QRS at high septum, but Micra may exhibit significantly more reduced QRS duration than TV-PM at low septum (Micra vs. TV-PM: 143.0 [142.8–156.5] ms vs. 163.5 ± 17.5 ms, p = 0.044).
Conclusion
The narrowest-paced QRS complex for Micra leadless pacemakers is achieved at high septum, and pacing at low septum by Micra may acquire shorter QRS duration than conventional TV-PM.
目的：比较年龄、性别和适应症匹配的Micra无导线起搏器和传统经静脉起搏器（TV-PM）植入患者不同部位的QRS节律持续时间。方法：选取上海交通大学新华医院的82例患者，分为两组，每组41例，根据性别、年龄、起搏器适应证进行匹配，分别行Micra和TV-PM植入。然后分析患者的基线数据，使用三分区和九分区方法描述的起搏部位，以及12导联心电图上的有节奏QRS持续时间。结果：总体而言，本组患者的平均年龄为79.2岁，以男性为主（75.6%）。房室结功能障碍是起搏器治疗最常见的适应症（56.1%）。两组大多数患者的植入部位均为中隔，尤其是第5位。Micra （145 ms）和TV-PM （133 ms）在高间隔时的QRS最短，但Micra比TV-PM在低间隔时的QRS持续时间明显缩短（Micra vs. TV-PM: 143.0 [142.8-156.5] ms vs. 163.5±17.5 ms, p = 0.044）。结论：Micra无铅起搏器在高间隔处可获得最窄起搏QRS复合体，Micra在低间隔起搏可获得比传统TV-PM更短的QRS持续时间。
{"title":"Micra Leadless and Transvenous Pacemaker: A Single-Center Comparative Study of QRS Wave Duration Resulting From Different Pacing Sites","authors":"Yichi Yu, Xiaomin Yang, Xiaoming Lian, Yan Zhao, Bo Liu, Xiangfei Feng, Qunshan Wang, Yigang Li","doi":"10.1111/anec.70050","DOIUrl":"10.1111/anec.70050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare the paced QRS duration on different sites in age-, gender-, and indication-matched patients implanted with Micra leadless pacemakers and conventional transvenous pacemakers (TV-PM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A total of 82 patients from Xinhua Hospital, Shanghai Jiaotong University, were enrolled, including two groups of 41 patients matched according to gender, age, and pacemaker indications, who underwent Micra and TV-PM implantations, respectively. The baseline data of the patients, the pacing site described using three- and nine-partition methods, and the paced QRS duration on 12-lead electrocardiogram were then analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, patients in our population were on average 79.2 years of age and mostly male (75.6%). Atrioventricular node dysfunction was the most common indication (56.1%) for pacemaker therapy. Mid-septum, especially Site 5, is the implantation site for most patients in both groups. Micra (145 ms) and TV-PM (133 ms) both had the narrowest-paced QRS at high septum, but Micra may exhibit significantly more reduced QRS duration than TV-PM at low septum (Micra vs. TV-PM: 143.0 [142.8–156.5] ms vs. 163.5 ± 17.5 ms, <i>p</i> = 0.044).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The narrowest-paced QRS complex for Micra leadless pacemakers is achieved at high septum, and pacing at low septum by Micra may acquire shorter QRS duration than conventional TV-PM.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Syed Ali Raza Abidi, Afreen Quadri, Muhammad Umer Riaz Gondal, Fatima Hayat, Shafia Naeem, Fawad Talat, Amin Mehmoodi, Jahanzeb Malik
Radiofrequency ablation (RFA) is a safe and effective treatment for patients experiencing ventricular and atrial tachyarrhythmias. While complications after RFA are generally rare, the occurrence of coronary artery (CA) injury, albeit infrequent, can have significant clinical implications. Given the proximity of CAs to common ablation sites, understanding the interplay between RFA and CA perfusion pathophysiology is paramount. Although previous studies have discussed the presentation and outcomes of CA injury post-ablation, a comprehensive review consolidating the mechanisms of CA injury following RFA remains absent in the cardiology literature. In this review, we conducted an extensive literature search spanning the past three decades to explore the link between the biophysics of RFA and CA perfusion pathophysiology, focusing on injury mechanisms. We delve into RFA lesion pathology, elucidate the mechanisms of CA injury resulting from RFA, and examine factors influencing lesion formation, such as convective cooling and the “shadow effect.” Furthermore, we outline methods to mitigate CA injury post-RFA and propose novel research avenues to optimize lesion formation and ensure the safety of arrhythmia treatments, particularly in cases where tissue ablation is performed close to CAs.
{"title":"Pathophysiological Effects on Coronary Arteries Following Radiofrequency Ablation: A Comprehensive Review","authors":"Syed Ali Raza Abidi, Afreen Quadri, Muhammad Umer Riaz Gondal, Fatima Hayat, Shafia Naeem, Fawad Talat, Amin Mehmoodi, Jahanzeb Malik","doi":"10.1111/anec.70021","DOIUrl":"10.1111/anec.70021","url":null,"abstract":"<p>Radiofrequency ablation (RFA) is a safe and effective treatment for patients experiencing ventricular and atrial tachyarrhythmias. While complications after RFA are generally rare, the occurrence of coronary artery (CA) injury, albeit infrequent, can have significant clinical implications. Given the proximity of CAs to common ablation sites, understanding the interplay between RFA and CA perfusion pathophysiology is paramount. Although previous studies have discussed the presentation and outcomes of CA injury post-ablation, a comprehensive review consolidating the mechanisms of CA injury following RFA remains absent in the cardiology literature. In this review, we conducted an extensive literature search spanning the past three decades to explore the link between the biophysics of RFA and CA perfusion pathophysiology, focusing on injury mechanisms. We delve into RFA lesion pathology, elucidate the mechanisms of CA injury resulting from RFA, and examine factors influencing lesion formation, such as convective cooling and the “shadow effect.” Furthermore, we outline methods to mitigate CA injury post-RFA and propose novel research avenues to optimize lesion formation and ensure the safety of arrhythmia treatments, particularly in cases where tissue ablation is performed close to CAs.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maria A. Pabon, Amrit Misra, Kimberlee Gauvreau, Madeline E. Duncan, Ava Conklin, Katherine E. Economy, Fred M. Wu, Thomas Tadros, Anne Marie Valente, For the STORCC Investigators
Background
Electrocardiograms (EKGs) are routinely performed in pregnant patients with pre-existing cardiovascular disease. However, in pregnant patients with congenital heart disease (CHD), EKG changes during gestation have not been explored.
Methods
We performed a retrospective study of pregnant patients with CHD enrolled in the STORCC initiative. Patients were included if they had at least two EKGs across the perinatal period and were grouped by specific conditions: atrial septal defect (ASD), tetralogy of Fallot, congenital pulmonary stenosis, coarctation of the aorta (CoA), bicuspid aortic valve (BAV), systemic right ventricle (SRV), and Fontan circulation. EKG parameters were measured in all available EKGs by two investigators, blinded to diagnosis and time of gestation.
Results
One hundred and seventy pregnant patients were included. There was a statistically significant increase in HR from pre-pregnancy to third trimester in all groups except for those with Fontan and SRV. Patients with ASD and BAV had a statistically significant increase in their QTc (ASD:13 ms, p = 0.017; BAV:7 ms, p = 0.018) during pregnancy. QRS duration was shorter (4 ms) in the third trimester for patients with ASD (p = 0.033) and CoA (p = 0.014). Despite these individual findings, EKG parameters remained within normal limits and regressed to baseline in the postpartum period.
Conclusions
Patients with CHD have statistically significant EKG changes throughout pregnancy, but the values remain within normal limits. Like patients without heart disease, those with CHD increase their HR during pregnancy, except individuals with SRV and Fontan, who appear to lack capacity for physiologic HR augmentation.
背景：心电图（EKGs）是妊娠期已有心血管疾病患者的常规检查。然而，在患有先天性心脏病（CHD）的妊娠患者中，尚未探讨妊娠期间的心电图变化。方法：我们对参加STORCC计划的怀孕冠心病患者进行了回顾性研究。如果患者在围产期至少有两次心电图，并根据具体情况进行分组：房间隔缺损（ASD）、法洛四联症、先天性肺动脉狭窄、主动脉缩窄（CoA）、二尖瓣主动脉瓣（BAV）、系统性右心室（SRV）和Fontan循环。在所有可用的心电图参数测量由两名调查员，盲诊断和妊娠时间。结果：纳入170例孕妇。除Fontan和SRV组外，所有组从孕前到妊娠晚期的HR均有统计学意义的增加。ASD和BAV患者的QTc增加具有统计学意义(ASD:13 ms, p = 0.017；BAV:7 ms, p = 0.018)。ASD （p = 0.033）和CoA （p = 0.014）患者妊娠晚期QRS持续时间较短（4 ms）。尽管有这些个体的发现，心电图参数仍在正常范围内，并在产后回归到基线。结论：冠心病患者妊娠期心电图变化具有统计学意义，但仍在正常范围内。与没有心脏病的患者一样，CHD患者在怀孕期间心率增加，但SRV和Fontan患者似乎缺乏生理性心率增加的能力。
{"title":"Electrocardiographic Changes in Pregnant Patients With Congenital Heart Disease","authors":"Maria A. Pabon, Amrit Misra, Kimberlee Gauvreau, Madeline E. Duncan, Ava Conklin, Katherine E. Economy, Fred M. Wu, Thomas Tadros, Anne Marie Valente, For the STORCC Investigators","doi":"10.1111/anec.70037","DOIUrl":"10.1111/anec.70037","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Electrocardiograms (EKGs) are routinely performed in pregnant patients with pre-existing cardiovascular disease. However, in pregnant patients with congenital heart disease (CHD), EKG changes during gestation have not been explored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective study of pregnant patients with CHD enrolled in the STORCC initiative. Patients were included if they had at least two EKGs across the perinatal period and were grouped by specific conditions: atrial septal defect (ASD), tetralogy of Fallot, congenital pulmonary stenosis, coarctation of the aorta (CoA), bicuspid aortic valve (BAV), systemic right ventricle (SRV), and Fontan circulation. EKG parameters were measured in all available EKGs by two investigators, blinded to diagnosis and time of gestation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred and seventy pregnant patients were included. There was a statistically significant increase in HR from pre-pregnancy to third trimester in all groups except for those with Fontan and SRV. Patients with ASD and BAV had a statistically significant increase in their QTc (ASD:13 ms, <i>p</i> = 0.017; BAV:7 ms, <i>p</i> = 0.018) during pregnancy. QRS duration was shorter (4 ms) in the third trimester for patients with ASD (<i>p</i> = 0.033) and CoA (<i>p</i> = 0.014). Despite these individual findings, EKG parameters remained within normal limits and regressed to baseline in the postpartum period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients with CHD have statistically significant EKG changes throughout pregnancy, but the values remain within normal limits. Like patients without heart disease, those with CHD increase their HR during pregnancy, except individuals with SRV and Fontan, who appear to lack capacity for physiologic HR augmentation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11705495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142943315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ibrahim Antoun, Xin Li, Zakariyya Vali, Ahmed Kotb, Ahmed Abdelrazik, Ivelin Koev, Riyaz Somani, G. André Ng
Background
Pulmonary vein isolation (PVI) is the most promising management method for paroxysmal atrial fibrillation (PAF). The P wave in the electrocardiogram (ECG) represents atrial depolarization. This study aims to correlate P-wave parameters after PVI with outcomes.
Methods
This single-center retrospective study included consecutive patients with first-time PVI for PAF between 2018 and 2019 and targeted pulmonary veins (PVs). Procedure success was defined by freedom of ECG-documented AF at 12 months. Digital 12 leads ECGs with 1–50 hertz bandpass filter were monitored before the procedure. P-wave amplitude (PWA) and P-wave terminal force in V1 (PTFV1) Corrected P-wave duration (PWDc), and P-wave dispersion (PWDisp), were measured before and after ablation.
Results
The final analysis included 180 patients, of which 130 (72%) had successful ablations and 53 (30%) had radiofrequency ablation (RF). Males comprised 71% of the patients; the mean age was 60. Demographics were similar between both arms p < 0.001. Patients with failed PVI had increased PWDc after PVI (139–146 ms, p < 0.001) compared to patients with successful PVI. PWA increased significantly after failed PVI (1.6–2 mV, p < 0.001) and successful PVI (1.6–1.8 mV, p = 0.008). PWD (hazard ratio [HR]: 2.5, 95% confidence interval [CI]: 1.4–4.2, p < 0.001) and PWA (HR: 1.7, 95% CI: 1.2–2.9, p = 0.03) were independently associated with PVI failure at 12 months. PWdisp and PTFV1 were not correlated with outcomes.
Conclusion
Increased PWDc and PWA after PVI were independently associated with failed ablation for PAF, supporting the role of P-wave parameters in predicting outcomes.
{"title":"The Value of P-Wave Parameters Changes in Predicting Catheter Ablation Outcomes for Paroxysmal Atrial Fibrillation","authors":"Ibrahim Antoun, Xin Li, Zakariyya Vali, Ahmed Kotb, Ahmed Abdelrazik, Ivelin Koev, Riyaz Somani, G. André Ng","doi":"10.1111/anec.70047","DOIUrl":"10.1111/anec.70047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pulmonary vein isolation (PVI) is the most promising management method for paroxysmal atrial fibrillation (PAF). The P wave in the electrocardiogram (ECG) represents atrial depolarization. This study aims to correlate P-wave parameters after PVI with outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center retrospective study included consecutive patients with first-time PVI for PAF between 2018 and 2019 and targeted pulmonary veins (PVs). Procedure success was defined by freedom of ECG-documented AF at 12 months. Digital 12 leads ECGs with 1–50 hertz bandpass filter were monitored before the procedure. P-wave amplitude (PWA) and P-wave terminal force in V1 (PTFV1) Corrected P-wave duration (PWDc), and P-wave dispersion (PWDisp), were measured before and after ablation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The final analysis included 180 patients, of which 130 (72%) had successful ablations and 53 (30%) had radiofrequency ablation (RF). Males comprised 71% of the patients; the mean age was 60. Demographics were similar between both arms <i>p</i> < 0.001. Patients with failed PVI had increased PWDc after PVI (139–146 ms, <i>p</i> < 0.001) compared to patients with successful PVI. PWA increased significantly after failed PVI (1.6–2 mV, <i>p</i> < 0.001) and successful PVI (1.6–1.8 mV, <i>p</i> = 0.008). PWD (hazard ratio [HR]: 2.5, 95% confidence interval [CI]: 1.4–4.2, <i>p</i> < 0.001) and PWA (HR: 1.7, 95% CI: 1.2–2.9, <i>p</i> = 0.03) were independently associated with PVI failure at 12 months. PWdisp and PTFV1 were not correlated with outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Increased PWDc and PWA after PVI were independently associated with failed ablation for PAF, supporting the role of P-wave parameters in predicting outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11686087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Brugada syndrome (BrS) is an inherited channelopathy characterized by right precordial ST-segment elevation. This study investigates the clinical and genetic characteristics of children with BrS in Hong Kong.
Methods
A retrospective review was conducted at the only tertiary pediatric cardiology center in Hong Kong from 2002 to 2022, including all pediatric BrS patients under 18 years old. The diagnosis of BrS was established with a type 1 ECG pattern detected spontaneously or induced by flecainide, excluding secondary causes.
Results
Eight probands of mean age 10 years old were identified. Male dominance was observed (6 boys vs. 2 girls). The mean follow-up duration was 4.6 years (Median 3.5 years). Patients had type 1 ECG pattern either spontaneously (n = 4) or provoked by flecainide (n = 4). Fever was present in seven patients at the initial presentation, and two patients experienced aborted cardiac arrest and one had symptomatic ventricular tachycardia. All symptomatic patients received implantable cardioverter-defibrillator placement. Five asymptomatic patients (62.5%) were diagnosed with BrS through ECG during febrile illness, and they remained asymptomatic following conservative management involving strict fever control and medication avoidance. Two patients with mixed phenotype (one with long QT syndrome and another with ectopic atrial tachycardia) required antiarrhythmics and one patient received transcatheter ablation for atrial tachycardia to achieve optimal arrhythmia control.
Conclusion
Fever plays a significant role in unmasking BrS in children. Asymptomatic children with BrS managed conservatively have a favorable prognosis. Difficult arrhythmia control was found in patients with mixed phenotype.
{"title":"A Tale of Two Conditions: Pediatric Brugada Syndrome Unveiled—Navigating the Challenges of Coexisting Arrhythmia and Fever-Induced ECG Pattern","authors":"Hei-To Leung, Sit-Yee Kwok, Fong-Ying Shih, Kin-Shing Lun, Tak-Cheung Yung, Sabrina Tsao","doi":"10.1111/anec.70009","DOIUrl":"10.1111/anec.70009","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Brugada syndrome (BrS) is an inherited channelopathy characterized by right precordial ST-segment elevation. This study investigates the clinical and genetic characteristics of children with BrS in Hong Kong.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective review was conducted at the only tertiary pediatric cardiology center in Hong Kong from 2002 to 2022, including all pediatric BrS patients under 18 years old. The diagnosis of BrS was established with a type 1 ECG pattern detected spontaneously or induced by flecainide, excluding secondary causes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight probands of mean age 10 years old were identified. Male dominance was observed (6 boys vs. 2 girls). The mean follow-up duration was 4.6 years (Median 3.5 years). Patients had type 1 ECG pattern either spontaneously (<i>n</i> = 4) or provoked by flecainide (<i>n</i> = 4). Fever was present in seven patients at the initial presentation, and two patients experienced aborted cardiac arrest and one had symptomatic ventricular tachycardia. All symptomatic patients received implantable cardioverter-defibrillator placement. Five asymptomatic patients (62.5%) were diagnosed with BrS through ECG during febrile illness, and they remained asymptomatic following conservative management involving strict fever control and medication avoidance. Two patients with mixed phenotype (one with long QT syndrome and another with ectopic atrial tachycardia) required antiarrhythmics and one patient received transcatheter ablation for atrial tachycardia to achieve optimal arrhythmia control.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Fever plays a significant role in unmasking BrS in children. Asymptomatic children with BrS managed conservatively have a favorable prognosis. Difficult arrhythmia control was found in patients with mixed phenotype.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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