Left ventricular non-compaction (LVNC) is a rare cardiomyopathy characterized by prominent trabeculations and deep recesses. Neonatal cases, particularly with severe metabolic disturbances, are uncommon. We report a 2-day-old neonate with LVNC and dilated cardiomyopathy, presenting recurrent heart failure associated with hyperkalemia, metabolic acidosis, hyperlactatemia, and hypoglycemia. Management included mechanical ventilation, metabolic correction, and heart failure therapy, leading to improved cardiac function. Genetic analysis revealed a de novo heterozygous pathogenic ACTN2 deletion spanning exons 2–6. This case broadens the phenotypic spectrum of ACTN2-related LVNC and suggests a potential link between metabolic disturbances and cardiac deterioration.
{"title":"De Novo ACTN2 Variant in a Chinese Neonate With Left Ventricular Non-Compaction and Metabolic Disturbances: A Rare Case Report","authors":"Jinqiu Huang, Ziyue Zhang, Juxian Yang","doi":"10.1111/anec.70117","DOIUrl":"10.1111/anec.70117","url":null,"abstract":"<p>Left ventricular non-compaction (LVNC) is a rare cardiomyopathy characterized by prominent trabeculations and deep recesses. Neonatal cases, particularly with severe metabolic disturbances, are uncommon. We report a 2-day-old neonate with LVNC and dilated cardiomyopathy, presenting recurrent heart failure associated with hyperkalemia, metabolic acidosis, hyperlactatemia, and hypoglycemia. Management included mechanical ventilation, metabolic correction, and heart failure therapy, leading to improved cardiac function. Genetic analysis revealed a de novo heterozygous pathogenic <i>ACTN2</i> deletion spanning exons 2–6. This case broadens the phenotypic spectrum of <i>ACTN2</i>-related LVNC and suggests a potential link between metabolic disturbances and cardiac deterioration.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146008540","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}
His bundle typically passes through the central fibrous body of the atrioventricular node and then enters the membranous portion of the interventricular septum, where it branches into the left and right bundle branches. The feasibility and safety of left bundle branch area pacing (LBBAP) in patients with perimembranous ventricular septal defect (pmVSD) have not been reported.
{"title":"Is Left Bundle Branch Pacing Feasible in Patients With Ventricular Septal Defect?","authors":"Binbin Luo, Longfu Jiang, Lu Zhang, Jiabo Shen","doi":"10.1111/anec.70150","DOIUrl":"10.1111/anec.70150","url":null,"abstract":"<p>His bundle typically passes through the central fibrous body of the atrioventricular node and then enters the membranous portion of the interventricular septum, where it branches into the left and right bundle branches. The feasibility and safety of left bundle branch area pacing (LBBAP) in patients with perimembranous ventricular septal defect (pmVSD) have not been reported.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12820410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146008563","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}
Saad Manzoor, Mounika Kotte, Jahanzeb Malik, Bhavna Singla, Shivam Singla, Muhammad Subhan, Fnu Sandesh, Pooja Kumari, Abdullah Ashraf, Abida Perveen
Objective
This meta-analysis aimed to evaluate the impact of esophageal temperature monitoring (ETM) on the incidence of esophageal injury during cryoballoon ablation (CBA) for atrial fibrillation (AF).
Methods
A systematic search identified randomized controlled and observational studies comparing CBA procedures performed with versus without ETM. Data on study design, patient characteristics, procedural details, and esophageal outcomes were extracted. The primary endpoint was the incidence of endoscopically detected esophageal lesions (EDEL). Secondary outcomes included severe ulceration, symptomatic esophageal thermal injury (ETI), and atrioesophageal fistula (AEF). Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Risk of bias was assessed according to Cochrane guidelines, and publication bias was evaluated with funnel plots.
Results
Four studies comprising 269 patients were included. ETM significantly reduced the risk of EDEL compared with no ETM (pooled OR 0.57, 95% CI 0.39–0.85), with low to moderate heterogeneity. Subgroup analyses confirmed consistent benefits across randomized and observational designs. Severe esophageal ulceration and symptomatic ETI were infrequent, and no AEF cases were reported. Funnel plot analysis indicated no major publication bias.
Conclusion
ETM significantly lowers the incidence of esophageal injury during CBA and should be considered a routine safety measure to improve procedural outcomes.
目的：本荟萃分析旨在评估食道温度监测（ETM）对房颤（AF）冷冻球囊消融（CBA）期间食道损伤发生率的影响。方法：系统检索了随机对照和观察性研究，比较了有ETM和没有ETM的CBA手术。提取了有关研究设计、患者特征、手术细节和食管结局的数据。主要终点是内镜检查食管病变（EDEL）的发生率。次要结局包括严重溃疡、症状性食管热损伤（ETI）和房-食管瘘（AEF）。比值比（ORs）和95%置信区间（ci）采用随机效应模型进行汇总。根据Cochrane指南评估偏倚风险，用漏斗图评估发表偏倚。结果：纳入4项研究，共269例患者。与未行ETM相比，ETM显著降低了EDEL的风险（合并OR 0.57, 95% CI 0.39-0.85），具有低至中等异质性。亚组分析证实了随机设计和观察设计的一致益处。严重食管溃疡和有症状的ETI少见，无AEF病例报道。漏斗图分析显示无重大发表偏倚。结论：ETM可显著降低CBA术中食管损伤的发生率，应作为一种常规的安全措施，以改善手术结果。
{"title":"Impact of Esophageal Temperature Monitoring on Esophageal Injury in PVI: A Systematic Review and Meta-Analysis","authors":"Saad Manzoor, Mounika Kotte, Jahanzeb Malik, Bhavna Singla, Shivam Singla, Muhammad Subhan, Fnu Sandesh, Pooja Kumari, Abdullah Ashraf, Abida Perveen","doi":"10.1111/anec.70156","DOIUrl":"10.1111/anec.70156","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This meta-analysis aimed to evaluate the impact of esophageal temperature monitoring (ETM) on the incidence of esophageal injury during cryoballoon ablation (CBA) for atrial fibrillation (AF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search identified randomized controlled and observational studies comparing CBA procedures performed with versus without ETM. Data on study design, patient characteristics, procedural details, and esophageal outcomes were extracted. The primary endpoint was the incidence of endoscopically detected esophageal lesions (EDEL). Secondary outcomes included severe ulceration, symptomatic esophageal thermal injury (ETI), and atrioesophageal fistula (AEF). Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Risk of bias was assessed according to Cochrane guidelines, and publication bias was evaluated with funnel plots.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four studies comprising 269 patients were included. ETM significantly reduced the risk of EDEL compared with no ETM (pooled OR 0.57, 95% CI 0.39–0.85), with low to moderate heterogeneity. Subgroup analyses confirmed consistent benefits across randomized and observational designs. Severe esophageal ulceration and symptomatic ETI were infrequent, and no AEF cases were reported. Funnel plot analysis indicated no major publication bias.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ETM significantly lowers the incidence of esophageal injury during CBA and should be considered a routine safety measure to improve procedural outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12816882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003004","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}
A 30-year-old woman with a history of prior ablation for a concealed left posteroseptal accessory pathway (AP) presented with incessant narrow QRS tachycardia, highlighting a rare complication of incomplete AP ablation.
Methods and Results
Adenosine transiently terminated the tachycardia, which recurred immediately. Electrophysiology study confirmed orthodromic atrioventricular reentry tachycardia (AVRT) due to a slow-conducting AP at the previously ablated site. Three-dimensional mapping localized the AP to the left posteroseptal region, and radiofrequency ablation at the shortest VA interval successfully eliminated the arrhythmia.
Conclusion
This case illustrates incessant AVRT caused by an iatrogenic slow-conducting posteroseptal accessory pathway following incomplete ablation. Recognition of this mechanism is important to guide appropriate repeat ablation and prevent tachycardia-induced cardiomyopathy.
{"title":"Incessant Narrow QRS Complex Tachycardia in a Patient With a Prior Ablation History","authors":"Yi Liu, Yuwei Chen, Xiangbin Xiao, Xiaobo Pu","doi":"10.1111/anec.70154","DOIUrl":"10.1111/anec.70154","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>A 30-year-old woman with a history of prior ablation for a concealed left posteroseptal accessory pathway (AP) presented with incessant narrow QRS tachycardia, highlighting a rare complication of incomplete AP ablation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>Adenosine transiently terminated the tachycardia, which recurred immediately. Electrophysiology study confirmed orthodromic atrioventricular reentry tachycardia (AVRT) due to a slow-conducting AP at the previously ablated site. Three-dimensional mapping localized the AP to the left posteroseptal region, and radiofrequency ablation at the shortest VA interval successfully eliminated the arrhythmia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case illustrates incessant AVRT caused by an iatrogenic slow-conducting posteroseptal accessory pathway following incomplete ablation. Recognition of this mechanism is important to guide appropriate repeat ablation and prevent tachycardia-induced cardiomyopathy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12811688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145987827","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 interest the article by Kazantzi et al. examining the association between established P-wave parameters and left atrial hemodynamics in the context of atrial cardiomyopathy (ACM) (Kazantzi et al. <span>2026</span>). The authors should be acknowledged for addressing a clinically relevant question using a prospective design and comprehensive echocardiographic assessment. Their conclusion that advanced interatrial block (IAB) is the most reliable electrocardiographic marker of impaired left atrial function is clearly presented and supported by internal consistency within the dataset.</p><p>Nevertheless, several methodological aspects warrant closer scrutiny. The study population is heterogeneous, comprising patients with prior atrial fibrillation, embolic stroke of undetermined source, and individuals without manifest cardiovascular disease. While this broad inclusion enhances external validity, it may dilute pathophysiologically specific associations between P-wave indices and atrial remodeling. Current consensus documents emphasize that ACM represents a spectrum with variable electrical, structural, and mechanical manifestations, and pooling such diverse phenotypes may obscure parameter-specific diagnostic performance (Goette et al. <span>2024</span>).</p><p>A further concern relates to the operational definition of pathological P-wave parameters. Thresholds derived from consensus recommendations are largely based on epidemiological associations rather than mechanistic validation against atrial tissue pathology or gold-standard imaging. In particular, the dismissal of P-wave terminal force in lead V1 as a hemodynamic marker may reflect cohort characteristics rather than a true lack of biological relevance, given its previously demonstrated association with atrial fibrosis and stroke risk in population-based studies (Kamel et al. <span>2014</span>).</p><p>Additionally, the reliance on cross-sectional echocardiographic markers limits causal inference. Left atrial strain and PA-TDI are sensitive indicators of atrial function, yet they remain load-dependent and subject to inter-vendor variability. Longitudinal assessment or correlation with advanced imaging modalities such as late gadolinium-enhanced cardiac magnetic resonance imaging could have strengthened the argument that advanced IAB truly captures the substrate of atrial cardiomyopathy rather than representing an epiphenomenon of aging and comorbidity burden (Bisbal et al. <span>2020</span>).</p><p>Finally, the clinical implications of prioritizing advanced IAB over other P-wave parameters deserve cautious interpretation. While advanced IAB appears strongly associated with impaired atrial hemodynamics, its relatively low prevalence may limit utility as a screening tool. A multiparametric approach integrating electrocardiographic, echocardiographic, and biomarker data may better reflect the complex biology of ACM and align with contemporary views of atrial disease as a continuum r
我们饶有兴趣地阅读了Kazantzi等人的文章，该文章研究了心房心肌病（ACM）背景下已建立的p波参数与左房血流动力学之间的关系（Kazantzi et al. 2026）。作者使用前瞻性设计和全面的超声心动图评估来解决临床相关问题，应该得到承认。他们的结论是，晚期房间传导阻滞（IAB）是左房功能受损最可靠的心电图标志物，这一结论得到了数据集内部一致性的清晰呈现和支持。然而，有几个方法方面值得更仔细的审查。研究人群是异质性的，包括既往房颤患者、来源不明的栓塞性卒中患者和无明显心血管疾病的个体。虽然这种广泛的包含增强了外部有效性，但它可能会淡化p波指数与心房重构之间的病理生理特异性关联。目前的共识文件强调，ACM代表了一个具有可变电学、结构和力学表现的光谱，汇集这些不同的表型可能会模糊特定参数的诊断性能（Goette et al. 2024）。进一步的关注涉及病理p波参数的操作定义。从共识建议中得出的阈值主要基于流行病学关联，而不是针对心房组织病理学或金标准成像的机制验证。特别是，考虑到先前在基于人群的研究中证实与心房纤维化和卒中风险相关，V1导联p波末端力作为血流动力学标志物的消失可能反映了队列特征，而不是真正缺乏生物学相关性（Kamel et al. 2014）。此外，对横断面超声心动图标记物的依赖限制了因果推断。左心房应变和PA-TDI是心房功能的敏感指标，但它们仍然依赖于负荷，并受到供应商之间的差异。纵向评估或与晚期钆增强心脏磁共振成像等先进成像方式的相关性可能会加强这样一种观点，即先进的IAB真正捕获了心房心肌病的基底，而不是代表衰老和合并症负担的附带现象（Bisbal et al. 2020）。最后，优先考虑晚期IAB而不是其他p波参数的临床意义值得谨慎解释。虽然晚期IAB似乎与心房血流动力学受损密切相关，但其相对较低的患病率可能限制了其作为筛查工具的效用。综合心电图、超声心动图和生物标志物数据的多参数方法可能更好地反映ACM的复杂生物学，并与当代心房疾病作为一个连续体而不是二元实体的观点保持一致（Kreimer和Gotzmann 2022）。所有的作者都对计划、写作和修订做出了贡献。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或分析数据集。
{"title":"Electrocardiographic Markers of Atrial Cardiomyopathy: Strengths and Limits of P-Wave–Based Assessment","authors":"Mehmet Mustafa Yılmaz, Mücahit Aker, Macit Kalçık","doi":"10.1111/anec.70152","DOIUrl":"10.1111/anec.70152","url":null,"abstract":"<p>We read with interest the article by Kazantzi et al. examining the association between established P-wave parameters and left atrial hemodynamics in the context of atrial cardiomyopathy (ACM) (Kazantzi et al. <span>2026</span>). The authors should be acknowledged for addressing a clinically relevant question using a prospective design and comprehensive echocardiographic assessment. Their conclusion that advanced interatrial block (IAB) is the most reliable electrocardiographic marker of impaired left atrial function is clearly presented and supported by internal consistency within the dataset.</p><p>Nevertheless, several methodological aspects warrant closer scrutiny. The study population is heterogeneous, comprising patients with prior atrial fibrillation, embolic stroke of undetermined source, and individuals without manifest cardiovascular disease. While this broad inclusion enhances external validity, it may dilute pathophysiologically specific associations between P-wave indices and atrial remodeling. Current consensus documents emphasize that ACM represents a spectrum with variable electrical, structural, and mechanical manifestations, and pooling such diverse phenotypes may obscure parameter-specific diagnostic performance (Goette et al. <span>2024</span>).</p><p>A further concern relates to the operational definition of pathological P-wave parameters. Thresholds derived from consensus recommendations are largely based on epidemiological associations rather than mechanistic validation against atrial tissue pathology or gold-standard imaging. In particular, the dismissal of P-wave terminal force in lead V1 as a hemodynamic marker may reflect cohort characteristics rather than a true lack of biological relevance, given its previously demonstrated association with atrial fibrosis and stroke risk in population-based studies (Kamel et al. <span>2014</span>).</p><p>Additionally, the reliance on cross-sectional echocardiographic markers limits causal inference. Left atrial strain and PA-TDI are sensitive indicators of atrial function, yet they remain load-dependent and subject to inter-vendor variability. Longitudinal assessment or correlation with advanced imaging modalities such as late gadolinium-enhanced cardiac magnetic resonance imaging could have strengthened the argument that advanced IAB truly captures the substrate of atrial cardiomyopathy rather than representing an epiphenomenon of aging and comorbidity burden (Bisbal et al. <span>2020</span>).</p><p>Finally, the clinical implications of prioritizing advanced IAB over other P-wave parameters deserve cautious interpretation. While advanced IAB appears strongly associated with impaired atrial hemodynamics, its relatively low prevalence may limit utility as a screening tool. A multiparametric approach integrating electrocardiographic, echocardiographic, and biomarker data may better reflect the complex biology of ACM and align with contemporary views of atrial disease as a continuum r","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12784103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145931508","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}
Temporary pacing during acute inferior MI or no-reflow can trigger ventricular fibrillation rather than prevent it. Four mechanisms are highlighted: (1) acute ischemia lowers VF threshold and creates repolarization heterogeneity; (2) fragmented electrograms cause undersensing and asynchronous spikes; (3) bradycardia-related long RR cycles position spikes on the T-wave (“R-on-T”); and (4) catheter micro-displacement induces mechanical extrasystoles. We propose a bedside decision framework—three questions before pacing—and a prevention bundle focused on urgent ischemia reversal, continuous electrogram surveillance, and early electrode removal. Bradycardia in this setting is often transient, but the electrophysiological vulnerability is not. Treating ischemia first and avoiding unnecessary pacing are paramount to prevent iatrogenic arrhythmia.
{"title":"Why Temporary Pacing in Acute Inferior Myocardial Infarction or No-Reflow Becomes a Trigger—Not a Remedy—For Ventricular Fibrillation: Undersensing, “R-On-T”, Catheter Trauma and the Ischaemic Substrate","authors":"Zhong-Qun Zhan, Hai-Jun Xu","doi":"10.1111/anec.70149","DOIUrl":"10.1111/anec.70149","url":null,"abstract":"<p>Temporary pacing during acute inferior MI or no-reflow can trigger ventricular fibrillation rather than prevent it. Four mechanisms are highlighted: (1) acute ischemia lowers VF threshold and creates repolarization heterogeneity; (2) fragmented electrograms cause undersensing and asynchronous spikes; (3) bradycardia-related long RR cycles position spikes on the T-wave (“R-on-T”); and (4) catheter micro-displacement induces mechanical extrasystoles. We propose a bedside decision framework—three questions before pacing—and a prevention bundle focused on urgent ischemia reversal, continuous electrogram surveillance, and early electrode removal. Bradycardia in this setting is often transient, but the electrophysiological vulnerability is not. Treating ischemia first and avoiding unnecessary pacing are paramount to prevent iatrogenic arrhythmia.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12784284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145931641","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}
Aveir, as a newly approved leadless pacemaker (LP), has been increasingly adopted in clinical practice. However, its application in the Chinese population remains limited. This retrospective study aimed to evaluate the safety and efficacy of the Aveir LP in Chinese patients.
Methods
A retrospective analysis was conducted on patients who underwent LP implantation at the First Affiliated Hospital of Xiamen University between June 2024 and October 2024. Implantation sites included the right ventricular septum and the right ventricular free wall. Parameters were collected preoperatively and at 1-month post-implantation.
Results
A total of 16 patients were included, and all cases achieved successful implantation. At the 1-month follow-up, the pacing threshold improved from 0.68 ± 0.42 to 0.59 ± 0.27 V, impedance decreased from 740.00 ± 268.53 to 557.5 ± 129.69 Ω, and R-wave sensing increased from 8.51 ± 3.83 to 11.4 ± 4.22 mV. No complications were observed. There were no significant differences in measurements of the aorta, ascending aorta, left atrium, right atrium, left ventricular end-diastolic diameter, interventricular septal thickness, left ventricular end-systolic diameter, or ejection fraction between preoperative and 1-month post-implantation. Similarly, no significant changes in tricuspid regurgitation were noted between preoperative and 1-month post-implantation.
Conclusion
This study demonstrated the safety and efficacy of Aveir VR implantation in the Chinese population, with no complications or adverse effects on right heart function. Both the right ventricular free wall and septum were shown to be safe implantation sites with satisfactory device performance, highlighting the free wall as a viable alternative.
{"title":"Safety and Efficacy of Aveir Leadless Pacemaker in Chinese Patients","authors":"Wuyang Zheng, Ziguan Zhang, Zuheng Liu, Yuxiao Ma, Changqing Sun, Wangwei He, Yan Ge, Xiongbiao Lin, Yueming Wu, Qiang Xie","doi":"10.1111/anec.70141","DOIUrl":"10.1111/anec.70141","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Aveir, as a newly approved leadless pacemaker (LP), has been increasingly adopted in clinical practice. However, its application in the Chinese population remains limited. This retrospective study aimed to evaluate the safety and efficacy of the Aveir LP in Chinese patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted on patients who underwent LP implantation at the First Affiliated Hospital of Xiamen University between June 2024 and October 2024. Implantation sites included the right ventricular septum and the right ventricular free wall. Parameters were collected preoperatively and at 1-month post-implantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 16 patients were included, and all cases achieved successful implantation. At the 1-month follow-up, the pacing threshold improved from 0.68 ± 0.42 to 0.59 ± 0.27 V, impedance decreased from 740.00 ± 268.53 to 557.5 ± 129.69 Ω, and R-wave sensing increased from 8.51 ± 3.83 to 11.4 ± 4.22 mV. No complications were observed. There were no significant differences in measurements of the aorta, ascending aorta, left atrium, right atrium, left ventricular end-diastolic diameter, interventricular septal thickness, left ventricular end-systolic diameter, or ejection fraction between preoperative and 1-month post-implantation. Similarly, no significant changes in tricuspid regurgitation were noted between preoperative and 1-month post-implantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrated the safety and efficacy of Aveir VR implantation in the Chinese population, with no complications or adverse effects on right heart function. Both the right ventricular free wall and septum were shown to be safe implantation sites with satisfactory device performance, highlighting the free wall as a viable alternative.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12774324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910334","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}
Yaodongqin Xia, Xuan Lu, Minglong Chen, Mingfang Li
Introduction
Metabolic syndrome (MetS) and atrial cardiomyopathy (AtCM) are recognized as risk factors for cardiovascular disease, including stroke. We aimed to determine the combined impact of MetS and AtCM on stroke mortality.
Methods
Participants were selected from the Third National Health and Nutrition Examination (NHANES III) Survey. MetS was defined according to the Adult Treatment Panel III, while AtCM was defined as deep terminal negativity of the P wave in V1 (DTNPV1). Survey-weighted Firth penalized Cox analysis was performed to determine the adjusted HRs and 95% CIs of stroke mortality by MetS-AtCM status, including metabolically healthy without AtCM (MHNA; reference), metabolically unhealthy without AtCM (MUNA), metabolically healthy with AtCM (MHA), metabolically unhealthy with AtCM (MUA).
Results
A total of 4315 participants were included in the analysis. Throughout the follow-up, the rates of stroke mortality increased across the MetS-AtCM status categories: 1.56, 2.78, 4.68, and 8.24 per 1000 person-years in MHNA, MUNA, MHA, and MUA groups, respectively. Compared to the MHNA participants, MUA were at a higher risk of stroke mortality (HR = 3.33, 95% CI 1.24–8.94, p = 0.018). Stroke mortality showed a non-significant upward trend in both MUNA (HR = 1.57, 95% CI 0.96–2.59, p = 0.074) and MHA (HR = 1.61, 95% CI 0.52–5.00, p = 0.401) groups.
Conclusions
Our findings suggest a potential joint association of MetS and AtCM on stroke mortality. Further RCTs are warranted to evaluate the efficacy of anticoagulation in preventing ischemic stroke and reducing stroke mortality among individuals with both MetS and AtCM.
导言：代谢综合征（MetS）和心房心肌病（AtCM）被认为是心血管疾病的危险因素，包括中风。我们的目的是确定met和AtCM对卒中死亡率的综合影响。方法：从第三次全国健康与营养检查（NHANES III）调查中选择参与者。MetS定义根据成人治疗方案III， AtCM定义为V1 P波深端负性（DTNPV1）。采用调查加权的Firth惩罚Cox分析，确定MetS-AtCM状态下卒中死亡率的调整hr和95% ci，包括无AtCM代谢健康（MHNA; reference）、无AtCM代谢不健康（MUNA）、有AtCM代谢健康（MHA）、有AtCM代谢不健康（MUA）。结果：共纳入4315名参与者。在整个随访过程中，MHNA、MUNA、MHA和MUA组的卒中死亡率分别为每1000人年1.56、2.78、4.68和8.24。与MHNA组相比，MUA组卒中死亡风险更高（HR = 3.33, 95% CI 1.24-8.94, p = 0.018）。卒中死亡率在MUNA组（HR = 1.57, 95% CI 0.96-2.59, p = 0.074）和MHA组（HR = 1.61, 95% CI 0.52-5.00, p = 0.401）均呈无显著上升趋势。结论：我们的研究结果表明MetS和AtCM与卒中死亡率有潜在的联合关联。进一步的随机对照试验有必要评估抗凝在met和AtCM患者中预防缺血性卒中和降低卒中死亡率的功效。
{"title":"Metabolic Syndrome and Atrial Cardiomyopathy on the Risk of Stroke Mortality in the General Population","authors":"Yaodongqin Xia, Xuan Lu, Minglong Chen, Mingfang Li","doi":"10.1111/anec.70148","DOIUrl":"10.1111/anec.70148","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Metabolic syndrome (MetS) and atrial cardiomyopathy (AtCM) are recognized as risk factors for cardiovascular disease, including stroke. We aimed to determine the combined impact of MetS and AtCM on stroke mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants were selected from the Third National Health and Nutrition Examination (NHANES III) Survey. MetS was defined according to the Adult Treatment Panel III, while AtCM was defined as deep terminal negativity of the P wave in V1 (DTNPV1). Survey-weighted Firth penalized Cox analysis was performed to determine the adjusted HRs and 95% CIs of stroke mortality by MetS-AtCM status, including metabolically healthy without AtCM (MHNA; reference), metabolically unhealthy without AtCM (MUNA), metabolically healthy with AtCM (MHA), metabolically unhealthy with AtCM (MUA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 4315 participants were included in the analysis. Throughout the follow-up, the rates of stroke mortality increased across the MetS-AtCM status categories: 1.56, 2.78, 4.68, and 8.24 per 1000 person-years in MHNA, MUNA, MHA, and MUA groups, respectively. Compared to the MHNA participants, MUA were at a higher risk of stroke mortality (HR = 3.33, 95% CI 1.24–8.94, <i>p</i> = 0.018). Stroke mortality showed a non-significant upward trend in both MUNA (HR = 1.57, 95% CI 0.96–2.59, <i>p</i> = 0.074) and MHA (HR = 1.61, 95% CI 0.52–5.00, <i>p</i> = 0.401) groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings suggest a potential joint association of MetS and AtCM on stroke mortality. Further RCTs are warranted to evaluate the efficacy of anticoagulation in preventing ischemic stroke and reducing stroke mortality among individuals with both MetS and AtCM.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12754273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145861659","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}
Population-based evidence on the predictive role of left ventricular ejection fraction (LVEF) in incident Cardiac Conduction Dysfunction (CCD) and the mediating effects of electrophysiological parameters remains understudied. This study aimed to characterize the relationship between LVEF and incident CCD and explore the potential mediating effects of electrophysiological parameters.
Methods
This prospective cohort study included 32,398 participants (96.6% White ethnicity) from the UK Biobank with analyzable LVEF and electrocardiogram data. Incident CCD was defined as the first occurrence of atrioventricular block, left bundle branch block, or other conduction disorders. Stepwise backward Cox regression and sensitivity analyses evaluated the association between LVEF and CCD. Additionally, mediation analysis was performed to examine QRS duration, PQ interval, and corrected QT interval as potential mediators.
Results
During a mean follow-up of 6.96 ± 1.63 years, 484 incident CCD cases were identified. LVEF was an independent predictor of incident CCD, with each 1-standard deviation increase in LVEF associated with a 17% reduction in risk (adjusted hazard ratio, 0.83; 95% confidence interval, 0.77–0.89; p < 0.001). Sensitivity analyses across LVEF thresholds, competing risks, and exclusion of early events confirmed the robustness of these findings. Mediation analysis showed that PQ interval mediated 6% (p < 0.001), QRS duration mediated 17% (p < 0.001), and corrected QT interval mediated −3% (p = 0.002) of the total effect.
Conclusion
LVEF is independently associated with incident CCD, with electrophysiological parameters potentially explaining part of this association. These findings underscore the clinical relevance of myocardial mechano-electrical coupling in large-scale population settings.
{"title":"Left Ventricular Ejection Fraction and Incident Cardiac Conduction Dysfunction: Exploring the Mediating Effects of Electrophysiological Parameters","authors":"Qie Zhang, Feilong Zhang, Yuhao Hu, Jinfeng Wang, Xinlin Yang, Zhou Du, Yuting Chen, Jiran Shen, Ronghui Yu","doi":"10.1111/anec.70146","DOIUrl":"10.1111/anec.70146","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Population-based evidence on the predictive role of left ventricular ejection fraction (LVEF) in incident Cardiac Conduction Dysfunction (CCD) and the mediating effects of electrophysiological parameters remains understudied. This study aimed to characterize the relationship between LVEF and incident CCD and explore the potential mediating effects of electrophysiological parameters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective cohort study included 32,398 participants (96.6% White ethnicity) from the UK Biobank with analyzable LVEF and electrocardiogram data. Incident CCD was defined as the first occurrence of atrioventricular block, left bundle branch block, or other conduction disorders. Stepwise backward Cox regression and sensitivity analyses evaluated the association between LVEF and CCD. Additionally, mediation analysis was performed to examine QRS duration, PQ interval, and corrected QT interval as potential mediators.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During a mean follow-up of 6.96 ± 1.63 years, 484 incident CCD cases were identified. LVEF was an independent predictor of incident CCD, with each 1-standard deviation increase in LVEF associated with a 17% reduction in risk (adjusted hazard ratio, 0.83; 95% confidence interval, 0.77–0.89; <i>p</i> < 0.001). Sensitivity analyses across LVEF thresholds, competing risks, and exclusion of early events confirmed the robustness of these findings. Mediation analysis showed that PQ interval mediated 6% (<i>p</i> < 0.001), QRS duration mediated 17% (<i>p</i> < 0.001), and corrected QT interval mediated −3% (<i>p</i> = 0.002) of the total effect.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>LVEF is independently associated with incident CCD, with electrophysiological parameters potentially explaining part of this association. These findings underscore the clinical relevance of myocardial mechano-electrical coupling in large-scale population settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12744959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145848752","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 study by Yoosefi et al. proposing the SV3 + SV4 voltage sum—defined as the algebraic addition of the S-wave amplitudes in leads V3 and V4—as a new ECG criterion for left ventricular hypertrophy (LVH) and exploring whether age, sex, and hypertension improve diagnostic performance (Yoosefi et al. <span>2025</span>). Using their thresholds, the authors reported a sensitivity of 0.609 and specificity of 0.669 overall; with sex-specific cutoffs, performance reached 0.500/0.809 in women and 0.556/0.910 in men (Yoosefi et al. <span>2025</span>). These values represent a modest improvement over traditional voltage criteria but still illustrate limited sensitivity, especially in women.</p><p>To assess generalizability, we externally validated SV3 + SV4 in a Mexican cohort (<i>n</i> = 664) using both the global and sex-specific thresholds. The non–sex-specific cutoff achieved an AUC of 0.685 (95% CI 0.644–0.726), accuracy 0.654, and sensitivity 0.606. Applying sex-specific thresholds increased specificity to 0.879 but reduced sensitivity to 0.412, indicating that the anticipated benefit of separate cutoffs did not translate into improved diagnostic balance.</p><p>We compared these findings with our recently published Marcos VCG-ECG model, a clinically interpretable, signal-only algorithm that integrates electrocardiographic and vectorcardiographic features through a rule-based C5.0 classifier (De la Garza Salazar and Egenriether <span>2025</span>). Developed and validated against echocardiographic LVH, this model achieved an AUC of 0.779 (95% CI 0.715–0.844), accuracy 0.755, sensitivity 0.731, and specificity 0.775—outperforming SV3 + SV4 while maintaining full interpretability through explicit rule sets grounded in physiologic P-QRS-T wave and vector-loop relationships. Consistent with Yoosefi et al., adding demographic variables did not improve discrimination.</p><p>The authors also present an SVM analysis that achieved an F1-score of 0.714 in men (Yoosefi et al. <span>2025</span>). While encouraging, this estimate derives from a small dataset (<i>n</i> = 159; LVH 14.5%), which increases the risk of optimistic performance. Some feature combinations showed near-zero sensitivity but perfect specificity—formally “high-performing,” yet clinically uninformative. These results highlight the importance of class-balance awareness and transparent reporting of class-wise metrics in small ML datasets.</p><p>Taken together, three practical messages arise. (1) External validation remains essential, as SV3 + SV4 performance decreased outside the derivation cohort. (2) Voltage-only summation may have reached its diagnostic ceiling, given persistent sensitivity–specificity trade-offs (Faggiano et al. <span>2024</span>). (3) Interpretable, multiparametric ECG/VCG models may offer a better diagnostic equilibrium while preserving transparency and physiologic traceability (De la Garza Salazar and Egenriether <span>2025</span>; Huang et al.
我们饶有兴趣地阅读了Yoosefi等人提出的SV3 + SV4电压和（定义为导联V3和v4 s波振幅的代数相加）作为左心室肥厚（LVH）的新心电图标准的研究，并探讨了年龄、性别和高血压是否能改善诊断性能（Yoosefi et al. 2025）。使用他们的阈值，作者报告敏感性为0.609，特异性为0.669；按性别划分，女性的表现为0.500/0.809，男性为0.556/0.910 （yosefi et al. 2025）。这些值与传统电压标准相比略有改善，但仍然表明灵敏度有限，特别是在女性中。为了评估其普遍性，我们在墨西哥队列（n = 664）中使用全局阈值和性别特异性阈值对SV3 + SV4进行了外部验证。非性别特异性截断的AUC为0.685 (95% CI 0.644-0.726)，准确度为0.654，灵敏度为0.606。应用性别特异性阈值将特异性提高到0.879，但将敏感性降低到0.412，这表明单独截止点的预期益处并没有转化为改善的诊断平衡。我们将这些发现与我们最近发表的Marcos VCG-ECG模型进行了比较，Marcos VCG-ECG模型是一种临床可解释的纯信号算法，通过基于规则的C5.0分类器（De la Garza Salazar and Egenriether 2025）整合了心电图和矢量心电图特征。根据超声心动图LVH进行开发和验证，该模型的AUC为0.779 (95% CI为0.715-0.844)，准确度为0.755，灵敏度为0.731，特异性为0.775，优于SV3 + SV4，同时通过基于生理P-QRS-T波和矢量环关系的明确规则集保持完全的可解释性。与Yoosefi等人的结论一致，加入人口统计变量并没有改善歧视。作者还提出了一个支持向量机分析，男性的f1得分为0.714 （yosefi et al. 2025）。虽然令人鼓舞，但这一估计来自一个小数据集（n = 159; LVH 14.5%），这增加了乐观表现的风险。一些特征组合显示出接近零的敏感性，但完美的特异性——形式上“高性能”，但临床上缺乏信息。这些结果突出了类平衡意识和在小型ML数据集中透明报告类明智指标的重要性。综上所述，有三个实际的信息。(1)外部验证仍然是必要的，因为SV3 + SV4的性能在派生队列之外下降。(2)考虑到持续的敏感性-特异性权衡，仅电压求和可能已经达到其诊断上限（Faggiano et al. 2024）。(3)可解释的多参数ECG/VCG模型可以提供更好的诊断平衡，同时保持透明度和生理可追溯性（De la Garza Salazar and Egenriether 2025; Huang et al. 2025）。Yoosefi等人为重新审视基于ecg的LVH检测提供了有价值的刺激（Yoosefi等人，2025）。我们的外部验证表明，SV3 + SV4可能无法泛化相同的性能配置文件，特别是在特定于性别的截止值下。Marcos VCG-ECG等可解释的纯信号模型在实践中可以提供更高更均衡的准确性。我们支持进一步的多中心验证SV3 + SV4，并鼓励未来的标准以可解释的、形态丰富的ECG/VCG方法为基准，严格关注类别平衡和亚组表现（De la Garza Salazar and Egenriether 2025; Faggiano et al. 2024; Huang et al. 2025）。Fernando De la Garza Salazar：概念化，方法论，形式分析，软件，数据管理，可视化，调查，资源，监督，验证，撰写原始草案，审查和编辑，项目管理。作者没有什么可报道的。作者声明无利益冲突。支持本研究结果的数据可向通讯作者索取。由于隐私或道德限制，这些数据不会公开。
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