Sung Soo Kim, Jeong Tae Byoun, Donghyeon Joo, Jum Suk Ko, Nam Ho Kim, Hyung Ki Jeong
A 58-year-old man experienced a ventricular fibrillation storm with prominent inferolateral J waves and was diagnosed with early repolarization syndrome. Initial coronary angiography showed no significant stenosis and the other evaluations for ventricular fibrillation were unremarkable. Despite conventional therapy for ventricular fibrillation, it recurred. Isoproterenol infusion suppressed the J wave and successfully mitigated ventricular fibrillation episodes. This case highlights the role of isoproterenol in managing early repolarization syndrome-related ventricular fibrillation storms and the possible pathogenic link between SCN5A mutations and J wave syndromes.
{"title":"Successful Isoproterenol Treatment for Ventricular Fibrillation Storm in Early Repolarization Syndrome With SCN5A Mutation","authors":"Sung Soo Kim, Jeong Tae Byoun, Donghyeon Joo, Jum Suk Ko, Nam Ho Kim, Hyung Ki Jeong","doi":"10.1111/anec.70143","DOIUrl":"10.1111/anec.70143","url":null,"abstract":"<p>A 58-year-old man experienced a ventricular fibrillation storm with prominent inferolateral J waves and was diagnosed with early repolarization syndrome. Initial coronary angiography showed no significant stenosis and the other evaluations for ventricular fibrillation were unremarkable. Despite conventional therapy for ventricular fibrillation, it recurred. Isoproterenol infusion suppressed the J wave and successfully mitigated ventricular fibrillation episodes. This case highlights the role of isoproterenol in managing early repolarization syndrome-related ventricular fibrillation storms and the possible pathogenic link between SCN5A mutations and J wave syndromes.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12703576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145755017","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}
Muhammad Hanzla Umair, Shahab Saidullah, Sadaf Shabeer, Roha Daneyal, Neha Kumar, Priyanka Shetiya, Hina Ahmed Siddiqi, Haresh Kumar, Anjali Bai, Raja Sadam Mehmood, Abida Perveen, F. N. U. Abdullah, Jahanzeb Malik
Background
Venous puncture failure during cardiac implantable electronic device (CIED) implantation is a significant procedural challenge, particularly in fasting patients. Pre-procedural intravenous normal saline (NS) infusion may enhance venous filling and improve procedural outcomes, but evidence in this setting is limited.
Methods
We conducted a retrospective cohort study at Abbas Institute of Medical Sciences, including 2852 patients undergoing CIED implantation. Patients were divided into two groups: those who received intravenous NS infusion prior to the procedure (n = 1130) and those who did not (n = 1722). Baseline demographics, procedural details, and outcomes—including venous puncture failure, arterial puncture, site change, and acute kidney injury (AKI)—were compared.
Results
The NS group demonstrated a significantly lower rate of venous puncture failure (4.6% vs. 8.9%, p < 0.001) and arterial puncture failure (1.6% vs. 2.8%, p = 0.03). AKI occurred less frequently in the NS group, although this difference was not statistically significant (1.8% vs. 2.6%, p = 0.09). Predictors of venous puncture failure included absence of NS infusion (OR 2.1, 95% CI 1.5–3.0), BMI ≥ 30, and CKD. ROC analysis demonstrated good model discrimination (AUC = 0.81).
背景：心脏植入式电子装置（CIED）植入过程中静脉穿刺失败是一个重大的程序挑战，特别是在禁食患者中。术前静脉生理盐水（NS）输注可增强静脉充盈并改善手术结果，但这方面的证据有限。方法：我们在阿巴斯医学科学研究所进行回顾性队列研究，包括2852例接受CIED植入的患者。患者分为两组：术前接受NS静脉输注的患者（n = 1130）和未接受NS静脉输注的患者（n = 1722）。比较基线人口统计学、手术细节和结果——包括静脉穿刺失败、动脉穿刺、部位改变和急性肾损伤（AKI）。结果：NS组静脉穿刺失败率明显低于对照组（4.6% vs. 8.9%）。结论：术前NS输注可显著提高空腹植入术患者静脉穿刺成功率。
{"title":"Outcomes of Intravenous Normal Saline Infusion Pre-Cardiac Implantable Electronic Devices Versus No Infusion in Fasting","authors":"Muhammad Hanzla Umair, Shahab Saidullah, Sadaf Shabeer, Roha Daneyal, Neha Kumar, Priyanka Shetiya, Hina Ahmed Siddiqi, Haresh Kumar, Anjali Bai, Raja Sadam Mehmood, Abida Perveen, F. N. U. Abdullah, Jahanzeb Malik","doi":"10.1111/anec.70139","DOIUrl":"10.1111/anec.70139","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Venous puncture failure during cardiac implantable electronic device (CIED) implantation is a significant procedural challenge, particularly in fasting patients. Pre-procedural intravenous normal saline (NS) infusion may enhance venous filling and improve procedural outcomes, but evidence in this setting is limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study at Abbas Institute of Medical Sciences, including 2852 patients undergoing CIED implantation. Patients were divided into two groups: those who received intravenous NS infusion prior to the procedure (<i>n</i> = 1130) and those who did not (<i>n</i> = 1722). Baseline demographics, procedural details, and outcomes—including venous puncture failure, arterial puncture, site change, and acute kidney injury (AKI)—were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The NS group demonstrated a significantly lower rate of venous puncture failure (4.6% vs. 8.9%, <i>p</i> < 0.001) and arterial puncture failure (1.6% vs. 2.8%, <i>p</i> = 0.03). AKI occurred less frequently in the NS group, although this difference was not statistically significant (1.8% vs. 2.6%, <i>p</i> = 0.09). Predictors of venous puncture failure included absence of NS infusion (OR 2.1, 95% CI 1.5–3.0), BMI ≥ 30, and CKD. ROC analysis demonstrated good model discrimination (AUC = 0.81).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Pre-procedural NS infusion significantly improves venous puncture success in fasting patients undergoing CIED implantation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12703552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145755001","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}
Abdulkarim Jamal Abdunnaser Ben Yezza, Mubashir Hussain, Hafiz Muhammad Hashim Butt, Qurban Hussain Khan, Aadarsh Kumar Ramani, Abida Perveen, Muhammad Zeeshan Khan, FNU Abdullah, Jahanzeb Malik
Background
Temporary pacemaker (TPM) implantation is a critical intervention for managing symptomatic bradyarrhythmias. While infraclavicular access via subclavian or internal jugular veins is commonly used, the supraclavicular approach has emerged as a promising alternative with potential benefits in safety and procedural efficiency. However, data comparing these approaches, particularly in resource-limited settings, remain limited.
Methods
We conducted a retrospective observational study at a tertiary care center, evaluating all patients who underwent TPM implantation via either supraclavicular or infraclavicular venous access between January 2020 and December 2024. Baseline characteristics, procedural success, complications, and outcomes were compared. Multivariate logistic regression identified predictors of complications. A ROC curve and Kaplan–Meier analysis were used to evaluate model performance and complication-free survival.
Results
Of 3569 patients, 1644 received supraclavicular access and 1925 received infraclavicular access. The supraclavicular group had a significantly lower overall complication rate (9.3% vs. 14.8%, p < 0.001), including fewer arterial punctures, pneumothoraces, lead dislodgements, and hematomas. First-attempt success (89.4% vs. 83.2%, p < 0.001) and mean procedure time (24.6 ± 7.8 min vs. 29.1 ± 9.4 min, p < 0.001) were also better with supraclavicular access. On multivariate analysis, supraclavicular access was independently associated with fewer complications (adjusted OR 0.59, p < 0.001). Kaplan–Meier analysis showed longer complication-free survival in the supraclavicular group (log-rank p = 0.01).
Conclusions
Supraclavicular venous access for TPM implantation is associated with fewer complications, greater procedural efficiency, and improved patient outcomes compared to infraclavicular access. Wider adoption may improve safety in high-volume or resource-limited settings.
背景：临时起搏器（TPM）植入是治疗症状性慢速心律失常的关键干预措施。锁骨下入路通常经锁骨下静脉或颈内静脉入路，锁骨上入路在安全性和手术效率方面具有潜在的优势。然而，比较这些方法的数据，特别是在资源有限的情况下，仍然有限。方法：我们在三级保健中心进行了一项回顾性观察研究，评估了2020年1月至2024年12月期间通过锁骨上或锁骨下静脉通道进行TPM植入的所有患者。比较基线特征、手术成功、并发症和结果。多因素logistic回归确定了并发症的预测因素。采用ROC曲线和Kaplan-Meier分析评价模型性能和无并发症生存期。结果：3569例患者中，锁骨上通路1644例，锁骨下通路1925例。锁骨上组的总并发症发生率明显较低（9.3% vs. 14.8%）。结论：与锁骨下置入相比，锁骨上静脉置入TPM的并发症更少，手术效率更高，患者预后更好。更广泛的采用可能会提高大批量或资源有限环境下的安全性。
{"title":"Outcomes of Supraclavicular Access in Temporary Pacemaker Implantation","authors":"Abdulkarim Jamal Abdunnaser Ben Yezza, Mubashir Hussain, Hafiz Muhammad Hashim Butt, Qurban Hussain Khan, Aadarsh Kumar Ramani, Abida Perveen, Muhammad Zeeshan Khan, FNU Abdullah, Jahanzeb Malik","doi":"10.1111/anec.70132","DOIUrl":"10.1111/anec.70132","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Temporary pacemaker (TPM) implantation is a critical intervention for managing symptomatic bradyarrhythmias. While infraclavicular access via subclavian or internal jugular veins is commonly used, the supraclavicular approach has emerged as a promising alternative with potential benefits in safety and procedural efficiency. However, data comparing these approaches, particularly in resource-limited settings, remain limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective observational study at a tertiary care center, evaluating all patients who underwent TPM implantation via either supraclavicular or infraclavicular venous access between January 2020 and December 2024. Baseline characteristics, procedural success, complications, and outcomes were compared. Multivariate logistic regression identified predictors of complications. A ROC curve and Kaplan–Meier analysis were used to evaluate model performance and complication-free survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 3569 patients, 1644 received supraclavicular access and 1925 received infraclavicular access. The supraclavicular group had a significantly lower overall complication rate (9.3% vs. 14.8%, <i>p</i> < 0.001), including fewer arterial punctures, pneumothoraces, lead dislodgements, and hematomas. First-attempt success (89.4% vs. 83.2%, <i>p</i> < 0.001) and mean procedure time (24.6 ± 7.8 min vs. 29.1 ± 9.4 min, <i>p</i> < 0.001) were also better with supraclavicular access. On multivariate analysis, supraclavicular access was independently associated with fewer complications (adjusted OR 0.59, <i>p</i> < 0.001). Kaplan–Meier analysis showed longer complication-free survival in the supraclavicular group (log-rank <i>p</i> = 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Supraclavicular venous access for TPM implantation is associated with fewer complications, greater procedural efficiency, and improved patient outcomes compared to infraclavicular access. Wider adoption may improve safety in high-volume or resource-limited settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70132","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145720706","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}
Implantable cardioverter-defibrillators (ICD) are first-line treatment to prevent sudden cardiac death due to recurrent ventricular tachycardia and fibrillation (VT/VF). However, some patients with organic heart disease (OHD) die without ever receiving appropriate ICD therapy. This study aimed to identify predictors of death without appropriate ICD therapy in patients with OHD who received ICD or cardiac resynchronization therapy with a defibrillator (CRT-D) for secondary prevention.
Methods
We analyzed consecutive patients who received ICD/CRT-D for secondary prevention between 2000 and 2022. Patients without OHD or those alive without appropriate ICD therapy were excluded. The “no-benefit group” included patients who died or developed severe disability without appropriate ICD therapy or those who died within 1 year after their first appropriate therapy. The “benefit group” included patients who survived > 1 year after appropriate therapy. Clinical characteristics were compared between the groups.
Results
Of the 170 patients analyzed (median follow-up: 9.1 years), 43 (25%) were classified into the no-benefit group (30 died without appropriate therapy, 10 died within 1 year of first appropriate therapy, and 3 developed severe disability without appropriate therapy). Multivariate analyses identified age > 70 years and history of VF as independent predictors of “no benefit.” Among patients with VF aged ≥ 70 years, 71% were classified into the no-benefit group.
Conclusions
Although 75% of patients benefited from ICD therapy for secondary prevention, elderly patients with VF may gain limited benefits from ICD implantation.
{"title":"Benefits of Implantable Cardioverter–Defibrillator for Secondary Prevention in Patients With Organic Heart Disease","authors":"Rie Akagawa, Sou Otsuki, Minori Sakurazawa, Atsushi Kato, Hironori Furuse, Naomasa Suzuki, Yasuhiro Ikami, Yuki Hasegawa, Masaomi Chinushi, Takayuki Inomata","doi":"10.1111/anec.70131","DOIUrl":"10.1111/anec.70131","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Implantable cardioverter-defibrillators (ICD) are first-line treatment to prevent sudden cardiac death due to recurrent ventricular tachycardia and fibrillation (VT/VF). However, some patients with organic heart disease (OHD) die without ever receiving appropriate ICD therapy. This study aimed to identify predictors of death without appropriate ICD therapy in patients with OHD who received ICD or cardiac resynchronization therapy with a defibrillator (CRT-D) for secondary prevention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed consecutive patients who received ICD/CRT-D for secondary prevention between 2000 and 2022. Patients without OHD or those alive without appropriate ICD therapy were excluded. The “no-benefit group” included patients who died or developed severe disability without appropriate ICD therapy or those who died within 1 year after their first appropriate therapy. The “benefit group” included patients who survived > 1 year after appropriate therapy. Clinical characteristics were compared between the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 170 patients analyzed (median follow-up: 9.1 years), 43 (25%) were classified into the no-benefit group (30 died without appropriate therapy, 10 died within 1 year of first appropriate therapy, and 3 developed severe disability without appropriate therapy). Multivariate analyses identified age > 70 years and history of VF as independent predictors of “no benefit.” Among patients with VF aged ≥ 70 years, 71% were classified into the no-benefit group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although 75% of patients benefited from ICD therapy for secondary prevention, elderly patients with VF may gain limited benefits from ICD implantation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70131","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145720716","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}
Asynchronous pacing itself does not directly lead to the development of malignant ventricular arrhythmias. However, acute myocardial ischemia caused by acute reduction in coronary blood flow can result in a “vulnerable myocardium” and simultaneously impair pacemaker sensing function. Such a scenario may give rise to unintended asynchronous pacing, which can act as a trigger for malignant ventricular arrhythmias. We present a case illustrating how ischemia-induced pacemaker sensing failure contributed to life-threatening ventricular arrhythmias, highlighting the critical interplay between myocardial perfusion status and pacemaker behavior.
{"title":"Acute Reduction in Blood Flow in the Right Coronary Artery After PCI Facilitates Pacemaker-Induced Ventricular Fibrillation","authors":"Bo Wu, Yaqin Chen, Jianjun Tang, Jia He","doi":"10.1111/anec.70135","DOIUrl":"10.1111/anec.70135","url":null,"abstract":"<p>Asynchronous pacing itself does not directly lead to the development of malignant ventricular arrhythmias. However, acute myocardial ischemia caused by acute reduction in coronary blood flow can result in a “vulnerable myocardium” and simultaneously impair pacemaker sensing function. Such a scenario may give rise to unintended asynchronous pacing, which can act as a trigger for malignant ventricular arrhythmias. We present a case illustrating how ischemia-induced pacemaker sensing failure contributed to life-threatening ventricular arrhythmias, highlighting the critical interplay between myocardial perfusion status and pacemaker behavior.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12686961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145706976","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}
Erol Tülümen, Mathieu Kruska, Sara Wuerfel, Maximilian Kohl, Volker Liebe, Ibrahim Akin, Juergen Kuschyk, Daniel Duerschmied, Martin Borggrefe, Boris Rudic
Background
Ajmaline challenge (AC) is used for diagnosing suspected Brugada syndrome (BS) in patients with unexplained syncope, survived cardiac arrest, or for family screening.
Purpose
To evaluate baseline ECG markers predicting a positive AC in the absence of a spontaneous diagnostic Brugada ECG.
Methods
Baseline ECGs of 221 consecutive patients undergoing AC (up to 1 mg/kg bodyweight) were analyzed. ECGs from positive and negative tests were compared, with Q-, R-, S-, J-, and T-wave amplitudes and intervals measured in all 12 leads.
Results
221 patients underwent AC; the cohort was 71% male, and 7% had survived cardiac arrest. AC was positive in 93 patients (42%). Prominent S-waves in lead II and J-waves in V1 predicted a positive AC (S-wave duration: 36 vs. 22 ms, p < 0.01; J-wave amplitude V1: 0.06 vs. 0.01 mV, p < 0.001). ROC analysis confirmed discriminative value for S-wave duration in lead II (AUC 0.79) and J-wave amplitude in V1 (AUC 0.71). A cut off of ≥ 19 ms for S-wave duration in lead II showed 96% sensitivity for a positive test (OR 17.3, p < 0.001). J-wave amplitude in V1 ≥ 0.05 mV was also significantly associated (OR 5.4, p < 0.001).
Conclusion
In patients without a spontaneous diagnostic Brugada ECG, prominent S-waves in lead II and J-waves in V1 are subtle electrical abnormalities that help identify patients and family members with a higher likelihood of positive AC.
背景：Ajmaline激发（AC）用于诊断不明原因晕厥、心脏骤停存活患者的疑似Brugada综合征（BS），或用于家庭筛查。目的：评估在没有Brugada心电图自发诊断的情况下预测AC阳性的基线心电图标记。方法：分析221例连续接受AC治疗（高达1mg /kg体重）患者的基线心电图。将阳性和阴性试验的心电图与所有12导联测得的Q-、R-、S-、J-和t -波振幅和间隔进行比较。结果：221例患者行AC；该队列71%为男性，7%心脏骤停存活。AC阳性93例（42%）。II导联突出的s波和V1导联突出的j波预测交流阳性（s波持续时间：36 vs 22 ms）， p结论：在没有自发诊断Brugada心电图的患者中，II导联突出的s波和V1导联突出的j波是细微的电异常，有助于识别交流阳性可能性较高的患者及其家属。
{"title":"ECG Markers of Positive Drug Challenge With Ajmaline in Patients With Brugada Syndrome","authors":"Erol Tülümen, Mathieu Kruska, Sara Wuerfel, Maximilian Kohl, Volker Liebe, Ibrahim Akin, Juergen Kuschyk, Daniel Duerschmied, Martin Borggrefe, Boris Rudic","doi":"10.1111/anec.70137","DOIUrl":"10.1111/anec.70137","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ajmaline challenge (AC) is used for diagnosing suspected Brugada syndrome (BS) in patients with unexplained syncope, survived cardiac arrest, or for family screening.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To evaluate baseline ECG markers predicting a positive AC in the absence of a spontaneous diagnostic Brugada ECG.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Baseline ECGs of 221 consecutive patients undergoing AC (up to 1 mg/kg bodyweight) were analyzed. ECGs from positive and negative tests were compared, with Q-, R-, S-, J-, and T-wave amplitudes and intervals measured in all 12 leads.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>221 patients underwent AC; the cohort was 71% male, and 7% had survived cardiac arrest. AC was positive in 93 patients (42%). Prominent S-waves in lead II and J-waves in V1 predicted a positive AC (S-wave duration: 36 vs. 22 ms, <i>p</i> < 0.01; J-wave amplitude V1: 0.06 vs. 0.01 mV, <i>p</i> < 0.001). ROC analysis confirmed discriminative value for S-wave duration in lead II (AUC 0.79) and J-wave amplitude in V1 (AUC 0.71). A cut off of ≥ 19 ms for S-wave duration in lead II showed 96% sensitivity for a positive test (OR 17.3, <i>p</i> < 0.001). J-wave amplitude in V1 ≥ 0.05 mV was also significantly associated (OR 5.4, <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In patients without a spontaneous diagnostic Brugada ECG, prominent S-waves in lead II and J-waves in V1 are subtle electrical abnormalities that help identify patients and family members with a higher likelihood of positive AC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12683172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145699294","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}
Hina Pervaiz, Farooq Hyder, Aimen Binte Moazzam, Fnu Abdullah, Abida Perveen, Jahanzeb Malik
Objective
To compare the acute and long-term outcomes of high-power ablation for typical atrial flutter using a 4-mm irrigated catheter (4-IC) versus an 8-mm non-irrigated catheter (8-NIC).
Methods
We conducted a retrospective cohort study of 215 patients who underwent cavotricuspid isthmus (CTI) ablation between January 2019 and December 2024. Patients were divided into two groups based on the catheter used: 4-IC (n = 113) and 8-NIC (n = 102). Baseline, procedural, and follow-up data were analyzed.
Results
Both groups achieved 100% acute procedural success with no significant difference in CTI block rates. The 8-NIC group had significantly shorter procedure duration (68.4 ± 15.2 vs. 77.4 ± 18.5 min, p < 0.001), reduced fluoroscopy time, and fewer lesions with shorter total RF delivery time. Periprocedural complications were rare and similar between groups. Over a mean follow-up of 15.7 ± 7.2 months, atrial flutter recurrence occurred in 12.6% of patients, with no significant difference between groups (14.2% vs. 10.8%, p = 0.442). Rates of atrial fibrillation, pacemaker implantation, and continued anticoagulation were also comparable.
Conclusion
Both ablation strategies are safe and effective, with the 8-mm catheter offering greater procedural efficiency without compromising long-term outcomes.
目的比较4mm冲洗导管（4-IC）与8mm非冲洗导管（8-NIC）治疗典型心房扑动的急性和长期疗效。方法：我们对2019年1月至2024年12月期间接受颈尖瓣峡部（CTI）消融的215例患者进行了回顾性队列研究。根据使用的导管将患者分为两组：4-IC （n = 113）和8-NIC （n = 102）。分析基线、程序和随访数据。结果两组急性手术成功率均为100%，CTI阻滞率无显著差异。8-NIC组手术时间明显缩短（68.4±15.2分钟vs. 77.4±18.5分钟，p < 0.001），透视时间缩短，病灶减少，总射频传递时间缩短。围手术期并发症罕见，两组间相似。在平均15.7±7.2个月的随访中，12.6%的患者再次发生心房扑动，组间差异无统计学意义（14.2% vs 10.8%, p = 0.442）。心房颤动、起搏器植入和持续抗凝的发生率也具有可比性。结论两种消融策略都是安全有效的，8mm导管在不影响长期预后的前提下提供了更高的手术效率。
{"title":"Evaluation of Two High-Power Ablation Approaches in the Management of Typical Atrial Flutter: A Retrospective Study","authors":"Hina Pervaiz, Farooq Hyder, Aimen Binte Moazzam, Fnu Abdullah, Abida Perveen, Jahanzeb Malik","doi":"10.1111/anec.70128","DOIUrl":"https://doi.org/10.1111/anec.70128","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare the acute and long-term outcomes of high-power ablation for typical atrial flutter using a 4-mm irrigated catheter (4-IC) versus an 8-mm non-irrigated catheter (8-NIC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study of 215 patients who underwent cavotricuspid isthmus (CTI) ablation between January 2019 and December 2024. Patients were divided into two groups based on the catheter used: 4-IC (<i>n</i> = 113) and 8-NIC (<i>n</i> = 102). Baseline, procedural, and follow-up data were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both groups achieved 100% acute procedural success with no significant difference in CTI block rates. The 8-NIC group had significantly shorter procedure duration (68.4 ± 15.2 vs. 77.4 ± 18.5 min, <i>p</i> < 0.001), reduced fluoroscopy time, and fewer lesions with shorter total RF delivery time. Periprocedural complications were rare and similar between groups. Over a mean follow-up of 15.7 ± 7.2 months, atrial flutter recurrence occurred in 12.6% of patients, with no significant difference between groups (14.2% vs. 10.8%, <i>p</i> = 0.442). Rates of atrial fibrillation, pacemaker implantation, and continued anticoagulation were also comparable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Both ablation strategies are safe and effective, with the 8-mm catheter offering greater procedural efficiency without compromising long-term outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70128","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626834","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}
Aconitine poisoning produces lethal ventricular arrhythmias through persistent activation of cardiac sodium channels. We critically comment on a recent case report describing 28 biphasic shocks for aconitine-induced electrical storm, addressing three fundamental questions. First, we demonstrate that verapamil is contraindicated as it worsens hypotension and reflex sympathetic activation without antagonizing sodium channel toxicity. Second, we review the evidence for magnesium sulfate: while basic science and observational data support its mechanistic role as a calcium antagonist and sodium channel modulator, Class IC antiarrhythmics (flecainide) demonstrate superior conversion rates (86% vs. 22% for magnesium monotherapy). Magnesium should be viewed as an evidence-based adjunct, not mandated first-line therapy. Third, we identify critical monitoring gaps including dynamic electrolyte assessment, ionized calcium repletion, and toxin quantification that must be addressed in future cases. We propose a practical, evidence-based algorithm emphasizing: (1) first-line flecainide 2 mg/kg IV, (2) magnesium sulfate adjunct targeting serum levels of 1.5–2.0 mmol/L, (3) aggressive calcium repletion to > 1.00 mmol/L, (4) early high-flux hemoperfusion within 6 h, and (5) VA-ECMO for refractory cases. Verapamil, diltiazem, and β-blockers as sole agents should be explicitly avoided.
{"title":"Magnesium in Aconitine-Induced Electrical Storm—Mechanism Yes, Mandate No","authors":"Zhong-Qun Zhan, Hai-Jun Xu","doi":"10.1111/anec.70133","DOIUrl":"https://doi.org/10.1111/anec.70133","url":null,"abstract":"<p>Aconitine poisoning produces lethal ventricular arrhythmias through persistent activation of cardiac sodium channels. We critically comment on a recent case report describing 28 biphasic shocks for aconitine-induced electrical storm, addressing three fundamental questions. First, we demonstrate that verapamil is contraindicated as it worsens hypotension and reflex sympathetic activation without antagonizing sodium channel toxicity. Second, we review the evidence for magnesium sulfate: while basic science and observational data support its mechanistic role as a calcium antagonist and sodium channel modulator, Class IC antiarrhythmics (flecainide) demonstrate superior conversion rates (86% vs. 22% for magnesium monotherapy). Magnesium should be viewed as an evidence-based adjunct, not mandated first-line therapy. Third, we identify critical monitoring gaps including dynamic electrolyte assessment, ionized calcium repletion, and toxin quantification that must be addressed in future cases. We propose a practical, evidence-based algorithm emphasizing: (1) first-line flecainide 2 mg/kg IV, (2) magnesium sulfate adjunct targeting serum levels of 1.5–2.0 mmol/L, (3) aggressive calcium repletion to > 1.00 mmol/L, (4) early high-flux hemoperfusion within 6 h, and (5) VA-ECMO for refractory cases. Verapamil, diltiazem, and β-blockers as sole agents should be explicitly avoided.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70133","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626755","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}
<p>We read with great interest the article by Long et al. (<span>2025</span>) published in the <i>Annals of Noninvasive Electrocardiology</i>. The authors deserve commendation for addressing this clinically significant yet underexplored topic, highlighting the evolving role of transesophageal echocardiography (TEE) in improving procedural precision and safety during left atrial appendage occlusion (LAAO). Their effort to focus on patients with Non-Organic Heart Disease (NOHD) adds meaningful depth to existing literature by clarifying the diagnostic and guiding potential of transesophageal echocardiography (TEE) in this unique subgroup. However, despite the study's strengths and valuable insights, it has the following limitations that merit consideration.</p><p>First, there is an absence of a control or comparative imaging group (e.g., Intracardiac Echocardiography or 3D-CT). Without comparison to other imaging modalities, the study cannot isolate whether TEE offers superior, equivalent, or inferior diagnostic accuracy and procedural guidance for Left Atrial Appendage Occlusion (LAAO) in Non- Organic Heart Disease (NOHD) patients. This undermines the external validity of claims about TEE's “superior application value.” Serpa et al. (<span>2025</span>) demonstrated that Intracardiac Echocardiography (ICE) provides comparable safety and imaging accuracy to TEE in LAAO procedures, with fewer anesthesia-related risks. Second, there is a potential selection bias due to exclusion of patients with structural or valvular disease. Excluding patients with organic heart disease limits generalizability to the broader Atrial Fibrillation (AF) population, which often includes structural comorbidities. It may overestimate TEE efficacy in real-world practice. Berti et al. (<span>2018</span>) in a multicenter registry found that structural abnormalities significantly affect TEE imaging windows and procedural success rates. Third, there is a lack of quantitative hemodynamic or functional assessment beyond morphology. The study focuses solely on anatomical and dimensional metrics (LAA diameter, atrial size) without correlating them with hemodynamic parameters such as Left Atrial Appendage (LAA) flow velocity or atrial strain. This limits the interpretation of functional improvement post-LAAO. Sonaglioni et al. (<span>2022</span>) emphasized that mechanical concordance between the left atrium and LAA predicts thrombus risk better than morphology alone. Fourth, there is an absence of anesthesia or procedural risk analysis related to TEE. TEE often requires sedation or general anesthesia, which carries cardiopulmonary risks, particularly in elderly patients. Omitting these factors could underestimate procedural complication rates. Reardon et al. (<span>2025</span>) documented that TEE in non-operative settings carried a 6%–8% rate of minor airway or hemodynamic events. Future studies should include a prospective comparative arm using ICE or 3D-CT to assess how TEE stac
我们饶有兴趣地阅读了Long et al.（2025）发表在《无创心电学年鉴》上的文章。作者解决了这个具有临床意义但尚未被充分探讨的话题，强调了经食管超声心动图（TEE）在提高左心耳闭塞（LAAO）手术精度和安全性方面的作用。他们致力于关注非器质性心脏病（NOHD）患者，通过阐明经食管超声心动图（TEE）在这一独特亚组中的诊断和指导潜力，为现有文献增加了有意义的深度。然而，尽管这项研究的优势和有价值的见解，它有以下局限性值得考虑。首先，没有对照或比较影像学组（如心内超声心动图或3D-CT）。在没有与其他成像方式进行比较的情况下，该研究无法区分TEE对非器质性心脏病（NOHD）患者左心耳闭塞（LAAO）的诊断准确性和程序指导是优于、等同还是较差。这就破坏了TEE“优越的应用价值”的外在有效性。Serpa等人（2025）证明，在LAAO手术中，心内超声心动图（ICE）的安全性和成像准确性与TEE相当，麻醉相关风险更少。其次，由于排除了结构性或瓣膜疾病的患者，存在潜在的选择偏倚。排除器质性心脏病患者限制了心房颤动（AF）人群的广泛性，这通常包括结构性合并症。它可能高估了TEE在现实生活中的有效性。Berti等人（2018）在一项多中心注册中发现，结构异常显著影响TEE成像窗口和手术成功率。第三，除了形态学之外，缺乏定量的血流动力学或功能评估。该研究仅关注解剖和尺寸指标（LAA直径，心房大小），而不将其与血流动力学参数（如左心房附件（LAA）流速或心房应变）相关联。这限制了对laao后功能改进的解释。Sonaglioni等人（2022）强调左心房和LAA之间的力学一致性比单独的形态学更能预测血栓风险。第四，缺乏与TEE相关的麻醉或程序风险分析。TEE通常需要镇静或全身麻醉，这有心肺风险，特别是对老年患者。忽略这些因素可能会低估手术并发症的发生率。Reardon等人（2025）记录了非手术环境下TEE的轻微气道或血流动力学事件发生率为6%-8%。未来的研究应包括使用ICE或3D-CT进行前瞻性比较，以评估TEE在准确性、手术时间和安全性方面的优劣。扩展到包括器质性和非器质性心脏病的多中心队列将使结果更具普遍性，并允许有意义的亚组洞察。研究人员还应增加功能指标，如LAA排空速度、应变成像和血流模式，以将结构发现与心脏恢复联系起来。最后，报告麻醉类型、持续时间和并发症将确保TEE的临床益处与手术风险之间的平衡。总之，尽管Long等人的研究对TEE在NOHD患者LAAO中的术中和术后应用提供了有价值的见解，但通过更广泛、比较和功能整合的研究来解决这些方法学上的差距，将提高其研究结果的可靠性和临床适用性。我们赞扬作者的贡献，并希望这些观察结果支持超声心动图指导结构性心脏干预的未来进展。所有作者均符合ICMJE作者资格标准，并对本文做出了重要而平等的贡献。所有作者同意最终版本，并同意对工作的各个方面负责，确保数据和解释的准确性和完整性。作者没有什么可报告的。担保人声明：所有作者已阅读并同意稿件的最终版本。他们对数据的完整性和数据分析的准确性承担全部责任。透明声明：作者确认本手稿是对所报道研究的诚实、准确和透明的描述，没有遗漏研究的重要方面，并且已经解释了计划研究中的任何差异（如果相关，已登记）。作者没有什么可报告的。作者声明无利益冲突。数据共享不适用于本文，因为在当前研究中没有生成数据集；所有数据均来源于已发表的文献。
{"title":"Critical Reflections on the Role of Transesophageal Echocardiography in Guiding Left Atrial Appendage Occlusion in Patients With Non-Organic Heart Disease","authors":"Ahmed Raza, Shahzadi Gulfishan","doi":"10.1111/anec.70130","DOIUrl":"10.1111/anec.70130","url":null,"abstract":"<p>We read with great interest the article by Long et al. (<span>2025</span>) published in the <i>Annals of Noninvasive Electrocardiology</i>. The authors deserve commendation for addressing this clinically significant yet underexplored topic, highlighting the evolving role of transesophageal echocardiography (TEE) in improving procedural precision and safety during left atrial appendage occlusion (LAAO). Their effort to focus on patients with Non-Organic Heart Disease (NOHD) adds meaningful depth to existing literature by clarifying the diagnostic and guiding potential of transesophageal echocardiography (TEE) in this unique subgroup. However, despite the study's strengths and valuable insights, it has the following limitations that merit consideration.</p><p>First, there is an absence of a control or comparative imaging group (e.g., Intracardiac Echocardiography or 3D-CT). Without comparison to other imaging modalities, the study cannot isolate whether TEE offers superior, equivalent, or inferior diagnostic accuracy and procedural guidance for Left Atrial Appendage Occlusion (LAAO) in Non- Organic Heart Disease (NOHD) patients. This undermines the external validity of claims about TEE's “superior application value.” Serpa et al. (<span>2025</span>) demonstrated that Intracardiac Echocardiography (ICE) provides comparable safety and imaging accuracy to TEE in LAAO procedures, with fewer anesthesia-related risks. Second, there is a potential selection bias due to exclusion of patients with structural or valvular disease. Excluding patients with organic heart disease limits generalizability to the broader Atrial Fibrillation (AF) population, which often includes structural comorbidities. It may overestimate TEE efficacy in real-world practice. Berti et al. (<span>2018</span>) in a multicenter registry found that structural abnormalities significantly affect TEE imaging windows and procedural success rates. Third, there is a lack of quantitative hemodynamic or functional assessment beyond morphology. The study focuses solely on anatomical and dimensional metrics (LAA diameter, atrial size) without correlating them with hemodynamic parameters such as Left Atrial Appendage (LAA) flow velocity or atrial strain. This limits the interpretation of functional improvement post-LAAO. Sonaglioni et al. (<span>2022</span>) emphasized that mechanical concordance between the left atrium and LAA predicts thrombus risk better than morphology alone. Fourth, there is an absence of anesthesia or procedural risk analysis related to TEE. TEE often requires sedation or general anesthesia, which carries cardiopulmonary risks, particularly in elderly patients. Omitting these factors could underestimate procedural complication rates. Reardon et al. (<span>2025</span>) documented that TEE in non-operative settings carried a 6%–8% rate of minor airway or hemodynamic events. Future studies should include a prospective comparative arm using ICE or 3D-CT to assess how TEE stac","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 6","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70130","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145601709","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}
Ahmed Raza, Muhammad Irfan, Abdullah Jawad, Rizwan Razzaq, Deedar Hussain
<p>We read with great interest the article by Farah et al. (<span>2025</span>) published in the <i>Annals of Noninvasive Electrocardiology</i>. The authors should be commended for addressing an underexplored area, highlighting the coexistence of conduction abnormalities in patients with atrial fibrillation and their potential prognostic implications. Their effort to analyze age and gender subgroups adds further depth to the field of electrocardiology. However, despite its contributions, the study has the following limitations that merit discussion. First, there is a lack of echocardiographic or structural heart disease assessment. Without echocardiographic data, the study cannot determine whether observed Bundle Branch Block (BBB) or axis deviations are independent phenomena or secondary to structural abnormalities (e.g., left ventricular hypertrophy, cardiomyopathy). This limits the ability to attribute conduction abnormalities directly to atrial fibrillation (AF). Storkås et al. (<span>2020</span>) showed that left axis deviation in patients with Left Bundle Branch Block (LBBB) often reflects underlying myocardial disease, affecting response to therapy. Second, control for cardiovascular comorbidities and risk factors is not discussed. Hypertension, diabetes, ischemic heart disease, and heart failure significantly influence both AF and BBB incidence. Without adjusting for these, associations may be confounded, exaggerating or masking the true link between AF and LBBB. Das et al. (<span>2001</span>) reported that prolonged QRS with LBBB and left axis deviation (LAD) strongly correlates with poor left ventricular (LV) systolic function, often tied to comorbidities. Third, since ECGs were assessed retrospectively at a single time point, causality cannot be inferred, did LBBB precede AF or develop as a consequence of AF? This temporal uncertainty weakens conclusions about prognostic implications. Eriksson et al. (<span>2025</span>) emphasized that BBB may be a marker of progressive degenerative disease, requiring longitudinal follow-up to confirm causation. Fourth, there is an absence of QRS morphology subtype and hemiblock analysis. Lumping all LBBB or RBBB cases together may overlook important subgroups such as left anterior hemiblock (LAHB) or posterior fascicular block, which have distinct prognostic implications. Michowitz et al. (<span>2017</span>) highlighted the diagnostic challenge of differentiating QRS morphologies involving right BBB and left anterior hemiblock, which can mimic or mask arrhythmias. Finally, there is a lack of functional or clinical outcome correlation. The study only analyzed ECG findings without linking them to clinical outcomes (mortality, hospitalizations, heart failure exacerbations). This limits the clinical significance of the observed associations. Baldasseroni and De Biase et al. (TRAPIST Study <span>2025</span>) found that coexisting LBBB and AF in heart failure patients significantly increased mortality and ho
我们饶有兴趣地阅读了Farah et al.（2025）发表在《无创心电学年鉴》上的文章。作者应该受到赞扬，因为他们解决了一个未被探索的领域，强调了心房颤动患者中传导异常的共存及其潜在的预后影响。他们对年龄和性别亚组的分析进一步深入了心电学领域。然而，尽管它的贡献，该研究有以下局限性值得讨论。首先，缺乏超声心动图或结构性心脏病评估。由于没有超声心动图数据，本研究无法确定所观察到的束支传导阻滞（BBB）或轴向偏离是独立现象还是继发于结构异常（如左室肥厚、心肌病）。这限制了将传导异常直接归因于心房颤动的能力。stork等人（2020）研究表明，左束支传导阻滞（LBBB）患者的左轴偏差往往反映出潜在的心肌疾病，影响对治疗的反应。其次，没有讨论心血管合并症和危险因素的控制。高血压、糖尿病、缺血性心脏病和心力衰竭对房颤和血脑屏障的发生率均有显著影响。如果没有对这些因素进行调整，这些关联可能会被混淆，夸大或掩盖心房颤动和左脑卒中之间的真正联系。Das等人（2001）报道，伴有LBBB和左轴偏差（LAD）的QRS延长与左室（LV）收缩功能差密切相关，通常与合并症有关。第三，由于脑电图是在单一时间点回顾性评估的，因此无法推断因果关系，下脑区是先于房颤还是作为房颤的结果发展的？这种时间上的不确定性削弱了有关预后影响的结论。Eriksson等人（2025）强调血脑梗死可能是进行性退行性疾病的标志，需要纵向随访来确认病因。第四，缺乏QRS形态学亚型和半块分析。将所有LBBB或RBBB病例集中在一起可能会忽略重要的亚群，如左前半脑阻滞（LAHB）或后束阻滞，它们具有不同的预后意义。Michowitz等人（2017）强调了区分涉及右血脑屏障和左前半块的QRS形态学的诊断挑战，这可以模拟或掩盖心律失常。最后，缺乏功能或临床结果的相关性。该研究仅分析了心电图结果，而没有将其与临床结果（死亡率、住院率、心力衰竭加重）联系起来。这限制了观察到的关联的临床意义。Baldasseroni和De Biase等（TRAPIST Study 2025）发现，心力衰竭患者并发LBBB和房颤显著增加死亡率和住院率。未来的研究应采用前瞻性队列设计，结合纵向心电图（ECG）和结局跟踪，结合超声心动图和高级成像（如心脏MRI）来控制结构性心脏病。必须使用多变量回归来解释合并症概况，以分离房颤和传导异常之间的独立关联。传导亚型分层（如LAHB，左后束传导阻滞）将提高特异性，同时将结果与临床结果（如死亡率，住院率和心力衰竭）联系起来将建立预后意义，而不仅仅是患病率。总之，虽然本研究为房颤、束支阻滞和轴偏之间的关系提供了有价值的见解，但通过前瞻性、全面性和结果导向的研究来解决突出的局限性，将增强未来研究结果的临床适用性。所有作者均符合ICMJE作者资格标准，并对本文做出了重要而平等的贡献。所有作者同意最终版本，并同意对工作的各个方面负责，确保数据和解释的准确性和完整性。担保人声明：所有作者已阅读并同意稿件的最终版本。他们对数据的完整性和数据分析的准确性承担全部责任。透明声明：作者确认本手稿是对所报道研究的诚实、准确和透明的描述，没有遗漏研究的重要方面，并且已经解释了计划研究中的任何差异（如果相关，已登记）。作者没有什么可报告的。作者声明无利益冲突。数据共享不适用于本文，因为在当前研究期间没有生成或分析数据集。
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