Acute occlusion of the left main coronary artery (LMCA) is one of the most severe forms of acute coronary syndrome. Besides the typical electrocardiogram changes, it is important to promptly recognize atypical changes and hasten revascularization therapy without delays. By analyzing specific cases, this work revealed that ST-segment elevation in aVR and aVL leads, accompanied by newly developed bifascicular block that cannot be ruled out as pathological, but without ST-segment deviation in the chest leads, highly indicates a rare electrocardiographic manifestation of complete occlusion of the LMCA. On the other hand, subtotal occlusion represents an even rarer scenario.
{"title":"A Rare Case of Atypical Electrocardiogram Changes in Subtotal Occlusion of the Left Main Coronary Artery","authors":"Honglin Ni, Zhicheng Gao, Jun Yao","doi":"10.1111/anec.70100","DOIUrl":"https://doi.org/10.1111/anec.70100","url":null,"abstract":"<p>Acute occlusion of the left main coronary artery (LMCA) is one of the most severe forms of acute coronary syndrome. Besides the typical electrocardiogram changes, it is important to promptly recognize atypical changes and hasten revascularization therapy without delays. By analyzing specific cases, this work revealed that ST-segment elevation in aVR and aVL leads, accompanied by newly developed bifascicular block that cannot be ruled out as pathological, but without ST-segment deviation in the chest leads, highly indicates a rare electrocardiographic manifestation of complete occlusion of the LMCA. On the other hand, subtotal occlusion represents an even rarer scenario.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 4","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70100","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315377","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}
Lilli C. Wiedenmann, Joachim R. Ehrlich, Ilan Goldenberg
Background
Female LQTS patients are at high risk for arrhythmogenic events during the postpartum period due to hormonal influence on cardiac repolarization.
Methods
We observed an LQT1 patient with previous cardiac events during pregnancy and 3 weeks postpartum. We obtained ECG recordings and quantified sex hormone levels.
Estradiol and Progesterone decline rapidly after birth, correlating to QTc prolongation and elevated risk for arrhythmogenic events. Therefore, modification of pharmacological or device therapy may be considered.
{"title":"Postpartum QT Prolongation in a Long QT Syndrome Type 1 Patient","authors":"Lilli C. Wiedenmann, Joachim R. Ehrlich, Ilan Goldenberg","doi":"10.1111/anec.70079","DOIUrl":"https://doi.org/10.1111/anec.70079","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Female LQTS patients are at high risk for arrhythmogenic events during the postpartum period due to hormonal influence on cardiac repolarization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We observed an LQT1 patient with previous cardiac events during pregnancy and 3 weeks postpartum. We obtained ECG recordings and quantified sex hormone levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Peak pregnancy: QTc: 420 ± 7 ms, Estradiol: 24.18 ng/mL, Progesterone: 218 ng/mL. Seven days postpartum: QTc prolongation to 455 ± 5 ms. 22 days postpartum: QTc: 452 ± 5, Estradiol: 0.013 ng/mL, Progesterone: 0.25 ng/mL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Estradiol and Progesterone decline rapidly after birth, correlating to QTc prolongation and elevated risk for arrhythmogenic events. Therefore, modification of pharmacological or device therapy may be considered.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 4","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70079","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144244730","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}
Alireza Oraii, David Conen, Linda S. Johnson, William F. McIntyre, Faith Kirabo, Kumar Balasubramanian, Alexander P. Benz, Jonas Oldgren, Jens Cosedis Nielsen, Jeff Healey
Background
Alcohol intake increases recurrence of atrial fibrillation (AF), but its relationship with cardiovascular outcomes is less well characterized. We aimed to study the association between different levels of alcohol intake and cardiovascular outcomes in a global cohort of patients with AF.
Methods
This is a cross-sectional analysis of the RE-LY AF registry, including 15,400 patients with AF who visited emergency departments in 47 countries. Patients were categorized into abstainers, light (< 7 standard drinks [SD]/week), moderate (7–13 SD/week), and heavy drinkers (≥ 14 SD/week). Outcomes were stroke/systemic embolism, heart failure (HF) hospitalization, and major bleeding at 1-year follow-up. Logistic mixed-effects regression models were used to calculate multivariable-adjusted odds ratios (aOR) with a 95% confidence interval (CI).
Results
In total,14,058 patients (mean age = 65.9 ± 14.7 years, 48.0% women) with available alcohol intake level data were included. This consisted of 12,091 (86.0%) abstainers, 1150 (8.2%) light, 458 (3.3%) moderate, and 359 (2.6%) heavy drinkers. The odds of stroke/systemic embolism were not significantly different in light (aOR = 0.88, 95% CI: 0.60–1.28), moderate (aOR = 0.91, 95% CI: 0.53–1.57) or heavy drinkers (aOR = 0.79, 95% CI: 0.41–1.54) compared to abstainers. Major bleedings were numerically, but not statistically significantly, higher among heavy drinkers (aOR = 1.52, 95% CI: 0.82–2.80). Compared to abstainers, alcohol intake was associated with fewer HF hospitalizations (light: aOR = 0.73, 95% CI: 0.58–0.92; moderate: aOR = 0.53, 95% CI: 0.35–0.78; heavy: aOR = 0.63, 95% CI: 0.41–0.98). However, this protective association was observed only in upper-middle and high-income countries (p-interaction < 0.001).
Conclusion
Alcohol drinking is unlikely to be associated with increased thromboembolic events in patients with AF, but may be associated with a lower risk of HF hospitalizations.
{"title":"Alcohol Intake and Cardiovascular Outcomes in Patients With Atrial Fibrillation: RE-LY AF Registry Analysis","authors":"Alireza Oraii, David Conen, Linda S. Johnson, William F. McIntyre, Faith Kirabo, Kumar Balasubramanian, Alexander P. Benz, Jonas Oldgren, Jens Cosedis Nielsen, Jeff Healey","doi":"10.1111/anec.70096","DOIUrl":"https://doi.org/10.1111/anec.70096","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Alcohol intake increases recurrence of atrial fibrillation (AF), but its relationship with cardiovascular outcomes is less well characterized. We aimed to study the association between different levels of alcohol intake and cardiovascular outcomes in a global cohort of patients with AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a cross-sectional analysis of the RE-LY AF registry, including 15,400 patients with AF who visited emergency departments in 47 countries. Patients were categorized into abstainers, light (< 7 standard drinks [SD]/week), moderate (7–13 SD/week), and heavy drinkers (≥ 14 SD/week). Outcomes were stroke/systemic embolism, heart failure (HF) hospitalization, and major bleeding at 1-year follow-up. Logistic mixed-effects regression models were used to calculate multivariable-adjusted odds ratios (aOR) with a 95% confidence interval (CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total,14,058 patients (mean age = 65.9 ± 14.7 years, 48.0% women) with available alcohol intake level data were included. This consisted of 12,091 (86.0%) abstainers, 1150 (8.2%) light, 458 (3.3%) moderate, and 359 (2.6%) heavy drinkers. The odds of stroke/systemic embolism were not significantly different in light (aOR = 0.88, 95% CI: 0.60–1.28), moderate (aOR = 0.91, 95% CI: 0.53–1.57) or heavy drinkers (aOR = 0.79, 95% CI: 0.41–1.54) compared to abstainers. Major bleedings were numerically, but not statistically significantly, higher among heavy drinkers (aOR = 1.52, 95% CI: 0.82–2.80). Compared to abstainers, alcohol intake was associated with fewer HF hospitalizations (light: aOR = 0.73, 95% CI: 0.58–0.92; moderate: aOR = 0.53, 95% CI: 0.35–0.78; heavy: aOR = 0.63, 95% CI: 0.41–0.98). However, this protective association was observed only in upper-middle and high-income countries (<i>p</i>-interaction < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Alcohol drinking is unlikely to be associated with increased thromboembolic events in patients with AF, but may be associated with a lower risk of HF hospitalizations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 4","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70096","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144213970","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}
Issa Asfour, Shahid Karim, Sair A. Tabraiz, Anwar Chahal, Mohammed Y. Khanji, Akil A. Sherif, Steve R. Ommen, Virend K. Somers, Grace Lin, Peter A. Brady
Background
Late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) imaging is a well-established indicator of myocardial fibrosis in hypertrophic cardiomyopathy (HCM). However, its association with electrocardiographic (ECG) abnormalities and the risk of atrial fibrillation (AF) remains uncertain.
Objectives
To investigate the association between the presence and burden of LGE with ECG characteristics, including precordial voltage, depolarization and repolarization abnormalities, and the incidence of AF in adults with HCM.
Methods
We conducted a retrospective cohort study of 144 adults with HCM with CMR and 12-lead ECG within 30 days of each other. LGE was quantified as a percentage of LV mass and categorized as absent, < 5%, or ≥ 5%. ECG parameters, including QRS voltage, repolarization abnormalities, and LVH criteria, were analyzed. Incident AF was assessed during a median follow-up of 6.6 years.
Results
LGE was present in 96 (67%) patients, with 21 (22%) having ≥ 5% LGE. There were no significant differences in precordial voltage between patients with and without LGE across Sokolow-Lyon, Cornell, and Romhilt-Estes criteria. However, T-wave inversion was more common in leads I (41% vs. 19%, p = 0.009), aVL (50% vs. 31%, p = 0.033), and V4 (41% vs. 23%, p = 0.035) in patients with LGE. Patients with ≥ 5% LGE had a significantly lower median LVEF (64% vs. 74%, p = 0.003). Additionally, LGE presence was not associated with an increased risk of incident AF (HR 1.8, 95% CI 0.6–5.3, p = 0.308).
Conclusion
In contrast to pediatric HCM, LGE is associated with specific ECG repolarization abnormalities, particularly T-wave inversion in lateral leads, but does not significantly affect precordial voltage in adults.
背景：心血管磁共振（CMR）成像的晚期钆增强（LGE）是肥厚性心肌病（HCM）心肌纤维化的一个公认指标。然而，其与心电图（ECG）异常和房颤（AF）风险的关系仍不确定。目的探讨成人HCM患者LGE的存在和负担与心电特征（包括心前电压、去极化和复极化异常）以及房颤发生率的关系。方法对144例HCM成人CMR和12导联心电图在30天内进行回顾性队列研究。将LGE量化为左室质量的百分比，并将其分为未见、<； 5%或≥5%。分析心电图参数，包括QRS电压、复极异常和LVH标准。在中位随访6.6年期间评估偶发性房颤。结果96例（67%）患者存在LGE，其中21例（22%）患者LGE≥5%。通过Sokolow-Lyon、Cornell和Romhilt-Estes标准，LGE患者和非LGE患者的心前电压无显著差异。然而，在LGE患者中，t波倒置在导联I （41% vs. 19%, p = 0.009）、aVL （50% vs. 31%, p = 0.033）和V4 （41% vs. 23%, p = 0.035）更常见。LGE≥5%的患者中位LVEF显著降低（64% vs. 74%, p = 0.003）。此外，LGE的存在与AF发生风险增加无关（HR 1.8, 95% CI 0.6-5.3, p = 0.308）。结论与儿童HCM相比，LGE与特定的ECG复极异常有关，特别是侧导联t波反转，但对成人心前电压无显著影响。
{"title":"Late Gadolinium Enhancement and Electrocardiographic Associations in Hypertrophic Cardiomyopathy","authors":"Issa Asfour, Shahid Karim, Sair A. Tabraiz, Anwar Chahal, Mohammed Y. Khanji, Akil A. Sherif, Steve R. Ommen, Virend K. Somers, Grace Lin, Peter A. Brady","doi":"10.1111/anec.70077","DOIUrl":"https://doi.org/10.1111/anec.70077","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) imaging is a well-established indicator of myocardial fibrosis in hypertrophic cardiomyopathy (HCM). However, its association with electrocardiographic (ECG) abnormalities and the risk of atrial fibrillation (AF) remains uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To investigate the association between the presence and burden of LGE with ECG characteristics, including precordial voltage, depolarization and repolarization abnormalities, and the incidence of AF in adults with HCM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study of 144 adults with HCM with CMR and 12-lead ECG within 30 days of each other. LGE was quantified as a percentage of LV mass and categorized as absent, < 5%, or ≥ 5%. ECG parameters, including QRS voltage, repolarization abnormalities, and LVH criteria, were analyzed. Incident AF was assessed during a median follow-up of 6.6 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>LGE was present in 96 (67%) patients, with 21 (22%) having ≥ 5% LGE. There were no significant differences in precordial voltage between patients with and without LGE across Sokolow-Lyon, Cornell, and Romhilt-Estes criteria. However, T-wave inversion was more common in leads I (41% vs. 19%, <i>p</i> = 0.009), aVL (50% vs. 31%, <i>p</i> = 0.033), and V4 (41% vs. 23%, <i>p</i> = 0.035) in patients with LGE. Patients with ≥ 5% LGE had a significantly lower median LVEF (64% vs. 74%, <i>p</i> = 0.003). Additionally, LGE presence was not associated with an increased risk of incident AF (HR 1.8, 95% CI 0.6–5.3, <i>p</i> = 0.308).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In contrast to pediatric HCM, LGE is associated with specific ECG repolarization abnormalities, particularly T-wave inversion in lateral leads, but does not significantly affect precordial voltage in adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 4","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70077","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144206853","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}
It is unclear to what extent silent atrial fibrillation (AF) is present in subjects previously undiagnosed with AF. The recently popular 7-day patch electrocardiography (ECG) monitoring may help answer this question.
Methods
In the Kitsuki and Usuki cities in Oita Prefecture, Japan, a study was conducted among subjects who underwent 7-day patch ECG monitoring (Heartnote) for silent AF screening during the national insurance health checkup between June and November 2023. Subjects were (1) 65–74 years old and have ≥ 1 of the following risk factors: hypertension, diabetes mellitus, stroke, transient ischemic attack, and underlying heart disease (heart failure and/or previous myocardial infarction) and (2) 75 years and older.
Results
A total of 571 subjects (307 females and 264 males, mean age 75.3 ± 5.4 years) were analyzed. Silent AF was detected in 16 out of 571 subjects (2.8%). Among those aged 75 years or older, silent AF was detected in 15 out of 291 subjects (5.2%). In multivariate analysis, among age, body mass index (BMI), hypertension, diabetes, stroke, and underlying heart disease, only age was the independent predictor of silent AF detection (odds ratio: 1.16, 95% confidence interval: 1.06–1.28, p < 0.01).
Conclusions
Seven-day patch ECG monitoring during the national insurance health checkup efficiently detected silent AF in individuals aged 75 years and older.
{"title":"Seven-Day Patch ECG Monitoring During National Insurance Health Checkup Efficiently Detected Silent Atrial Fibrillation in Individuals Aged 75 Years and Older","authors":"Miho Miyoshi, Nozomi Kodama, Hiroki Sato, Kazuhiro Masutomo, Hitoshi Kamiunten, Tetsuji Shinohara, Naohiko Takahashi","doi":"10.1111/anec.70092","DOIUrl":"https://doi.org/10.1111/anec.70092","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>It is unclear to what extent silent atrial fibrillation (AF) is present in subjects previously undiagnosed with AF. The recently popular 7-day patch electrocardiography (ECG) monitoring may help answer this question.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In the Kitsuki and Usuki cities in Oita Prefecture, Japan, a study was conducted among subjects who underwent 7-day patch ECG monitoring (Heartnote) for silent AF screening during the national insurance health checkup between June and November 2023. Subjects were (1) 65–74 years old and have ≥ 1 of the following risk factors: hypertension, diabetes mellitus, stroke, transient ischemic attack, and underlying heart disease (heart failure and/or previous myocardial infarction) and (2) 75 years and older.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 571 subjects (307 females and 264 males, mean age 75.3 ± 5.4 years) were analyzed. Silent AF was detected in 16 out of 571 subjects (2.8%). Among those aged 75 years or older, silent AF was detected in 15 out of 291 subjects (5.2%). In multivariate analysis, among age, body mass index (BMI), hypertension, diabetes, stroke, and underlying heart disease, only age was the independent predictor of silent AF detection (odds ratio: 1.16, 95% confidence interval: 1.06–1.28, <i>p</i> < 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Seven-day patch ECG monitoring during the national insurance health checkup efficiently detected silent AF in individuals aged 75 years and older.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 4","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70092","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144197074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper reports 4 cases of ventricular preexcitation (WPW) accompanied by left bundle branch block (LBBB). WPW appeared intermittently in all cases: Case 1 involved a right-sided accessory pathway, while Cases 2–4 involved left-sided accessory pathways. The electrocardiographic characteristics of both right-sided and left-sided accessory pathways coexisting with LBBB are discussed.
{"title":"Analysis of 4 Cases of Left Bundle Branch Block With Ventricular Preexcitation","authors":"M. M. Li Yi, B. M. Li Xingjie","doi":"10.1111/anec.70091","DOIUrl":"https://doi.org/10.1111/anec.70091","url":null,"abstract":"<p>This paper reports 4 cases of ventricular preexcitation (WPW) accompanied by left bundle branch block (LBBB). WPW appeared intermittently in all cases: Case 1 involved a right-sided accessory pathway, while Cases 2–4 involved left-sided accessory pathways. The electrocardiographic characteristics of both right-sided and left-sided accessory pathways coexisting with LBBB are discussed.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 4","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70091","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190794","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}
Wael Zaher, Lorenzo Marcon, Klaus-Richard Ebinger, Antonio Sorgente
Background
Ablation of the cavo-tricuspid isthmus (CTI) is the standard treatment for typical atrial flutter. High-power strategies have been described to improve lesion efficacy and durability.
Objective
To compare the acute success, safety, and long-term outcomes of two strategies of high-power CTI ablation using 8-mm gold-tip nonirrigated and 4-mm irrigated-tip catheters.
Methods
This single-center prospective cohort study included 253 patients who underwent CTI ablation. Patients were treated with either an 8-mm gold-tip nonirrigated catheter (60 W, ≥ 30 s) or a 4-mm irrigated catheter (45 W, ≥ 30 s). Procedural outcomes, safety, and long-term follow-up data were assessed.
Results
Using a propensity score matching, 180 patients were yielded with a 1:1 ratio. Acute bidirectional CTI block was achieved in 97.8% of the 4-mm group and 97.8% of the 8-mm group (p = 1.000). No major complications were reported. During a median follow-up of 27.7 ± 20.1 months, freedom from atrial arrhythmia was 93.3% in both groups (log rank p value 0.935). No significant differences were observed in atrial fibrillation incidence, pacemaker implantation, or cardiovascular mortality between the groups.
Conclusion
High-power CTI ablation with both 8-mm gold-tip nonirrigated and 4-mm irrigated catheters is highly effective and safe, providing durable outcomes over long-term follow-up.
{"title":"Comparison of Two High-Power Ablation Strategies for Typical Atrial Flutter: Acute and Long-Term Outcome","authors":"Wael Zaher, Lorenzo Marcon, Klaus-Richard Ebinger, Antonio Sorgente","doi":"10.1111/anec.70089","DOIUrl":"https://doi.org/10.1111/anec.70089","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ablation of the cavo-tricuspid isthmus (CTI) is the standard treatment for typical atrial flutter. High-power strategies have been described to improve lesion efficacy and durability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare the acute success, safety, and long-term outcomes of two strategies of high-power CTI ablation using 8-mm gold-tip nonirrigated and 4-mm irrigated-tip catheters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center prospective cohort study included 253 patients who underwent CTI ablation. Patients were treated with either an 8-mm gold-tip nonirrigated catheter (60 W, ≥ 30 s) or a 4-mm irrigated catheter (45 W, ≥ 30 s). Procedural outcomes, safety, and long-term follow-up data were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Using a propensity score matching, 180 patients were yielded with a 1:1 ratio. Acute bidirectional CTI block was achieved in 97.8% of the 4-mm group and 97.8% of the 8-mm group (<i>p</i> = 1.000). No major complications were reported. During a median follow-up of 27.7 ± 20.1 months, freedom from atrial arrhythmia was 93.3% in both groups (log rank <i>p</i> value 0.935). No significant differences were observed in atrial fibrillation incidence, pacemaker implantation, or cardiovascular mortality between the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>High-power CTI ablation with both 8-mm gold-tip nonirrigated and 4-mm irrigated catheters is highly effective and safe, providing durable outcomes over long-term follow-up.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 4","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70089","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144171623","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}
Ahmad Talebian, Ali Mohammad Shakiba, Adele Malekipoor, Fatemeh Hafezipour, Mohammad Mahdi Heidari, Fatemeh Talebian, Hamid Reza Gilasi
Introduction
QT interval corrected dispersion (QTcd) reflects the heterogeneity of ventricular repolarization and has been proposed as a marker for arrhythmic risk in various neurologic and cardiac conditions. The aim of this study was to evaluate QTcd differences between children with epilepsy and healthy controls, with attention to age and antiepileptic drug use.
Methods
A case–control study was conducted on 50 children with epilepsy and 50 age- and sex-matched control children admitted to Shahid Beheshti Hospital in Kashan in 2019. QTcd was manually measured from 12-lead electrocardiograms (ECGs). Data were analyzed using SPSS version 22.
Results
No overall significant difference was observed in QTcd between groups (p > 0.05). However, children with epilepsy under 5 years of age had significantly higher QTcd than controls of the same age (p = 0.014). Moreover, QTcd was significantly lower in children with epilepsy receiving medication compared with those not on treatment (p = 0.026).
Conclusion
Although overall QTcd did not differ significantly between epileptic and control children, age under five and antiepileptic drug use significantly influenced QTcd. These findings suggest the importance of cardiac evaluation and early treatment in younger patients with epilepsy.
QT间期校正离散度（QTcd）反映了心室复极的异质性，并被认为是各种神经和心脏疾病中心律失常风险的标志。本研究的目的是评估癫痫患儿与健康对照之间的QTcd差异，并注意年龄和抗癫痫药物的使用。方法对2019年卡尚市沙希德·贝赫什蒂医院收治的50例癫痫患儿和50例年龄、性别匹配的对照组患儿进行病例对照研究。QTcd由12导联心电图（ECGs）人工测量。数据分析采用SPSS version 22。结果两组间QTcd总体差异无统计学意义（p > 0.05）。而5岁以下癫痫患儿的QTcd明显高于同龄对照组（p = 0.014）。此外，接受药物治疗的癫痫患儿的QTcd明显低于未接受药物治疗的癫痫患儿（p = 0.026）。结论癫痫患儿与对照组总体QTcd差异不显著，但5岁以下儿童和抗癫痫药物使用对QTcd有显著影响。这些发现提示对年轻癫痫患者进行心脏评估和早期治疗的重要性。
{"title":"QTc Interval Dispersion in Pediatric Epilepsy: A Case–Control Study From Iran","authors":"Ahmad Talebian, Ali Mohammad Shakiba, Adele Malekipoor, Fatemeh Hafezipour, Mohammad Mahdi Heidari, Fatemeh Talebian, Hamid Reza Gilasi","doi":"10.1111/anec.70094","DOIUrl":"https://doi.org/10.1111/anec.70094","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>QT interval corrected dispersion (QTcd) reflects the heterogeneity of ventricular repolarization and has been proposed as a marker for arrhythmic risk in various neurologic and cardiac conditions. The aim of this study was to evaluate QTcd differences between children with epilepsy and healthy controls, with attention to age and antiepileptic drug use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A case–control study was conducted on 50 children with epilepsy and 50 age- and sex-matched control children admitted to Shahid Beheshti Hospital in Kashan in 2019. QTcd was manually measured from 12-lead electrocardiograms (ECGs). Data were analyzed using SPSS version 22.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No overall significant difference was observed in QTcd between groups (<i>p</i> > 0.05). However, children with epilepsy under 5 years of age had significantly higher QTcd than controls of the same age (<i>p</i> = 0.014). Moreover, QTcd was significantly lower in children with epilepsy receiving medication compared with those not on treatment (<i>p</i> = 0.026).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although overall QTcd did not differ significantly between epileptic and control children, age under five and antiepileptic drug use significantly influenced QTcd. These findings suggest the importance of cardiac evaluation and early treatment in younger patients with epilepsy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144091780","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}
To evaluate left atrial (LA) function in patients with embolic stroke of undetermined source (ESUS) and other subtypes of acute ischemic stroke (AIS) related to large-vessel occlusion (LVO).
Methods
Consecutive patients with LVO-related AIS were prospectively enrolled from July 2019 to August 2022. To compare LA function with ESUS patients, a control group without prior stroke was sex- and age-matched with ESUS patients in a 1:1 ratio. LA strain was measured within 3 days after stroke. Multivariable logistic regression analysis was performed to assess associations between LA function and stroke subtypes.
Results
This study included 126 patients (mean age 67.7 ± 12.3 year, 39.7% women). Of these, 28 patients met the diagnostic criteria for ESUS, while the remaining were classified as large artery atherosclerosis (n = 49) and non-valvular AF-related cardioembolic stroke (n = 49). Patients with ESUS had lower left atrial reservoir strain (LASr) and left atrial conduit strain (LAScd) compared to those with large artery atherosclerosis (27.8 ± 7.1% vs. 32.0 ± 5.3%, p = 0.004, and 14.3 ± 3.8% vs. 17.3 ± 4.6%, p = 0.005, respectively) and the control group (27.8 ± 7.1% vs. 37.6 ± 7.2%, p < 0.001 and 14.3 ± 3.8% vs. 21.5 ± 7.9%, p < 0.001, respectively). A 5% reduction in LASr and LAScd was associated with a 1.92- and 2.45-fold increase, respectively, in the likelihood of having ESUS compared to large artery atherosclerosis. Lower LASr and LAScd in ESUS patients were prone to be associated with a higher likelihood of cardiovascular events during follow-up.
Conclusions
LA strain is associated with ESUS in stroke patients with LVO. Further studies are needed to explore its utility in identifying specific stroke etiologies.
{"title":"The Role of Left Atrial Strain in Differentiating Embolic Stroke of Undetermined Source From Other Acute Ischemic Stroke Subtypes Related to Large-Vessel Occlusion","authors":"Yanjuan Zhang, Jincheng Jiao, Yingying Wang, Sheng Liu, Yuezhou Cao, Haibing Shi, Minglong Chen, Mingfang Li","doi":"10.1111/anec.70093","DOIUrl":"https://doi.org/10.1111/anec.70093","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>To evaluate left atrial (LA) function in patients with embolic stroke of undetermined source (ESUS) and other subtypes of acute ischemic stroke (AIS) related to large-vessel occlusion (LVO).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive patients with LVO-related AIS were prospectively enrolled from July 2019 to August 2022. To compare LA function with ESUS patients, a control group without prior stroke was sex- and age-matched with ESUS patients in a 1:1 ratio. LA strain was measured within 3 days after stroke. Multivariable logistic regression analysis was performed to assess associations between LA function and stroke subtypes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study included 126 patients (mean age 67.7 ± 12.3 year, 39.7% women). Of these, 28 patients met the diagnostic criteria for ESUS, while the remaining were classified as large artery atherosclerosis (<i>n</i> = 49) and non-valvular AF-related cardioembolic stroke (<i>n</i> = 49). Patients with ESUS had lower left atrial reservoir strain (LASr) and left atrial conduit strain (LAScd) compared to those with large artery atherosclerosis (27.8 ± 7.1% vs. 32.0 ± 5.3%, <i>p</i> = 0.004, and 14.3 ± 3.8% vs. 17.3 ± 4.6%, <i>p</i> = 0.005, respectively) and the control group (27.8 ± 7.1% vs. 37.6 ± 7.2%, <i>p</i> < 0.001 and 14.3 ± 3.8% vs. 21.5 ± 7.9%, <i>p</i> < 0.001, respectively). A 5% reduction in LASr and LAScd was associated with a 1.92- and 2.45-fold increase, respectively, in the likelihood of having ESUS compared to large artery atherosclerosis. Lower LASr and LAScd in ESUS patients were prone to be associated with a higher likelihood of cardiovascular events during follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LA strain is associated with ESUS in stroke patients with LVO. Further studies are needed to explore its utility in identifying specific stroke etiologies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70093","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085215","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}
To simulate thrombotic occlusion of catheters and develop a model for thrombotic occlusion in peripherally inserted central catheters (PICC), providing a framework for research on catheter occlusion and post-occlusion recanalization.
Methods
Following preparatory steps prior to modeling, sterile anticoagulant bovine blood was drawn and injected into the PICC. Subsequently, the catheter tip was clamped and left to stand for 72 h.
Results
A total of 140 catheter models were produced, all of which exhibited thrombosis, resulting in a 100% success rate for intra-catheter thrombus production. Of these, 118 models experienced no blood reflux when the syringe plunger was withdrawn and triggered an infusion pump alarm, achieving a catheter occlusion modeling success rate of 84.29%. There were 127 cases where syringe plunger withdrawal resulted in no blood reflux within the thrombotic catheter occlusion models, yielding an incidence rate of 90.71%, while 13 cases revealed blood reflux mixed with fine thrombosis, with an incidence rate of 9.29%. Additionally, 126 models triggered infusion pump alarms, with an incidence rate of 90%, while 14 models did not trigger alarms due to thrombus overflow at the catheter tip, with an incidence rate of 10%. The infusion pump alarm method and the syringe withdrawal method demonstrated a significant correlation in diagnosing thrombotic catheter occlusion.
Conclusion
The method for modeling thrombotic catheter occlusion used in this study is reliable, producing a model that accurately simulates the fundamental characteristics of thrombotic catheter occlusion. This model has the potential for application in clinical practice.
{"title":"Simulation and Modeling Thrombotic Occlusion in Peripherally Inserted Central Catheters","authors":"Feng-Xian Li, Qiao-hong Guo","doi":"10.1111/anec.70090","DOIUrl":"https://doi.org/10.1111/anec.70090","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To simulate thrombotic occlusion of catheters and develop a model for thrombotic occlusion in peripherally inserted central catheters (PICC), providing a framework for research on catheter occlusion and post-occlusion recanalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following preparatory steps prior to modeling, sterile anticoagulant bovine blood was drawn and injected into the PICC. Subsequently, the catheter tip was clamped and left to stand for 72 h.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 140 catheter models were produced, all of which exhibited thrombosis, resulting in a 100% success rate for intra-catheter thrombus production. Of these, 118 models experienced no blood reflux when the syringe plunger was withdrawn and triggered an infusion pump alarm, achieving a catheter occlusion modeling success rate of 84.29%. There were 127 cases where syringe plunger withdrawal resulted in no blood reflux within the thrombotic catheter occlusion models, yielding an incidence rate of 90.71%, while 13 cases revealed blood reflux mixed with fine thrombosis, with an incidence rate of 9.29%. Additionally, 126 models triggered infusion pump alarms, with an incidence rate of 90%, while 14 models did not trigger alarms due to thrombus overflow at the catheter tip, with an incidence rate of 10%. The infusion pump alarm method and the syringe withdrawal method demonstrated a significant correlation in diagnosing thrombotic catheter occlusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The method for modeling thrombotic catheter occlusion used in this study is reliable, producing a model that accurately simulates the fundamental characteristics of thrombotic catheter occlusion. This model has the potential for application in clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70090","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143950153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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