We report a case of a 21-year-old female manifesting narrow QRS complex tachycardia and alternating R-R intervals. The fixed RP interval suggested ventriculoatrial conduction via an accessory pathway (AP). The alternating PR intervals indicated anterograde conduction through the fast and slow nodal pathways, respectively. The coexistence of AP and dual atrioventricular nodal pathways is not rare, with most of them exhibiting as atrioventricular reentry tachycardia (AVRT) using the fast or slow nodal pathway exclusively as the anterograde limb. We propose that alternating dual nodal pathway AVRT may occur when the fast pathway's effective refractory period is between the cycle lengths of fast-nodal-pathway AVRT and slow-nodal-pathway AVRT.
{"title":"A Narrow QRS Tachycardia With Alternating R-R Interval","authors":"Fenglin Wu, Lijun Zeng, Xiaobo Pu","doi":"10.1111/anec.70075","DOIUrl":"https://doi.org/10.1111/anec.70075","url":null,"abstract":"<p>We report a case of a 21-year-old female manifesting narrow QRS complex tachycardia and alternating R-R intervals. The fixed RP interval suggested ventriculoatrial conduction via an accessory pathway (AP). The alternating PR intervals indicated anterograde conduction through the fast and slow nodal pathways, respectively. The coexistence of AP and dual atrioventricular nodal pathways is not rare, with most of them exhibiting as atrioventricular reentry tachycardia (AVRT) using the fast or slow nodal pathway exclusively as the anterograde limb. We propose that alternating dual nodal pathway AVRT may occur when the fast pathway's effective refractory period is between the cycle lengths of fast-nodal-pathway AVRT and slow-nodal-pathway AVRT.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762157","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}
We describe a patient who underwent AV node modification to create complete heart block in the setting of incessant, ablation-and-drug-refractory, symptomatic atypical atrial flutter. His dual chamber defibrillator (previously implanted for resuscitated cardiac arrest) was programmed to the VVIR mode at a faster pacing rate of 85 bpm. Serendipitously, this rate was an almost exact factorial of his flutter rate of 250–260 bpm. This resulted in every 6th flutter wave falling in the supernormal period, resulting in fixed-coupled supraventricular bigeminy and trigeminy in the setting of complete heart block. Reprogramming the pacing rate to 75 bpm abolished bigeminy and trigeminy.
{"title":"Serendipitous Supernormality","authors":"Behzad B. Pavri, Eitan Frankel","doi":"10.1111/anec.70069","DOIUrl":"https://doi.org/10.1111/anec.70069","url":null,"abstract":"<p>We describe a patient who underwent AV node modification to create complete heart block in the setting of incessant, ablation-and-drug-refractory, symptomatic atypical atrial flutter. His dual chamber defibrillator (previously implanted for resuscitated cardiac arrest) was programmed to the VVIR mode at a faster pacing rate of 85 bpm. Serendipitously, this rate was an almost exact factorial of his flutter rate of 250–260 bpm. This resulted in every 6th flutter wave falling in the supernormal period, resulting in fixed-coupled supraventricular bigeminy and trigeminy in the setting of complete heart block. Reprogramming the pacing rate to 75 bpm abolished bigeminy and trigeminy.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770167","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}
Complete blockage of the culprit coronary artery is associated with 30% of NSTEMI (non-ST-segment elevation myocardial infarction) patients. The culprit vessel in the left circumflex artery (LCX) is more prevalent in this subset of individuals. These people's clinical features and ischemia alterations on electrocardiography (ECG) are unknown. The goals of this study were to examine clinical features and identify predicted ECG abnormalities in NSTEMI patients with complete blockage of the culprit LCX.
Methods
This study enrolled 5215 consecutive NSTEMI patients' data. A total of 180 people were diagnosed with acute total occlusion of the culprit artery (ATOCA). Based on the culprit vessel, the patients were classified into three groups:ATOCA in the LAD (n = 46), ATOCA in the RCA (n = 38) and ATOCA in the LCX (n = 96). Furthermore, basic clinical data, ECG alterations, and the occurrence of major adverse cardiac events (MACEs) were gathered and examined.
Results
In this single-center investigation, we discovered that ATOCA was more prevalent in patients with NSTEMI in the LCX group. Patients with culprit LCX were more prone to having multivessel coronary disease (p = 0.015), poorer LVEF (p = 0.040), and a lower revascularization success rate (p = 0.019) during hospitalization, although there were no significant differences in MACEs in short and long follow-up. STV5 + STV6 ≥ 2.5 mm (OR = 2.595, 95% CI: 1.297 ~ 5.192) and T-wave imbalance (defined as an upright T-wave in V1 with an amplitude larger than V6 (T1–T6 ≥ 1 mm) recorded from the P-R interval)(OR = 3.871, 95% CI: 1.820 ~ 8.231) were shown to be independent predictors of NSTEMI patients with acute complete blockage of the culprit LCX in multivariate regression analysis.
Conclusion
The LCX is the most prevalent culprit vessel with acute complete occlusion in NSTEMI patients, yet it has little effect on clinical outcomes. This subset of patients may be predicted by STV5 + STV6 ≥ 2.5 mm and T-wave imbalance.
{"title":"Clinical and Electrocardiographic Characteristics in NSTEMI Patients With Acute Total Occlusion of Culprit Left Circumflex Artery","authors":"Yongshi Wei, Doudou Pei, Jiang Deng, Bryan Richard Sasmita, Lijun Mao, Fengpeng Jia","doi":"10.1111/anec.70070","DOIUrl":"https://doi.org/10.1111/anec.70070","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Complete blockage of the culprit coronary artery is associated with 30% of NSTEMI (non-ST-segment elevation myocardial infarction) patients. The culprit vessel in the left circumflex artery (LCX) is more prevalent in this subset of individuals. These people's clinical features and ischemia alterations on electrocardiography (ECG) are unknown. The goals of this study were to examine clinical features and identify predicted ECG abnormalities in NSTEMI patients with complete blockage of the culprit LCX.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study enrolled 5215 consecutive NSTEMI patients' data. A total of 180 people were diagnosed with acute total occlusion of the culprit artery (ATOCA). Based on the culprit vessel, the patients were classified into three groups:ATOCA in the LAD (<i>n</i> = 46), ATOCA in the RCA (<i>n</i> = 38) and ATOCA in the LCX (<i>n</i> = 96). Furthermore, basic clinical data, ECG alterations, and the occurrence of major adverse cardiac events (MACEs) were gathered and examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In this single-center investigation, we discovered that ATOCA was more prevalent in patients with NSTEMI in the LCX group. Patients with culprit LCX were more prone to having multivessel coronary disease (<i>p</i> = 0.015), poorer LVEF (<i>p</i> = 0.040), and a lower revascularization success rate (<i>p</i> = 0.019) during hospitalization, although there were no significant differences in MACEs in short and long follow-up. STV5 + STV6 ≥ 2.5 mm (OR = 2.595, 95% CI: 1.297 ~ 5.192) and T-wave imbalance (defined as an upright T-wave in V1 with an amplitude larger than V6 (T1–T6 ≥ 1 mm) recorded from the P-R interval)(OR = 3.871, 95% CI: 1.820 ~ 8.231) were shown to be independent predictors of NSTEMI patients with acute complete blockage of the culprit LCX in multivariate regression analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The LCX is the most prevalent culprit vessel with acute complete occlusion in NSTEMI patients, yet it has little effect on clinical outcomes. This subset of patients may be predicted by STV5 + STV6 ≥ 2.5 mm and T-wave imbalance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762156","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}
Hosam I. Taha, Abubakar Nazir, Ahmed A. Ibrahim, Mohamed S. Elgendy, Abdalhakim Shubietah, Hazem Reyad Mansour, Sherif Sary, Moataz Maged, Mustafa Turkmani, Mohamed Abuelazm
Objectives
Direct current cardioversion (DCCV) is commonly used for atrial fibrillation, but there is uncertainty about whether active chest compression improves its effectiveness. This meta-analysis evaluates the impact of active compression on cardioversion outcomes.
Methods
A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) retrieved from PubMed, Scopus, WOS, Embase, and Cochrane Library till September 2024. Statistical analysis was performed using R software (version 4.3.1), applying risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI). PROSPERO ID: CRD42024595499.
Results
Four RCTs with 737 patients were included. When compared to the no-compression approach, active compression during DCCV was not associated with any significant difference in cardioversion success (RR: 1.10; 95% CI [0.96, 1.25], p = 0.16), first shock success (RR: 1.62; 95% CI [0.94, 2.81], p = 0.08), number of shocks (MD: -0.32; 95% CI [−1.01, 0.36], p = 0.36), or crossover success (MD: 0.76; 95% CI [0.33, 1.77], p = 0.52). However, active compression was associated with a reduced successful shock energy (MD: -23.97 J; 95% CI [−26.84, −21.10], p < 0.01).
Conclusion
Active compression during DCCV does not significantly improve cardioversion success but may reduce the energy required for successful cardioversion, suggesting potential safety benefits. However, further studies are needed to determine its clinical relevance.
目的直流电复心术（DCCV）是房颤治疗的常用手段，但活动性胸外按压是否能提高其疗效尚不确定。本荟萃分析评估了主动压缩对心律转复结果的影响。方法综合PubMed、Scopus、WOS、Embase和Cochrane图书馆截至2024年9月的随机对照试验（RCTs）的证据，进行系统评价和荟萃分析。采用R软件（4.3.1版）进行统计分析，二分类结局采用风险比（RR），连续结局采用平均差异（MD）， 95%置信区间（CI）。普洛斯彼罗id: crd42024595499。结果纳入4项随机对照试验，共纳入737例患者。与无压缩入路相比，DCCV期间主动压缩与转复成功率无显著差异(RR: 1.10；95% CI [0.96, 1.25], p = 0.16)，首次休克成功(RR: 1.62；95% CI [0.94, 2.81], p = 0.08)，冲击次数(MD: -0.32；95% CI[−1.01,0.36],p = 0.36)或交叉成功(MD: 0.76；95% CI [0.33, 1.77], p = 0.52)。然而，主动压缩与成功冲击能量降低相关(MD: -23.97 J；95% CI[−26.84,−21.10],p < 0.01)。结论DCCV过程中主动按压不能显著提高心律转复成功率，但可能降低心律转复成功所需的能量，提示有潜在的安全性。然而，需要进一步的研究来确定其临床意义。
{"title":"Active Compression During External Cardioversion of Atrial Fibrillation: A Meta-Analysis of Randomized Controlled Trials","authors":"Hosam I. Taha, Abubakar Nazir, Ahmed A. Ibrahim, Mohamed S. Elgendy, Abdalhakim Shubietah, Hazem Reyad Mansour, Sherif Sary, Moataz Maged, Mustafa Turkmani, Mohamed Abuelazm","doi":"10.1111/anec.70074","DOIUrl":"https://doi.org/10.1111/anec.70074","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Direct current cardioversion (DCCV) is commonly used for atrial fibrillation, but there is uncertainty about whether active chest compression improves its effectiveness. This meta-analysis evaluates the impact of active compression on cardioversion outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) retrieved from PubMed, Scopus, WOS, Embase, and Cochrane Library till September 2024. Statistical analysis was performed using R software (version 4.3.1), applying risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI). PROSPERO ID: CRD42024595499.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four RCTs with 737 patients were included. When compared to the no-compression approach, active compression during DCCV was not associated with any significant difference in cardioversion success (RR: 1.10; 95% CI [0.96, 1.25], <i>p</i> = 0.16), first shock success (RR: 1.62; 95% CI [0.94, 2.81], <i>p</i> = 0.08), number of shocks (MD: -0.32; 95% CI [−1.01, 0.36], <i>p</i> = 0.36), or crossover success (MD: 0.76; 95% CI [0.33, 1.77], <i>p</i> = 0.52). However, active compression was associated with a reduced successful shock energy (MD: -23.97 J; 95% CI [−26.84, −21.10], <i>p</i> < 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Active compression during DCCV does not significantly improve cardioversion success but may reduce the energy required for successful cardioversion, suggesting potential safety benefits. However, further studies are needed to determine its clinical relevance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70074","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741421","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}
We introduced a case of a 69-year-old female patient with mitral valve prolapse with severe regurgitation who was transferred from the ICU to a regular ward after undergoing mitral valve replacement surgery. Routine ECG examination showed that the precordial leads were affected by the apical pulsation, leading to pseudo-ST segment depression and prolonged QT interval. In clinical practice, ECG artifacts caused by apical pulsation, if not carefully distinguished, may lead to unnecessary examinations and treatments for patients. Our case emphasizes the importance of accurately identifying ECG artifacts.
{"title":"Overestimated Myocardial Ischemia","authors":"Hang Lv, Ming Liu","doi":"10.1111/anec.70064","DOIUrl":"https://doi.org/10.1111/anec.70064","url":null,"abstract":"<p>We introduced a case of a 69-year-old female patient with mitral valve prolapse with severe regurgitation who was transferred from the ICU to a regular ward after undergoing mitral valve replacement surgery. Routine ECG examination showed that the precordial leads were affected by the apical pulsation, leading to pseudo-ST segment depression and prolonged QT interval. In clinical practice, ECG artifacts caused by apical pulsation, if not carefully distinguished, may lead to unnecessary examinations and treatments for patients. Our case emphasizes the importance of accurately identifying ECG artifacts.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70064","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717150","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}
Antiretroviral therapy (ART) has revolutionized the management of human immunodeficiency virus (HIV) infection by transforming it into a chronic but manageable condition. Despite its effectiveness in viral suppression and immune restoration, concerns remain regarding ART's potential impact on cardiovascular health, particularly on electrocardiographic (ECG) parameters.
Objective
This study investigated the effects of ART on ECG parameters in HIV-infected patients by analyzing pre- and post-therapy data.
Methods
A total of 83 HIV-positive patients were enrolled and evaluated for ECG parameters before and 3 months after ART initiation. Key parameters, including QRS duration, QT duration corrected by the Bazett formula (QTc interval), QRS-T angle, morphology in inferior leads, voltage in lead 1, and P-wave duration (MVP) score, were manually assessed. Statistical analyses compared pre- and post-ART values.
Results
No statistically significant changes were observed in ECG parameters post-ART. For example, QRS duration remained stable (pre-ART: 89.08 ± 12.01 ms; post-ART: 88.94 ± 10.00 ms, p = 0.849), as did QTc interval (pre-ART: 403.51 ± 22.22 ms; post-ART: 404.84 ± 14.91 ms, p = 0.563) and MVP ECG score (pre-ART: 3.02 ± 0.95; post-ART: 2.98 ± 0.87, p = 0.882). The QRS-T angle also showed no significant difference (p = 0.675).
Conclusion
ART does not appear to significantly affect ECG parameters in HIV-infected patients, supporting its favorable cardiac safety profile. These findings highlight the importance of regular ECG monitoring to ensure cardiovascular safety in patients undergoing ART.
抗逆转录病毒疗法（ART）已经彻底改变了人类免疫缺陷病毒（HIV）感染的管理，将其转化为一种慢性但可控的疾病。尽管抗逆转录病毒疗法在病毒抑制和免疫恢复方面有效，但人们仍然担心其对心血管健康的潜在影响，特别是对心电图（ECG）参数的影响。目的通过分析ART治疗前后的数据，探讨ART对hiv感染者心电参数的影响。方法对83例hiv阳性患者进行抗逆转录病毒治疗前和治疗后3个月的心电图参数评估。人工评估QRS持续时间、经Bazett公式校正的QT持续时间（QTc间隔）、QRS- t角、下导联形态、导联1电压、p波持续时间（MVP）评分等关键参数。统计分析比较了抗逆转录病毒治疗前后的价值。结果art治疗后心电图参数变化无统计学意义。例如，QRS持续时间保持稳定(art前：89.08±12.01 ms；art后：88.94±10.00 ms, p = 0.849)， QTc间隔(art前：403.51±22.22 ms；art后：404.84±14.91 ms, p = 0.563)和MVP ECG评分(art前：3.02±0.95；art后：2.98±0.87,p = 0.882)。QRS-T角度差异无统计学意义（p = 0.675）。结论ART对hiv感染患者的心电图参数没有明显影响，支持其良好的心脏安全性。这些发现强调了定期心电图监测对确保接受抗逆转录病毒治疗的患者心血管安全的重要性。
{"title":"The Impact of Antiretroviral Therapy on Electrocardiographic Parameters in Human Immundeficiency Virus-Positive Patients","authors":"Ahmet Anıl Başkurt, Yusuf Demir, Oktay Şenöz","doi":"10.1111/anec.70058","DOIUrl":"https://doi.org/10.1111/anec.70058","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Antiretroviral therapy (ART) has revolutionized the management of human immunodeficiency virus (HIV) infection by transforming it into a chronic but manageable condition. Despite its effectiveness in viral suppression and immune restoration, concerns remain regarding ART's potential impact on cardiovascular health, particularly on electrocardiographic (ECG) parameters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study investigated the effects of ART on ECG parameters in HIV-infected patients by analyzing pre- and post-therapy data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 83 HIV-positive patients were enrolled and evaluated for ECG parameters before and 3 months after ART initiation. Key parameters, including QRS duration, QT duration corrected by the Bazett formula (QTc interval), QRS-T angle, morphology in inferior leads, voltage in lead 1, and P-wave duration (MVP) score, were manually assessed. Statistical analyses compared pre- and post-ART values.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No statistically significant changes were observed in ECG parameters post-ART. For example, QRS duration remained stable (pre-ART: 89.08 ± 12.01 ms; post-ART: 88.94 ± 10.00 ms, <i>p</i> = 0.849), as did QTc interval (pre-ART: 403.51 ± 22.22 ms; post-ART: 404.84 ± 14.91 ms, <i>p</i> = 0.563) and MVP ECG score (pre-ART: 3.02 ± 0.95; post-ART: 2.98 ± 0.87, <i>p</i> = 0.882). The QRS-T angle also showed no significant difference (<i>p</i> = 0.675).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ART does not appear to significantly affect ECG parameters in HIV-infected patients, supporting its favorable cardiac safety profile. These findings highlight the importance of regular ECG monitoring to ensure cardiovascular safety in patients undergoing ART.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143698984","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}
Dongsheng Zhao, Yan Dong, Qiushi Chen, Fengxiang Zhang, Koulong Zheng
Objective
Investigate the distribution of triggers in paroxysmal atrial fibrillation (PAF) patients and assess the efficacy of circumferential pulmonary vein isolationI (CPVI) combined with non-pulmonary veins (PV) trigger ablation over 1 year.
Methods
This prospective study included 130 PAF patients undergoing initial catheter ablation. A standardized protocol was applied before CPVI, followed by ablation targeting non-PV triggers. Ablation success was marked by the inability to induce atrial fibrillation (AF) or related arrhythmias. Patients underwent Holter monitoring at intervals post-surgery, culminating in a 7-day exam at 12 months.
Results
Atrial fibrillation (AF) was induced in 88 patients (67.0%), with 94 foci identified. The left pulmonary vein was a common source, but the superior vena cava emerged as the most prevalent non-PV site. The 1-year success rate was 86.0%, with no significant differences in success rates among trigger types. However, non-PV triggers were linked to lower recurrence rates post-surgery (HR 0.27, 95% CI 0.08–0.96, p = 0.04).
Conclusion
The study found that the combination of drug stimulation and high-frequency atrial stimulation before CPVI significantly boosted AF induction rates and revealed a high incidence of non-PV triggers. Effective intraoperative induction and accurate identification of non-PV triggers, particularly in the superior vein cava (SVC), contributed to a substantial reduction in postoperative recurrence rates. This approach suggests a potential strategy for improving outcomes in PAF treatment.
目的探讨阵发性心房颤动（PAF）患者触发因素的分布，评价环肺静脉隔离（CPVI）联合非肺静脉（PV）触发消融治疗1年以上的疗效。方法本前瞻性研究纳入130例首次行导管消融的PAF患者。CPVI前采用标准化方案，随后针对非pv触发因素进行消融。消融成功的标志是不能诱发心房颤动（AF）或相关心律失常。患者术后每隔一段时间进行动态心电图监测，12个月时进行为期7天的检查。结果诱发心房颤动88例（67.0%），确定94个灶。左肺静脉是常见的来源，但上腔静脉是最常见的非pv部位。1年成功率为86.0%，不同触发类型的成功率无显著差异。然而，非pv诱因与术后复发率较低相关（HR 0.27, 95% CI 0.08-0.96, p = 0.04）。结论本研究发现，CPVI前联合药物刺激和高频心房刺激可显著提高AF诱导率，非pv诱因发生率较高。术中有效的诱导和准确识别非pv诱因，特别是在上腔静脉（SVC），有助于大幅降低术后复发率。这种方法为改善PAF治疗结果提供了一种潜在的策略。
{"title":"Distribution Patterns of Paroxysmal Atrial Fibrillation Triggers and Catheter Ablation Success Rates","authors":"Dongsheng Zhao, Yan Dong, Qiushi Chen, Fengxiang Zhang, Koulong Zheng","doi":"10.1111/anec.70065","DOIUrl":"https://doi.org/10.1111/anec.70065","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Investigate the distribution of triggers in paroxysmal atrial fibrillation (PAF) patients and assess the efficacy of circumferential pulmonary vein isolationI (CPVI) combined with non-pulmonary veins (PV) trigger ablation over 1 year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective study included 130 PAF patients undergoing initial catheter ablation. A standardized protocol was applied before CPVI, followed by ablation targeting non-PV triggers. Ablation success was marked by the inability to induce atrial fibrillation (AF) or related arrhythmias. Patients underwent Holter monitoring at intervals post-surgery, culminating in a 7-day exam at 12 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) was induced in 88 patients (67.0%), with 94 foci identified. The left pulmonary vein was a common source, but the superior vena cava emerged as the most prevalent non-PV site. The 1-year success rate was 86.0%, with no significant differences in success rates among trigger types. However, non-PV triggers were linked to lower recurrence rates post-surgery (HR 0.27, 95% CI 0.08–0.96, <i>p</i> = 0.04).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study found that the combination of drug stimulation and high-frequency atrial stimulation before CPVI significantly boosted AF induction rates and revealed a high incidence of non-PV triggers. Effective intraoperative induction and accurate identification of non-PV triggers, particularly in the superior vein cava (SVC), contributed to a substantial reduction in postoperative recurrence rates. This approach suggests a potential strategy for improving outcomes in PAF treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143689824","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}
Dmitry Neymark, Christopher Lee, William F. McIntyre, Maria Higgins, James W. Tam, Colette Seifer
Background
Frailty predisposes individuals to morbidity and mortality. Increasing numbers of elderly and comorbid individuals are undergoing primary prevention implantable cardioverter defibrillator (ICD) device placement. Little is known about the association of frailty with post-device implantation outcomes.
Methods
We conducted a single-center, prospective cohort study of 71 patients who underwent primary prevention ICD insertion and who had their baseline frailty status assessed using the Fried index. Participants were followed for a median period of 7.8 years.
Results
The mean age (± SD) was 70.6 ± 4.5 years. 12 (17%) patients met the criteria for frailty. 23 (33%) patients received cardiac resynchronization therapy. Frailty was associated with a significantly higher incidence of mortality (HR [95% CI]; 3.9 [1.2–12.1]), ED visits (2.7 [1.1–6.7]), and hospitalizations (2.8 [1.1–7.6]). Within the non-frail cohort, there was no association between Fried frailty scores and adverse outcomes. None of the frail patients received appropriate shock therapy.
Conclusion
Among primary prevention ICD recipients, frailty is associated with worse mortality and morbidity. Clinicians should consider frailty when discussing risks and benefits with this patient population.
{"title":"Association of Frailty With Clinical Outcomes in Patients Receiving Primary Prevention Implantable Cardioverter Defibrillators: A Prospective Cohort Study","authors":"Dmitry Neymark, Christopher Lee, William F. McIntyre, Maria Higgins, James W. Tam, Colette Seifer","doi":"10.1111/anec.70061","DOIUrl":"https://doi.org/10.1111/anec.70061","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Frailty predisposes individuals to morbidity and mortality. Increasing numbers of elderly and comorbid individuals are undergoing primary prevention implantable cardioverter defibrillator (ICD) device placement. Little is known about the association of frailty with post-device implantation outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a single-center, prospective cohort study of 71 patients who underwent primary prevention ICD insertion and who had their baseline frailty status assessed using the Fried index. Participants were followed for a median period of 7.8 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age (± SD) was 70.6 ± 4.5 years. 12 (17%) patients met the criteria for frailty. 23 (33%) patients received cardiac resynchronization therapy. Frailty was associated with a significantly higher incidence of mortality (HR [95% CI]; 3.9 [1.2–12.1]), ED visits (2.7 [1.1–6.7]), and hospitalizations (2.8 [1.1–7.6]). Within the non-frail cohort, there was no association between Fried frailty scores and adverse outcomes. None of the frail patients received appropriate shock therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Among primary prevention ICD recipients, frailty is associated with worse mortality and morbidity. Clinicians should consider frailty when discussing risks and benefits with this patient population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70061","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143629817","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}
Pheochromocytoma, a type of neuroendocrine tumor, can cause numerous symptoms and signs similar to those of other clinical conditions, with the classic triad being palpitations, headache, and diaphoresis. Patients with pheochromocytoma can present with various cardiac complications, including myocarditis, acute coronary syndromes, cardiomyopathy, heart failure, and arrhythmias. Here we report a case of pheochromocytoma that first presented with bidirectional ventricular tachycardia. The patient was initially diagnosed with acute viral myocarditis and was treated accordingly. A pheochromocytoma crisis with severe blood pressure fluctuation occurred after glucocorticoid administration, leading to further diagnostic work-up, which eventually revealed the adrenal pheochromocytoma.
{"title":"Bidirectional Ventricular Tachycardia due to Pheochromocytoma: A Case Report","authors":"Gui-yang Li, Man-Xin Lin, Fa-Guang Zhou, Qiang Li","doi":"10.1111/anec.70063","DOIUrl":"https://doi.org/10.1111/anec.70063","url":null,"abstract":"<p>Pheochromocytoma, a type of neuroendocrine tumor, can cause numerous symptoms and signs similar to those of other clinical conditions, with the classic triad being palpitations, headache, and diaphoresis. Patients with pheochromocytoma can present with various cardiac complications, including myocarditis, acute coronary syndromes, cardiomyopathy, heart failure, and arrhythmias. Here we report a case of pheochromocytoma that first presented with bidirectional ventricular tachycardia. The patient was initially diagnosed with acute viral myocarditis and was treated accordingly. A pheochromocytoma crisis with severe blood pressure fluctuation occurred after glucocorticoid administration, leading to further diagnostic work-up, which eventually revealed the adrenal pheochromocytoma.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595567","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}
Songcui Shen, Xiaolu Wang, Jingjuan Huang, Wenzhao Li
Background
Brugada syndrome (BrS) is associated with an electrocardiogram (ECG), but the causal relationship remains unclear. This study aimed to assess the bidirectional causal relationship between ECG parameters and BrS using Mendelian randomization (MR) analysis.
Methods
A bidirectional MR analysis using data from the OpenGWAS database. Six ECG parameters, including PR interval, PP interval, ST duration, QRS duration, T wave duration, and QT interval, were included in the forward MR analysis with BrS as the outcome. In the reverse MR analysis, BrS was the exposure and the aforementioned ECG parameters were the outcomes. The inverse-variance weighted (IVW) method was the primary analytical approach, complemented by four other methods to account for potential pleiotropy. Sensitivity analyses were performed using Cochran's Q test, MR-Egger intercept, and leave-one-out analysis to evaluate heterogeneity and pleiotropy.
Results
In the forward MR, genetically predicted ST duration (OR = 1.3478, 95% CI: 1.0611–1.7118, p = 0.014) and QRS duration (OR = 0.9582, 95% CI: 0.9208–0.9972, p = 0.036) showed significant associations with BrS. The reverse MR indicated that BrS was significantly associated with PR interval, QRS duration, P wave duration, and QT interval (all p < 0.05). Sensitivity analyses confirmed the robustness of the results in both forward and reverse MR analyses. However, there were significant horizontal pleiotropy and heterogeneity in reverse MR analysis.
Conclusions
This MR study supported a causal effect of ECG parameters, including ST duration and QRS duration, on BrS development.
{"title":"Causal Relationship Between Electrocardiogram Parameters and Brugada Syndrome: A Bidirectional Mendelian Randomization Study","authors":"Songcui Shen, Xiaolu Wang, Jingjuan Huang, Wenzhao Li","doi":"10.1111/anec.70060","DOIUrl":"https://doi.org/10.1111/anec.70060","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Brugada syndrome (BrS) is associated with an electrocardiogram (ECG), but the causal relationship remains unclear. This study aimed to assess the bidirectional causal relationship between ECG parameters and BrS using Mendelian randomization (MR) analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A bidirectional MR analysis using data from the OpenGWAS database. Six ECG parameters, including PR interval, PP interval, ST duration, QRS duration, T wave duration, and QT interval, were included in the forward MR analysis with BrS as the outcome. In the reverse MR analysis, BrS was the exposure and the aforementioned ECG parameters were the outcomes. The inverse-variance weighted (IVW) method was the primary analytical approach, complemented by four other methods to account for potential pleiotropy. Sensitivity analyses were performed using Cochran's Q test, MR-Egger intercept, and leave-one-out analysis to evaluate heterogeneity and pleiotropy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the forward MR, genetically predicted ST duration (OR = 1.3478, 95% CI: 1.0611–1.7118, <i>p</i> = 0.014) and QRS duration (OR = 0.9582, 95% CI: 0.9208–0.9972, <i>p</i> = 0.036) showed significant associations with BrS. The reverse MR indicated that BrS was significantly associated with PR interval, QRS duration, P wave duration, and QT interval (all <i>p</i> < 0.05). Sensitivity analyses confirmed the robustness of the results in both forward and reverse MR analyses. However, there were significant horizontal pleiotropy and heterogeneity in reverse MR analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This MR study supported a causal effect of ECG parameters, including ST duration and QRS duration, on BrS development.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595571","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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