Annals of Noninvasive Electrocardiology最新文献

We present the case of a 74-year-old man who developed 28 episodes of electrical storm secondary to aconitine poisoning from homemade herbal wine consumption, followed by complete recovery through 28 electrical cardioversions, hemopurification, and continuous magnesium sulfate infusion after 4 days. This case suggests that magnesium sulfate, by antagonizing calcium overload and stabilizing membrane potential, forms a synergistic effect with electrical resuscitation and hemopurification, and is the key to reversing the electrical storms caused by aconitine poisoning.

A 26-year-old woman with recurrent syncope was diagnosed with Andersen-Tawil syndrome (ATS) following abnormal electrocardiographic (ECG) findings. Her history of ventricular arrhythmias and prominent U waves on ECG led to genetic testing, which identified a KCNJ2 mutation. This case underscores the importance of recognizing ATS-specific ECG patterns, including broad U waves, in diagnosing arrhythmias. Following medication adjustments, her symptoms improved, highlighting the significance of tailored treatment for ATS-associated arrhythmias.

We read with great interest the systematic review by Ahmad et al. on dual-chamber implantable cardioverter defibrillators (ICDs) for left bundle branch area pacing (LBBAP) [1]. The authors commendably synthesize nascent evidence for this innovative strategy. Their findings—significant QRS narrowing (170 ± 17.4 ms to 121 ± 17.3 ms), improved LVEF (50% improvement in 2 studies), and no short-term complications in 34 patients—are promising, suggesting LBBAP-ICD as a viable alternative to cardiac resynchronization therapy defibrillators (CRT-D).

In conclusion, Ahmad et al. provide a valuable synthesis confirming the feasibility and short-term promise of LBBAP-ICD. However, this review powerfully highlights the preliminary nature of the evidence. Substantial investment in robust, comparative, long-term trials is now needed to determine if this approach fulfills its promise as a safe and effective alternative for patients.

The author takes full responsibility for the conception, design, data interpretation, and drafting of this manuscript.

The author declares no conflicts of interest.

A 9-year-old boy presented with repeated exteriorization of four implantable cardioverter-defibrillators (ICDs), despite changes in implantation site and the use of antimicrobial or polymeric envelopes. The initial device was placed following an episode of ventricular fibrillation, with imaging revealing non-obstructive hypertrophic cardiomyopathy. Over subsequent procedures, he developed hypertrophic incisional scarring and granulomatous inflammation. Titanium hypersensitivity was confirmed via dermal testing, though all wound and blood cultures remained negative. After partial exteriorization of a fifth device, a gold-coated ICD was implanted, with improved wound healing. This case underscores the need to consider allergic reactions to device materials when managing recurrent pocket complications.

We read with interest the article by Ali Amghaiab et al. titled “Decoding South African Flag Sign—When Lead V2 Speaks Volumes” published in JAMA Internal Medicine (Ali Amghaiab et al. 2025). The authors describe a case of suspected ST-segment elevation myocardial infarction (STEMI) based on isolated ST elevation in lead V2, subtle ST elevation in leads I and aVL, and reciprocal changes in lead III, ultimately attributed to occlusion of the first diagonal (D1) branch of the left anterior descending artery.

Although we commend the authors for highlighting this important and often underrecognized electrocardiographic pattern, we respectfully propose an alternative interpretation of the initial ECG. Upon close inspection, lead V2 does not demonstrate classic ST-segment elevation. Instead, it exhibits upsloping ST-segment depression followed by a tall, symmetric T wave, a morphology consistent with the de Winter pattern. Leads I and aVL similarly show hyperacute T waves without definitive ST elevation, suggesting early transmural ischemia rather than established injury current.

The de Winter pattern, originally described in proximal LAD occlusion, is increasingly recognized in isolated D1 occlusion, particularly when the ischemic vector is postero-inferiorly, aligning with the axis of lead V2 (de Winter et al. 2008). This pattern represents a STEMI equivalent, often preceding overt ST elevation, and mandates urgent reperfusion therapy.

This single-lead V2 de Winter pattern is, to my knowledge, previously unreported and may represent the earliest electrocardiographic signature of a proximally arising, anatomically dominant D1 branch. Recognition of isolated de Winter morphology in V2 as a solitary anterior lead sign of D1 occlusion is clinically invaluable, especially in the absence of contiguous lead involvement. It expands the spectrum of occlusion myocardial infarction (OMI) patterns and supports the shift from traditional STEMI versus NSTEMI paradigms toward OMI versus NOMI classification (McLaren et al. 2024).

We congratulate the authors on this insightful case and emphasize that hyperacute T waves and de Winter morphology, even in a single lead, should prompt immediate suspicion of coronary occlusion and urgent angiographic evaluation.

The author takes full responsibility for this article.

The author declares no conflicts of interest.